YouSaid · the spoken record

Atul Gawande

lines on the record: 91
first: 2018-10-02
most recent: 2018-10-02
sittings or episodes: 1
sources: podcast

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“And then I think maybe another one is that I think I can seem pretty relaxed, but I'm actually kind of a OCD control freak. So anybody who has to work with me, I have one of my colleagues here knows that it's not easy actually working around me. You know, it's I get to do really cool stuff and I feel really lucky that I'm in a phase in my life where I spend all my time working on things I want to be working on. But it's all hard work and it's all putting in the hours and then deciding that the reason I get my sleep is because I just, I'm ruthless about prioritization. I just tried to do no more than a couple of things at a time. I may do something different in a couple months so I can make it seem like I'm doing a million things at once, but I'm not actually only doing one thing at a time.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Going to start I think what are the greatest misperceptions? One might be that I'm smarter than I am. A lot of what I do is really just try to figure out the simple stuff and understand how you make that go. And I think I sometimes get credit for I get a lot more credit for Discovering things or making insights, then I deserve I'm mostly connecting ideas that none of which I've created and just try to make them a little more salient in a given moment because it was turned out to be meaningful for me. I think another thing is that I don't sleep. I get plenty of sleep.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Understanding what are the costs. There's not an algorithm that gives the answers to these. So that's the, this is the area where you get into some necessary fallibility. But is some of the most gratifying work you do as a clinician is this kind of judgment and work with a patient.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“It's a matching problem. And it's more complex than a simple algorithm or just knowing what the studies show. Understanding a person and what matters to them can include things like I need to get to a wedding next week or I really can't stand how much I've had to be in the hospital. I just need a break right now.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Enough mental capacity to do that, which ones would have such severe side effects. I'd be too wiped out or I have to be in an institution or would be struggling to get to that dinner table. Those became the guideposts. And I think the critical thing for people to understand, this isn't just about the end of life. Life is the accumulation of illnesses, most of which you'll survive. And now have to manage as time goes on. And you'll have medicines you'll need to be on and they'll have side effects and there'll be things that they help you do and things that they might hurt you from doing. You have to help us understand what your priorities and goals are for what matters in your life. And then you have a right to ask and demand that we help you pick the choices that will best achieve those within the realm of what's actually possible.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Having even with all of the experience in the room that my mother, my father, and I had as doctors, we were all doctors, we counted 120 years of experience in the room as we're talking to the oncologists and they go over eight different chemotherapies that he can have. And we have no idea what, like there are eight different combinations, as much as they try to explain, cannot understand. What all the choices are. And so wanted the guidance from the oncologist well, which option would allow him to do surgery, not lose his ability to do surgery, or when he did lose his ability to do surgery, then his goal was, well, what I still love is being with people. And so I want to be able to sit at the family dinner table and be around with family or friends and actually still have enough energy to converse.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“We already knew it was an incurable cancer. So everything we were doing was to prolong life. And to him, life, one of its key values was getting to continue to take care of patients. And so.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“And that means that the clinician should be someone who helps you understand and identify your goals given the cards in your hand right now, which may not be a great hand. But what matters to you now? And they should then be able to help you understand, here are the options, here's what they understand about them, but then help me match what my goal is with which one might give me my best shot at achieving that without sacrificing things that are important to me. And your role is that you need to help the clinician understand your goals and to be as clear as you can about that. You know, my father, when he had his brain tumor, his first goal was he was a surgeon. Do not Give me a treatment that's going to cost me my ability to keep doing surgery.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“What I wish all patients knew is what the role of the clinician ought to be and what their role is and that you can demand it. And the role of the clinician is not just to tell you the facts of what your situation is. Here's your disease. Here are the options, A, B, and C, here are the pros and cons, the risks, the benefits. But the role of a clinician is also be a counselor.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“For whom they would say, I still want that week. And that's okay. But it is not the vast majority. It's over 85% who say that there are limits to what they are willing to endure for the sake of longer life.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“But it's a week of suffering. And many people would choose not to have that week. Not everybody. And what's important is that we ask because there are some people.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“There are certainly situations, so classic case in point is a patient who's in the ICU on a ventilator suffering, and they are not getting better. They're just getting worse. And we'll have a family discussion. And when we don't have that discussion about what would this person be willing to go through for the sake of another week? We can't make them better, and what would they not be willing to go through? And the family will say another week on a ventilator is not life to them. They would not consider that, and by the way, it's not life to me. So when we decide to then turn off the ventilator and remove the breathing tube going down their throat and let them be comfortable. Where we may be shortening life, they may lose that week or two.