What Atul Gawande, medicine’s rock star, thinks about Maine health care

More than 1,100 people attended a conference in Augusta yesterday devoted to improving the health of Maine people. Hosted by Maine Quality Counts, the conference cast a spotlight on how Maine can better deliver both health and health care.

In a state of our size, that’s a pretty remarkable turnout. Dr. Sue Woods, a consumer health data expert for the VA, put it in perspective this way:

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The day’s big draw was Dr. Atul Gawande, a Brigham and Women’s surgeon, Harvard professor, author, and columnist for the New Yorker. His full list of accomplishments is extensive, and also includes the title of preeminent global thinker, according to both Time and Foreign Policy Magazine.

Dr. Atul Gawande (Source: Maine Quality Counts)

Dr. Atul Gawande (Source: Maine Quality Counts)

To health care nerds (I’m raising my hand here), he’s a rock star. The line for his book signing snaked around half of the Augusta Civic Center’s main floor. Much of his talk centered around that book, “Being Mortal,” an examination of medicine’s ambivalence about end-of-life care.

But I was struck by the historical perspective he lent to health care’s modern problems. We’ve made astounding advances in the science and technology of medicine in recent decades, Gawande said. Over the last 75 years, we’ve enumerated 60,000 ways the human body can fail, 4,000 medical and surgical procedures, 6,000 different drugs and thousands of ways to prevent illness, he said.

But deploying that knowledge to each and every community and individual is “arguably the most ambitious thing man has ever attempted,” he said.

Chief among the challenges — cost. Health care is eating up more and more of our household and government budgets, he said. That has led to what Gawande described as health care’s “deepest crisis of its existence.”

“There’s not a single state, not a single country that isn’t asking whether we can afford what doctors do,” he said.

States like Maine are moving toward answers, Gawande said. He credited a broad effort to improve health care quality in the state — a decade-long movement that has spanned chronic disease prevention, tracking hospital infections, empowering patients and more.

Sally Patterson of Eastern Maine Homecare, left, checks in on patient Christine McDonald at her home in Carmel on Sept. 12, 2013. (Carolyn Cole/Los Angeles Times/MCT)

Sally Patterson of Eastern Maine Homecare, left, checks in on patient Christine McDonald at her home in Carmel on Sept. 12, 2013. (Carolyn Cole/Los Angeles Times/MCT)

Gawande found proof in the numbers. Under Medicare, Maine falls into both the top quarter of states for best outcomes and the bottom quarter for Medicare costs, Gawande said.

“If the rest of the country were like Maine, we’d have tens, probably hundreds of billions of dollars available for everything from infrastructure and education to health,” he said.

Where health care works in harmony as a system, it’s most successful, Gawande said.

“We’ve been obsessed with the components — we want the best drugs, the best devices, the best doctors, the best specialists. But we don’t think much about how we put them together,” he said.

Try this analogy on for size: Imagine constructing a car with the very best parts, Gawande said. Porsche brakes, a BMW chassis, a Ferrari engine, and a Volvo body.

“You put it all together and what do you get?” he said. “A mess. A very expensive mess that does not go anywhere.”

To watch Gawande’s full speech, keep an eye on the Maine Quality Counts website for a link in the coming days.



Jackie Farwell

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.