Gawande Part II

If you missed my previous post, I recently had another chance to hear Dr. Atul Gawande speak, this time at the University of Akron.  Last time, I posted my initial impressions surrounding Dr. Gawande's promotion of the idea of coordinated, team-based medical care as the solution to what he has called the "appallingly patched-together ship" of American healtchare.
Today, I want to discuss Dr. Gawande's ideas for getting the "cowboys" of medicine to form "pit-crews".  I recently found out that this was not the first time that Dr. Gawande has shared this idea; he gave a similar speech at Havard's commencement which was posted online at The New Yorker.  In summary, Dr. Gawande identifies three skills necessary for a "pit crew" to function successfully as a system:
1) the ability to recognize successes and failures,
2) the ability to devise solutions
3) the ability to implement solutions on a wide scale. 

He also enumerates three values that members of the team need to share:
1) humility to understand that you can fail,
2) discipline to stick to standards to minimize failures
3) teamwork to allow others to save you from failure.

The difficulty in implementing solutions to the problems in healthcare today is that not every physician is on board with these values and it will be no easy task to convince everyone that this is what needs to be done, even with solid supporting evidence.  What Dr. Gawande is calling for is a cultural change in the profession of medicine and, to me, that is one of the most difficult changes to incite.  With cultural change, you cannot create policies that dictate people's values.  The values need to be internalized by all.

I would have really liked to hear Dr. Gawande's ideas for integrating discussion of these values in medical school.  At my own school, there is already a significant amount of time devoted to exploring values of medical practice so it would not be difficult to begin such discussions.  If any effective culture change is to be made, medical education must definitely be a target area.  After all, this is where a physician's enculturation begins.