For the last several years, I have been using Dr. Atul Gawande’s graduation speech to the Harvard Medical School Class of 2011 (“Cowboys and Pit Crews”) in teaching about the evolution of health care delivery I have witnessed over my years in practice.
When my medical career began (during Reagan’s first presidential term), hierarchical “parallel mono-disciplinary” care was the typical patient’s experience, where a patient was passed between specialists and hospitals until someone (hopefully) took the time to sit down and listen to their journey, piece together the story, mine the available paper records and validate the patient’s concerns with a reasonable differential diagnostic and therapeutic plan. This pattern of care delivery continues in many settings today.
In the closing decades of the last century we moved forward considerably with multidisciplinary (multiple specialties looking at the same patient at the same time, often in the same clinical space) and interdisciplinary teams (multiple specialties looking at the same patient at the same time, including the voice of patient and family, and agreeing on a single patient and family-centered set of treatment goals).
More recently, we have increasingly recognized that health is more than the absence of disease. The true drivers of health are determined by the 8,759 hours a year our patients spend at home in their community rather than the roughly one hour a year the average American spends in a provider’s office. In the future, the individual and population’s health will be addressed by a new model of integrated, community-care teams that include health care professionals but also community navigators and service providers as equal partners who are able to address issues like housing, food security, employment and economics. (But that’s the subject for another post.)
Time has proven that Dr. Gawande was right. The future of health care depends on our ability to function like pit crew teams with broad, horizontal, flexible, situational leadership structures.
But for the past several weeks, I wish we had a cowboy. Continue reading