Exploring "man's most ambitious endeavour" - surgeon's lecture looks at improving outcomes for patients

Exploring

Lecture by Professor Atul Gawande <em> - News </em>

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Faculty of Medicine

Division of Surgery, Oncology, Reproductive Biology and Anaesthetics


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By Laura Gallagher
Friday 8 June 2007

Acclaimed writer and eminent surgeon Professor Atul Gawande explored how surgeons and other medical professionals can go about improving the outcomes for the patients they treat, in a Centenary lecture at Imperial College London this week.

Professor Gawande is a general and endocrine surgeon from Brigham and Women's Hospital in Boston, Massachusetts. His latest book "Better - A Surgeon's Notes on Performance," formed the basis of his lecture. Professor Gawande’s previous book "Complications: A Surgeon's Notes on an Imperfect Science" was a finalist for America's National Book Award and was named by both Time magazine and Amazon.com as the best non-fiction book of 2002.

Introducing Professor Gawande, Imperial's Rector, Sir Richard Sykes , said: "Those of us who know a bit about how hard medics have to work would think that this is more than enough to be going on with. Not for our dynamic guest, however. After a long shift most of us would go home for some well-earned rest and relaxation. Professor Gawande, however, simply changes gear to focus on his second career - as a writer who uncovers and explains the many challenges and dilemmas that doctors face in their everyday lives."

In his lecture, Professor Gawande explored what it means to practice medicine and to be great at it: "We want the work to be done gently, with humaneness, and concern. And so it's not just the stakes – the fact that we work with people's lives in medicine – that makes it so interesting, it's the complexity. In fact I would argue that this is man's most ambitious endeavour, to keep this fragile body of human beings – all of them – alive as long as possible and as healthy as possible."

Professor Gawande is interested in how and why there can be vast differences between the outcomes for patients, depending on where they have received their treatment. In his talk, he used the example of treatment for cystic fibrosis in the United States, where there can be significant differences in results for patients, even between dedicated centres of excellence.

Professor Gawande explained that although such centres use the same treatment and follow the same guidelines, patients at centres with the best outcomes have a life expectancy of forty seven years, compared with an average national life expectancy of thirty three.

Professor Gawande visited the Co-Director of one of the best cystic fibrosis centres, to find out what made it different, as well as others who achieved similarly impressive outcomes in their fields. He told the audience what this taught him: "There are, for people at the top of their [bell] curve, certain attributes in the patterns that you discover along the way…He's not smarter than anybody else. What he is, is diligent. He understands what it actually means to pay attention to detail ... Diligence included being able to have surveillance for failure, it meant being able to see when you failed."

Bringing his talk to a close, Professor Gawande said: "What we want is some way that every physician is thinking every day about what they do, can recognise when they're succeeding, where they're failing, where they stand. It's going to require transparency about our own results and a willingness to compare ourselves to others and to think hard about whether we’re getting better or not…

"I think also that the other remarkable thing about medicine…is the fact that because this is our most ambitious endeavour as human beings, that this level of complexity in medicine can give lessons to other people in other fields as well…I think there are lessons coming out of medicine that can shape the entirety of how we work and function with all the knowledge that we’re now accumulating, and that is our special opportunity," concluded Professor Gawande.

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