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“And the kicker was they lived 25% longer, which meant that making that last ditch operation, the last ditch Fifth line of chemotherapy when the four others didn't work is mostly adding toxicity and harm out of an inability to come to a good decision about what your goals and priorities are and to honor them and to actually listen. And so what we're finding is that the flip side is when you actually have conversations with people and make it a normal part of what we do about your goals and priorities for your quality of life as well as for survival. We make better decisions about care they get better outcomes including they just feel better that you measure lower rates of anxiety and depression and getting pain under control better and avoiding nausea and all these things that actually matter to people. They are more functional, they're able to be at home and do the things they want to do more and they live equally long if not longer in the average.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“When we don't have that conversation, the result is that the carer is often out of alignment with people's priorities and goals. And the result of that is suffering. It also is a result is cost. We're often doing things that people don't want that are on the assumption that they would sacrifice any amount of quality of life for the sake of quantity of life. Now further studies that have been shown, including a randomized trial at the Mass General Hospital with state for lung cancer patients who all died in the course of care. And when they had conversations with a palliative care expert about their goals for their quality of life, the result was that they stopped their chemotherapy two months earlier, 50% lower likelihood that they would still be on chemotherapy two months before the end of their life. They spent about a third less money and time in the hospital and time in the ICU and had more time at home.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Right, exactly. This is all part of the journal. So the key lesson is that people have priorities in their life besides just living longer. Have goals for their quality of life. Well, as just and not just surviving, those goals and priorities differ from person to person and change over time for people. And so you have to ask people what their goals and priorities are. We rarely ask. We just finished a survey in Massachusetts. And it's our third year of doing the survey, and it hasn't budged. We're at 25% of people who have a serious life-limiting illness in the last year and have been hospitalized. Only 25% of had that conversation about their goals and priorities for their quality of life with their clinicians.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Yes. Well, and that's why discussing end of life care and talking about what we do when people have serious life-limiting illnesses was branded as a death penalty. When I started writing about this, it was to try to understand it doesn't feel that way. I'm a cancer surgeon. And what it feels like instead is it just feels like bad decision making. And this is what we found. Basically, there's some key lessons. And I'm a little embarrassed that it took me interviewing 200 patients and scores of practitioners to figure this out because it's going to seem so duh. But this is what came out of my trying to write my last book.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“There's a couple things. One is we think the US is a big outlier in this way, but in fact, it's not. When you look at studies outside the US, it's also fairly typical that it'd be around 23 to 25 percent of spending after age 65 last year of life. And when you understand that what happens is that we are in a situation where when you come to the end of life, you don't know when that last year of life is. Is tremendous uncertainty and how we manage that uncertainty is the great difficulty. And we manage it really badly. And so this is the second part of it, is that we assume that, hey, if I'm going to spend $100,000, that the problem is that we're just not, you know, we have to make a brutal decision and say, look, Gives people an extra month of life, and sorry, you just don't get it. It's not worth it.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Well, so the last year of life, we know that 25% of Medicare spending is in the last year of life, and most of that's in the last few months. So that's not 25% of all spending Medicare is just after 65. That's about half of spending occurs after half of all your healthcare spending on average will be after your age 65. So that's a huge chunk, but it's not like, you know, I've seen people claiming that all of it is because of end-of-life care. And that's not true either. It's a substantial amount.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“So we need to, and we can manage against that endpoint and we can, you know, goes back to those management metrics we talked about. Now I have a measure, now I have a target, let's not make that, let's make it so the average person has significant benefit when we operate. And then we change the process and the ways we do things and simplify it and get unnecessary wasted costs out of it and also take out the harm. And we're still a long way away from managing in a systematic way that way.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“The average person has not benefited. And so that has not filtered through and been adopted in any significant way. But now we're beginning to deploy systems which actually track for your health system how do your patients actually do? Lo and behold, they're showing the same thing But seeing now in our system, our surgeons are getting no benefit for this operation in reducing people's disability or pain at nine months after this procedure. So now we have information that suggests our system's just not working.