Atul Gawande's Commencement Address to 2009 Chicago Medical School Grads...

The New Yorker posted the commencement address that one of their staff writers delivered at the Chicago Medical School's graduation ceremony this past weekend.  You can enjoy the full transcript here.

A lot has been said about the cost of healthcare, its impact on the overall economy, and the various options to "fix it".  Gawande, himself an accomplished surgeon, draws on his equally substantial experience as a commentator and policy maker to provide some of the most engaging observations on the responsibilites care-providers bear in this issue.

I implore anyone interested in the great debate on healthcare reform (and perhaps more earnestly to those who are not) to read Gawande's startling reports on the disturbing variation in the cost of healthcare between nearby cities, and even within neighborhoods.  For example,

"A recent study of New York and Los Angeles hospitals found that even within cities, Medicare’s costs for patients of identical life expectancy differ by as much as double, depending on which hospital and physicians they go to."

 And the fact that despite the enormous expense of medical care, patients are not any better off!

"Yet studies find that in high-cost places—where doctors order more frequent tests and procedures, more specialist visits, more hospital admissions than the average—the patients do no better, whether measured in terms of survival, ability to function, or satisfaction with care. If anything, they seemed to do worse."

But beyond the familiar rhetoric on what's wrong with the system, Gawande has an inspired message to the flock of new care-givers ready to take on the mantle of their noble profession:  Don't wait for a fix to be handed down from on high.  Do what you are trained to do best: find solutions that show promise among your peers and mentors, then nurture them within your own practice.

Gawande calls this method finding "positive deviants".  He offers a remarkable story about a collegue and friend in charge of "a Save the Children program to reduce malnutrition in poor Vietnamese villages".  Finding himself out of funds, his friend opted to look within the villages to find instances of healthy children and attempt to understand what set them apart from the others.  By teaching other villagers the techniques that had nutured these healthy "positive deviants",

"In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to.

Gawande challenges the new doctors to learn about and understand techniques that produce "low-cost, high-quality institutions like the Mayo Clinic; the Geisinger Health System in rural Pennsylvania; Intermountain Health Care in Salt Lake City".  He boldly encourages the new physicians to find "ways to resist the tendency built into every financial incentive in our system to see patients as a revenue stream".

"Look for those in your community who are making health care better, safer, and less costly. Pay attention to them. Learn how they do it. And join with them."

Gawande's advice is genuine and earnest.  If the physicians walking across the stage that day have paid heed to his words, all of us along with our ailing healthcare system may yet have hope.