Wow!

Haven’t read Dr. Atul Gawande’s Better: A Surgeon’s Notes on Performance yet, but from an interview with Gawande on the Science Talk Podcast, it seems that his “systems” approach to his field is almost anthropological. In fact, much of the interview sounded like they would fit in discussions among medical anthropologists, including the importance of ingenuity in medical practise, local conceptions of health, social responsibility, etc.

It also goes well with a previous Science Talk interview with Dr. Christopher Cowley about which I previously blogged. That one had to do with a polemical article on medical ethics published (available as PDF). In that article, Cowley called for open discussion on medical training by making a few recommendations, some of which having to do with giving physicians a broader training. As could be expected, that article generated strong reaction, especially on the part of medical doctors. I sincerely hope that Gawande’s book will generate thoughtful discussion but I get the impression that medical specialists tend to react very strongly at the suggestion that some of the things they do could be improved outside of the strict training they receive. In other words, it seems that physicians and surgeons are unwilling to challenge some broad ideas about their fields. Of course, they’re strongly motivated to improve their practise and enhance their expertise. But it seems rare, in medical fields, to be taking a step back from practise and look at the broad picture.

To me, this is related to both extreme specialisation and to the social status afforded medical professionals.

Some anecdotal examples relating to my thinking about medical fields.

A friend of mine who’s whose [doh!] girlfriend is a student in medicine keeps teasing doctors by calling medicine a “technique.” Another friend, herself a student in medicine, says that it is frequent at the medical school where she is to portray medical students as an intellectual elite («crème de la crème»). Health professionals I know frequently say that one problem in the health system (especially in Quebec) is that physicians and surgeons have too much power. And, in my own experience, those physicians who have been best able to help me were those who took a broader view of health, outside of the strict application of well-remembered guidelines.

One argument against such discussions of what medicine could be revolve around the idea that “a good doctor is someone who has been well-trained.” Often phrased in the “if you had to go through surgery, wouldn’t you want the best surgeon to perform the operation?” (with the assumption that “the best surgeon” is someone who has the most credentials). This perspective is quite common in North America and it relates to a whole ideology of evaluation. Something similar is said about “the best students” (who are likely to be the ones getting “good grades”). What’s missing from it, IMHO, is mostly a notion of appropriateness, flexibility, ingenuity.

So Gawande’s book is sure to stir up some interesting ideas. Especially if medical professionals stop foaming at the mouth and actually spend a few hours thinking in a broader frame about the things they do.