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“And so our ability to begin, and the biggest problem there is, again, the lack of a system around this care, that when you step back and actually begin to measure what are we doing to people, and is it actually providing benefit? And as we add more and more information, we're getting more out of it. I'll give one example. Back surgery, we have a bunch of studies showing that when you do back surgery for pain, spinal surgery for pain, as opposed to for neurological symptoms where you have actual nerve damage. But when it's for pain, the average people have no benefit for disability or pain at about nine months or so.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“EEGs are good for detecting seizures. They're of no benefit for evaluating people with headaches. To cardiac catheterization for people with stable heart disease, Where medication management is actually the better way, it is of no value or act of harm to do these things. And it turned out that between 25 and 42% of Medicare patients of all Medicare patients 25 to 42% will have one of those 26 things done to them in any given year. And that's just 26 of the thousands of things that we do. That estimate of 30% is waste sounds incredible. But in fact, my experiences as well as lots of data is that that's the case.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Well, there's a couple things to separate here. The fact of rising healthcare costs is not the problem. What is the problem is how much of the costs are rising that are not actually connected in any way to value. So an example would be that we have a substantial amount of healthcare that we provide that provides no benefit or makes you worse. Estimates are that about 30% of healthcare is waste. It's going to things that are either much higher administrative costs that add no value. Or our actual treatments and tests and procedures and drugs that are of no benefit or actively harmful. I've written about, for example, there was a study of 26 different tests and procedures ranging from EEG for headaches.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Who is making sure all the stuff comes together? Oh, I don't want to bother my doctor with calling up the other specialist who disagrees with him and sorting out what's going on because they're so busy. That's crazy talk. We need the most experienced people on how are all of these components working together or not working together and then making it happen.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Realize we have teams of people, and this has also got to be the way we improve outcomes in healthcare and lower the costs as we start pushing down the components of things that really don't need somebody with 50 years of experience that you have the team members who are who have learned to handle the different parts of the care and then knit it together. And more and more, the role of the most experienced person is to make sure that all the parts come together. That's the irony is the most experienced people are doing some of the most mundane crap. In the system. And meanwhile, there seems to be, you know, your experience as a patient is that it's as if nobody's in charge.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“And that means our acknowledging that teams take care of people, that there are appropriate, you know, basically we have this term, oh, I'm going to forget the term. because it's not a totally memorable term, but it's basically that you have arrived at a place where you have a kind of certified ability to do this part of things. And maybe it's to, you know, you've reached the stage where I've observed you, you've done some practicing before you've done it on people. Now we've practiced on people and anybody might be the realm of who they practice on. Now the medical student has learned to do this and they are the one who can put in the nasogastric tube. And then at this level, they can open and close the incision. And at this level, they can do most of the operation and that we really start.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Getting to a better place is that we now, A, it's simply not permissible in American healthcare to have trainees taken care of most people, like the Veterans Administration used to be a place where a lot of people were being taken care of by trainees. It's not possible to be taken care of by a trainee who has not got supervision. And so that's changing remarkably. Now, though, you have to create the safe space that the people can actually learn.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“I didn't use all the resources on this person. And we have people who are learning as we go along. So since it's a problem of the commons, how do we all benefit from it while not losing it all? The way I look at it is what really pisses people off about training is if you're going to learn on me, but not somebody else. There's a privileged somebody Who doesn't get it. And so when we say, well, we'll learn on the homeless people. underlying social strata you see during training is there are some people who will be the people who you know the medical student does their first suturing you know of their of their the cut on their you know on their face and then there are the people who the chairman of surgery comes in and he or she is you know no one's going to touch them except for you know XYZ person and part of”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Yeah, and it's really hard because the short term, long-term question. We will be unable to provide the best possible care to a given patient over time if we are not also training people. And giving people opportunity to learn. So I want the most experienced person, well, the most experienced person is going to age out pretty soon. And so we have to have that way to make that happen. And so it's like a lot of things in medicine. My primary duty is to the benefit of this patient now, regardless of whether I use the entire world's resources. In the process, whether I fail to train anybody in that process, whether nobody learns anything out of it, and the societal reality that we all benefit as patients if we have some understanding of”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“It's much like parenting where so that's the difference. A parent isn't teaching. Sometimes it's the teacher, but it's much more, what do you want to do? As, you know, you're asking your child, what do you want to do? What's important to you? And will you be willing to have me give you feedback and some outside perspective on this, sometimes not, and I'm still going to give it to you. Yeah. And then they have to connect the dots. That's ultimately the hard part is that they have to learn it.