You may have seen some of Atul Gawande’s titles on my bookshelf. He’s a gifted writer whose books have highlighted some of my biggest frustrations with the ‘medical machine’ and how it runs. The Checklist Manifesto is one of my favorites. Dr. Gawande is a master storyteller, and in the New Yorker article, he weaves together the description of a family dinner at the Cheesecake Factory with how he’d like your trip to the doctor or hospital to be. I suspect he loves ‘doctoring’ (with all its intricacies and inefficiency) as much as I do. He’s made an interesting analysis with a comparison of the highly standardized production line at the Cheesecake Factory and how things are often done in the medical world.
Without a doubt, Gawande is a bit more enamored with his restaurant and its Skinnyliscious menu than I am. Focusing on his dining experience, the article makes a case for what healthcare can learn from the restaurant’s efficient, standardized operating procedures. Choosing to overlook some of the unhealthy menu offerings (maybe saving that topic for a later article), he focuses on how the chain delivers a cost-effective, consistently reproducible, fine dining experience. The article suggests that doctors and healthcare administrators have a great deal to learn about delivering a quality healthcare experience with reliable consistency. The article is well worth reading.
I, too, am interested in delivering excellent quality health care. I want my patients to have the experience that I’d like to have if I were on the other side of the stethoscope. After all, at some time in our lives, we are all patients…or parents of patients…and eventually children of patients. Like Dr. Gawande, I know that the more we standardize and automate the “health care machine”, the more consistent the results will be. And yes, I do believe the resulting health care will be better. But I am a doctor and a skeptical one at that. There are SO many variables in my day to day practice that regulating how much salt to put on a steak is hardly a fair comparison for most of what I do.
I see areas where consistency can and should be part of delivering first rate healthcare, but I know the real secret. True excellence will come only when the human connection, the true doctor-patient relationship is acknowledged as central to that excellence. The difference between ‘good’ and ‘great’ is not consistently delivered healthcare unless a skilled, compassionate physician providing it is more than icing on the standardized cake.
No two patients are alike, but all of my patients benefit from a computerized system for well visit reminders. This is a good application of Gawande’s core argument for automation and a consistent expectation met. The Bright Futures Coalition has made excellent and comprehensive lists of questions and advice to use in check-ups for any age, too. This standardization is good, and I recommend you click the link to read more if you are looking for your next wellness visit to be the ultimate in comprehensive. But as a parent, I’m not sure the Bright Futures checklist is that useful to me. My children are all healthy in different ways, and they need encouragement to work on different aspects of living even healthier. There is no computerized checklist that can standardize this variety. I need a doctor who may be gathering checklists of information about my children but who is not just checking them off some list.
If the process of healthcare delivery is better standardized, then I’d like to see the real value to both doctors and patient come in the time we have left over to really connect. If I’ll be handed the standardized Bright Future’s Checklist to complete (and it feels equivalent in length to the menu at the Cheesecake Factory, three hundred and eight items!) then I feel sure that no stone has been left unturned. With so much information shared so efficiently , in the time left over, we can get on to discussing things that are relevant to my family. My child’s doctor can focus on the whole child, my child, to offer a thorough physical exam, insightful perspective, and sound advice on things that matter to us . In fact, I want to ask about that menu at the Cheesecake Factory (Skinnyliscious and otherwise)… is it really all that good for you or is it just presented in a consistent, cost-effective manner?