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51 51 CEO/STRATEGY Dr. Atul Gawande on the Heroism of Incremental Care By Tamara Rosin P hysicians are heroes. ey touch peo- ple's lives in a uniquely tangible way and represent the difference between life and death for people on a daily basis. But not all physicians are viewed in the same way, and that is a problem that has broad-reaching repercussions, according to an article by Atul Gawande, MD, in e New Yorker. When we think of a heroic action, one of the first examples that might come to mind could be fire- fighters extinguishing a blazing house fire. e fire is put out and the dangerous situation is over. Done. People gravitate toward these depictions of heroism because they are episodic — they have a beginning and end, and most important- ly, the benefit is instant and measurable. In his article, Dr. Gawande explains he was "drawn to medicine by the aura of heroism — by the chance to charge in and solve a danger- ous problem." He ultimately chose to become a surgeon because "surgery was a definitive intervention at a critical moment in a person's life, with a clear, calculable, frequently trans- formative outcome." In comparison, the medical field of primary care gave Dr. Gawande a "squishy and un- certain" impression. ese clinicians don't put out a fire in a single night — or surgical procedure. Instead, their care is incremental, spanning weeks, months, even years or a life- time, with progress oen slow and medical approaches commonly amended as time car- ries on and symptoms change. Primary care oen doesn't allow for the instant gratification so many of us desire, especially when it comes to correcting health, but it is nonetheless in- dispensable to the healthcare system. Dr. Gawande believed becoming a surgeon would give him the opportunity to have the greatest overall impact on his patients' lives, but he eventually learned from observing his generalist colleagues that primary care "is the medical profession that has the greatest overall impact, including lower mortality and better health, not to mention lower medical costs." Numerous studies support this assertion, as does the entire nationwide push under healthcare reform to encourage all Americans to have a primary care physician. Still, Dr. Gawande won- dered what particular skill enabled this to be true. "Aer all, for any given situation specialists are likely to have more skill and experience, and more apt to follow the evidence of what works," he wrote. "Generalists have no advan- tage over specialists in any particular case. Yet, somehow, having a primary care clinician as your main source of care is better for you." All of the generalists he observed cited the same reason for this: the relationships they have with patients. "Studies have established that having a regular source of medical care, from a doctor who knows you, has a powerful effect on your willingness to seek care for se- vere symptoms. is alone appears to be a sig- nificant contributor to lower death rates," he wrote. "Observing the care, I began to grasp how the commitment to seeing people over time leads primary care clinicians to take an approach to problem solving that is very dif- ferent from that of doctors, like me, who pro- vide mainly episodic care." Success in medicine, he realized, is not mea- sured exclusively in episodic victories, al- though they are still important. Instead, "It is about the longer view of incremental steps that produce sustained progress. at, such clinicians argue, is what making a difference really looks like," Dr. Gawande wrote. Unfortunately, the U.S. healthcare system and the way it reimburses primary care physicians and other clinicians who treat patients on an incremental basis does not recognize this truth, according to Dr. Gawande. He acknowledges that as a surgeon, he has "a battalion of people and millions of dollars of equipment on hand when [he] arrive[s] in [his] operating room. In- crementalists are lucky if they can hire a nurse." Chronic diseases, which impose the greatest financial and resource burden on the U.S. healthcare system, are also the conditions that fall under the responsibility of incremental- ists. Yet these clinicians are paid substantially less than many specialists and are given fewer resources to do their job. "e difference be- tween what's made available to me as a surgeon and what's made available to our internists or pediatricians or H.I.V. specialists is not just shortsighted — it's immoral," he wrote. It is time for the shapers of healthcare policy to recognize "the heroism of the incremental," according to Dr. Gawande. "We can give up an antiquated set of priorities and shi our focus from rescue medicine to lifelong incremental care. Or we can leave mil- lions of people to suffer and die from condi- tions that, increasingly, can be predicted and managed. is isn't a bloodless policy choice; it's a medical emergency," he wrote. n Study: 25% of CEOs' Time Spent on Work That Could Be Automated By Tamara Rosin A pproximately one-third of the activities in 60 percent of all jobs could be automated, according to research recently reported by the Harvard Business Review. For CEOs, about 25 percent of their time is currently spent on activities that could be automated, such as analyzing re- ports and data to inform decisions. Researchers from McKinsey & Co. analyzed more than 2,000 workplace activities across 800 occupations. Researchers found the potential of automation is broader now than in the past because technologies such as robotics, artificial intelligence and machine learning are able to ac- complish cognitive capabilities in addition to physical ones, such as lip reading and driving, according to the report. The anxiety that surrounds automation largely centers on technology's ability to displace jobs. However, as compa- nies increasingly deploy automotive tools, it is important to focus efforts on equipping people with the necessary skills to succeed in the workforce of tomorrow, such as being able to interact more closely with machines in the workplace, ac- cording to the report. n