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Instead, I'm literally trying to get in the habit of accounting in my head one, two. It's so hard. I can never get to 30.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“There are ways to safely delegate and let people struggle. And so my coach is working with me on like, so if you want to be better at teaching people and get some better ratings on my teaching, I have to give people a little more opportunity to struggle. And so my goal is 30 seconds. I'm going to give them 30 seconds of struggling before I take over. So like if they can't find there's a part in an operation where you might have to find a blood vessel or a nerve and they can't find it. I get, you know, let's move this case along. Here it is.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“But you're joining that team because you have a set of goals. You have a coach to work with around your particular gaps and what you want to aim for. But you have to buy into what whatever the goals are, you've got to buy into them. And then you're the agent of making closing that gap. Now, the coach may bring some teaching. Let me model for you how to really make this shot, or let me suggest to you where you should move your feet and that kind of thing, or in the operating room, let me suggest to you. Think about what other instruments to use. But at its ideal level, for example, now what am I working on with my coach in the operating room? It's teaching. How do I, so I'm a real micromanager. I'm such a perfectionist. I have a hard time giving a trainee any rope, which I'm sure makes patients happy.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Yeah, so the teaching technique would, you know, what you described would be a teaching technique. A coach has a few things. They offer you an external version of your reality. They also work with you to set a goal. So here is where what I see are the gaps in your performance or what's going on. What do you want to work on? What are your goals? It's a little different. So for example, a tennis player hires the coach. So, you know, my goal is I want to get to number one. In order to get to number one, here are the 10 things that are wrong in your game as I view it from the outside. And you have to be able to feel that you trust the coach to have added to your own perception and you're integrating their perception with yours and you may disagree in some places not. But for the most part, you got to be willing to work with them. But then the second thing is then you are picking that goal. A little more complicated if you're the coach on the basketball team because they can bench you.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Well, I would describe coaching slightly differently. So I distinguish between the coach and the mentor, and there's a distinction between the coach and the teacher as well.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“To surgeons in all of our affiliated hospitals and trying it out, which means we have to learn how to teach people to be coaches and create a way to make it scalable to do those things. So I can sports. We've scaled coaching all the way down to Pee Wee League baseball. We have not remotely figured out how to do that as a routine part of being inside complex organizations are doing really complex things. And we're now trying to learn how to make that part of what we do and push the upper end of the excellent scale.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Plateaued and then getting his coaching first of all, you know. Watching one case and he had all kinds of things he had for me to work on, including where I was standing and how I used the light in the field and these things that I couldn't see for myself. And it's an important part of what a coach does is they provide an external check on your understanding of your reality. It's different from a mentor. A mentor is a lot of coaches that I hear about, that people call their coach, are just kind of life mentors or mentors. They don't have any data they're working from. They're just having what you say is going on in your life. And what you need is someone who's observing you, collecting, or talking to lots of people around you, getting some way to get an external fix on your reality. Well, we've actually now at Ariadne Lives, we've launched a project funded by our malpractice insurer to pilot bringing coaches to”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“And Yale won something like over the next couple of decades won all but a couple of the games. And then Harvard got a coach. And so applying that idea, we have, you know, I was writing that in your article. I was just trying it out for myself. I had one of my former professors who I'd admired and he'd retired come to the operating room, observe me, and give feedback after about 10 years of being in practice when my complication rates had sort of flattened out. I wasn't getting any better.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“That model is the primary one in professional life. Most musicians, in medicine, in teaching, in business. The other model is mostly out of sports, and that's the coaching model. And that says, I don't care if you're Roger Federer you will have blind spots when it comes to your own improvement and you need a coach. And over time, I think what we've been learning is the coaching model beats the teaching model, has significant advantages. It's certainly true in sports that when you've had teams, you go back to the first football games, American football games that happened in the 19th century. Harvard and Yale played the first kind of official football game. And Yale early on decided that they would have a coach. And Harvard said that's very, very de class ⁇ very uncool. Gentlemen don't need to be coached. We just know.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Yeah. So what's interesting about the work as it's gone along is the first step is trying to make sure you don't do the stupid things that people already know about that demonstrably get to better results. Do your checklist don't make the dumb mistakes. But then if you're trying to get to excellence at the other end of the scale, it's interesting to me that we have such different theories across different professions about how you make that happen. The pedagogical theory is you go to Juilliard, you get your 10,000 hours of practice with the violin and you then head out into the world and you're responsible for the rest of your self-improvement. Along the way.