May 15, 2007

The (MD) Bell Curve

I'm listening to physician and writer Atul Gawande read from his book Better: A Surgeon's Note on Performance," on APM's show Word For Word (audio file).

In the book, Gawande investigates what separates good doctors and great ones, by looking at success rates for various conditions. He talks about two hospitals that treat cystic fibrosis -- one in which the success rates are about average (Cincinnati Children's Hospital, with an average CF life expectancy of just over 30) and another in which the results are way above average (the Minnesota Cystic Fibrosis Center, at Fairview-University Children's Hospital, in Minneapolis, where CF patients typically live to over 40 years old).

He suggests the difference is due to above-and-beyond diligence on the part of doctors:
"[Center director, pediatrician Warren Warwick] believed that excellence came from seeing, on a daily basis, the difference between being 99.5-per-cent successful and being 99.95-per-cent successful. Many activities are like that, of course: catching fly balls, manufacturing microchips, delivering overnight packages. Medicine's only distinction is that lives are lost in those slim margins."

Gawande adds: "Warwick's combination of focus, aggressiveness, and inventiveness is what makes him extraordinary." (both quotes from the New Yorker article cited below)

Fascinating example of extraordinary work. Kind of inspiring -- how can we apply this to our own (less life-threatening but still important) work?

Read the CF story in the New Yorker, "THE BELL CURVE; What happens when patients find out how good their doctors really are?", December 6, 2004 pp. 82+. Available in LexisNexis and Academic Search Premier and other library databases.

Gawande was also on WHYY's Radio Times on May 15, 2007.

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