The New Health Dialogue

(We are reposting this -- we left out that Health Affairs co-sponsored this conference)

Yesterday we slogged our way through snow and ice to attend AcademyHealth’s and Health Affairs'  National Health Policy Conference, partly to bravely act like the historic blizzard(s) here haven’t affected our health care reform momentum. An impressive number of folks did manage to get to the conference but others were unable to find their snowshoes (or snowplanes as the case may be) and were forced to spend the fifth consecutive day holed up with their families. This included Atul Gawande, who gave his keynote lunch address over the phone from Boston. We are happy to report that we cannot confirm his claim that he gave his speech in his underwear but we can share his telephonically-imparted wisdom.

Dr. Gawande is not only one of our esteemed New America Foundation board members, a general and endocrine surgeon at Brigham and Women’s Hospital in Boston and New Yorker writer,  he is touting his latest book -- “The Checklist Manifesto.”  His keynote was in part about the lessons in his book -- that health care is too complex to assume that even the most highly trained and competent professionals can remember every detail related to a complex surgical procedure. He is fond of saying that we were fooled by penicillin -- thinking that we could cure everything with a simple injection, that the hard part was over once the cure was discovered. He argues that given the realities of our complicated treatments and procedures, we need simple, systematic solutions that acknowledge and prevent the repetitive patterns of medical errors.

Dr. Gawande also reminded the listeners about the dramatic problems in our health care delivery system. The fact that two million patients get hospital-related infections per year and that one in 20 die from those infections is a chilling statistic. The fact that half of the complications and deaths are avoidable is even more chilling. He noted the death this week of Pennsylvania Rep. John Murtha after complications from surgery -- perhaps another example of this tragic truth. This issue is one that would be addressed if federal reform is passed -- Section 3008 would financially penalize hospitals that had the highest rates of hospital-acquired conditions.

The fact that we do not systematically keep and examine statistics on the causes of preventable deaths, or do enough to learn whether we are repeating or improving on these statistics, is absurd, according to Dr. Gawande. He noted the difference between the attention being paid to the Toyota problems -- which as far as we know haven't killed anyone -- and our attitude toward medical errors, and avoidable complications and infections, which are killing tens of thousands. Gawande insisted that we need to measure the results and value of care in real time to repair what problems we discover. He stressed that he believes we can have this kind of transformation in our delivery of health care services even though “we are at a moment when the country doesn’t believe it.” Of course, he was speaking from outside the beltway. Here, pessimism about the prospects of health care reform looms larger than our snowstorms.  We wish Dr. Gawande (preferably fully clothed) could moderate the Feb. 25th bipartisan health care reform session announced by President Obama -- but that may take more than a checklist to survive.