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Think so now not well studying the operating room, but the reasonable evidence from psychologists looking at this question that when people have gotten to speak in a room just by introducing yourself saying here's my name, here's where I'm from, in a meeting where people are new to the meeting. The people who haven't been able to introduce themselves are much less likely to say anything in the course of the meeting. But if you've actually been able to hear yourself in the room and say, I'm here, this is who I am.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“It's like coming into a meeting room and everybody goes around introduce themselves. And what we found is that that activates the likelihood that everybody will speak up. And if it's run well, then everybody has spoken. And we can see that the places where that ability from the medical student to the most experienced clinician in the room. It's not, you know, you can see places where the surgeon doing all the talking and you can see places where that's a nurse doing all the talking and the power differential has gotten out of whack.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“You know it because everybody is speaking with an equal voice. People from the highest level to the lowest level, they have all been able to contribute. And when that exchange is the way that it occurs, then you know you're there. We're seeing it in our operating rooms. We introduced our safe surgery checklist. And one of the key items on the checklist, I think one of the most powerful is that people in the room all discuss the case, the anesthesiologists, the nurse, and the clinician and the surgeon to discuss what are the medical issues of the patient, what's our plan for the day, what are our worries about, you know, what are the non-routine things that can go wrong. Is the equipment and everything else in place? At the start, we asked people to introduce themselves by name and roll.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Fallibility, human weakness, the problems that occur because people are in conflict or they're tired or all of those things where you just weren't thinking those are part of human beings trying to work together on really hard things. And so in other industries that I've seen that have been able to create that space engineers on successful teams are able to create and you can see on teams within the same organization and the same research lab, for example. You can see good and bad culture within the teams. But when the leader has made it so people can actually speak up, a woman named Amy Edmondson has done a lot of research on how you create psychological safety. And it's creating a place where”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Yeah, I mean, the pilot's example is one where NASA also has a protected space where if you submit a report on an error or on a, what they call a near miss, it didn't crash the plane, but it could have, you get a get out of jail-free card. So, by reporting on it, you are not subject to investigation. Now, I think that we're coming to understand what people call a just culture, which is that there are clear norms and values which there is no get-out-a-jail-free card. You lie about what's happened or falsify information, you hide information, or you are actively subverting the system more malicious in certain ways. And those kind of behavioral norms are ones that should get you fired and are appropriately removed. But then you're talking about”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“But it is so much more about the culture that you build. And in the country at large, we don't live in that space. We still are in a space where, you know. President's acknowledging mistakes is seen still as a kind of weakness. And it's something that holds us back.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“That's the problem. So, the high reliability organization is a place where people are kind of obsessed with failure, are actually energized by like, I want to ferret out and find the next thing we can fix. And the opposite is the toxic organization where admitting failure just opens you up to attack and removal. You know, there are structures that can make it that are important to that, like not making it so that you're sued for talking about these things. Yeah.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“That we should bring the people who are part of the team to be part of the discussion so that everybody's on it. Now, creating that space is a combination of culture. Surgery couldn't get off the ground in the early part of the century without creating that place where you could work on engineering. Why are so many people dying? How do we cut down the infection rate? What do we do about making this very complicated thing work? And so we developed that culture. Making that be not punitive so the minute it starts to become something where and you're chucked out you know I'm going to use this again where the information used becomes weaponized”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“Nurse's fault, the anesthesiologist's fault, whatever. But then the problem is that you didn't bring them in the room. Like they should be here as well if they're”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT
“In fact, there's some shame to not being able to admit that you have something that you, you know, so the irony is surgeons are very confident people. You can't go into an operating room and do an operation without a kind of slightly absurd sense of confidence in yourself. You know, sometimes wrong, never endowed, it would be our mantra. But in that room, there's a kind of humility expected that is, you know, it's not cool. Flagellate yourself over the whole thing. It's in a way a kind of emotionless presentation. Here's where ex-person did something wrong and here's what I think I should have done differently. It's a kind of you have to take some ownership. And there's always a temptation to want to blame someone not in the room.”
2018-10-02 · The Knowledge Project with Shane Parrish · #42 Atul Gawande: The Path to Perpetual Progress · IDENTIFIED FROM THE TRANSCRIPT