The explosion of health care costs in America is not a problem rooted in economics; it's a problem rooted in scientific complexity. That was the message that author-surgeon Atul Gawande, MD, delivered this weekend to Stanford's newest medical school graduates.
With a new complexity comes a mandate to leave behind the notion of doctor as "individual artisan-specialist," said Gawande:
Half a century ago, medicine was neither costly nor effective. Since then, however, science has combatted our ignorance. It has enumerated and identified, according to the international disease-classification system, more than 13,600 diagnoses-13,600 different ways our bodies can fail. And for each one we’ve discovered beneficial remedies-remedies that can reduce suffering, extend lives, and sometimes stop a disease altogether. But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we’re struggling. There is no industry in the world with 13,600 different service lines to deliver.
"Medicine requires the successful function of systems-of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively."
The full text of Gawande's commencement address appears on the web today in the New Yorker.
Related: Medical school commencement marks beginning of new era in health-care reform
Previously: Congratulations to the Class of 2010 and Atul Gawande to speak at Stanford medical school commencement