How do we heal medicine? - Atul Gawande
i<00:00:17.039> got<00:00:17.279> my<00:00:17.520> start
i got my start
i got my start
in<00:00:18.800> writing<00:00:19.840> and<00:00:20.160> research<00:00:21.039> as<00:00:21.279> a<00:00:21.520> surgical
in writing and research as a surgical
in writing and research as a surgical
trainee
trainee
trainee
as<00:00:23.760> someone<00:00:24.080> who<00:00:24.320> was<00:00:24.640> a<00:00:24.800> long<00:00:25.119> ways<00:00:25.359> away<00:00:25.760> from
as someone who was a long ways away from
as someone who was a long ways away from
becoming<00:00:26.560> any<00:00:26.720> kind<00:00:26.960> of<00:00:27.039> an<00:00:27.199> expert<00:00:27.680> at
becoming any kind of an expert at
becoming any kind of an expert at
anything<00:00:29.359> so<00:00:29.599> the<00:00:29.760> natural<00:00:30.160> question<00:00:30.480> you<00:00:30.640> ask
anything so the natural question you ask
anything so the natural question you ask
then<00:00:31.279> at<00:00:31.359> that<00:00:31.599> point
then at that point
then at that point
is<00:00:32.239> how<00:00:32.320> do<00:00:32.480> i<00:00:32.640> get<00:00:32.800> good<00:00:33.040> at<00:00:33.120> what<00:00:33.280> i'm<00:00:33.440> trying
is how do i get good at what i'm trying
is how do i get good at what i'm trying
to<00:00:33.760> do<00:00:34.000> and<00:00:34.079> it<00:00:34.160> became<00:00:35.040> a<00:00:35.200> question<00:00:35.600> of
to do and it became a question of
to do and it became a question of
how<00:00:36.719> do<00:00:36.880> we<00:00:37.040> all<00:00:37.280> get<00:00:37.520> good<00:00:38.079> at<00:00:38.480> what<00:00:38.640> we're
how do we all get good at what we're
how do we all get good at what we're
trying<00:00:39.120> to<00:00:39.280> do
trying to do
trying to do
it's<00:00:41.440> hard<00:00:41.760> enough<00:00:42.000> to<00:00:42.160> learn<00:00:42.399> to<00:00:42.559> get<00:00:42.719> the
it's hard enough to learn to get the
it's hard enough to learn to get the
skills
skills
skills
try<00:00:44.960> to<00:00:45.120> learn<00:00:45.440> all<00:00:45.520> the<00:00:45.680> material<00:00:46.239> you<00:00:46.399> have
try to learn all the material you have
try to learn all the material you have
to<00:00:46.960> absorb<00:00:47.600> at
to absorb at
to absorb at
any<00:00:48.160> task<00:00:48.480> you're<00:00:48.640> taking<00:00:48.960> on<00:00:49.200> i<00:00:49.280> had<00:00:49.440> to<00:00:50.000> think
any task you're taking on i had to think
any task you're taking on i had to think
about<00:00:50.480> how<00:00:50.719> i
about how i
about how i
sew<00:00:51.600> and<00:00:51.840> how<00:00:52.079> i<00:00:52.640> cut<00:00:52.879> but<00:00:53.039> then<00:00:53.280> also<00:00:53.920> how<00:00:54.079> i
sew and how i cut but then also how i
sew and how i cut but then also how i
pick<00:00:54.480> the<00:00:54.640> right<00:00:54.879> person<00:00:55.280> to<00:00:55.440> come<00:00:55.680> to<00:00:55.840> an
pick the right person to come to an
pick the right person to come to an
operating<00:00:56.480> room
operating room
operating room
and<00:00:57.280> then<00:00:57.440> in<00:00:57.520> the<00:00:57.600> midst<00:00:57.920> of<00:00:58.079> all<00:00:58.160> this<00:00:58.399> came
and then in the midst of all this came
and then in the midst of all this came
this<00:00:58.879> new<00:00:59.600> context<00:01:00.239> for<00:01:00.399> thinking<00:01:00.800> about
this new context for thinking about
this new context for thinking about
what<00:01:01.600> it<00:01:01.680> meant<00:01:01.920> to<00:01:02.000> be<00:01:02.239> good<00:01:03.840> in<00:01:04.000> the<00:01:04.080> last<00:01:04.320> few
what it meant to be good in the last few
what it meant to be good in the last few
years<00:01:04.720> we<00:01:04.879> realized<00:01:05.280> we're<00:01:05.439> in<00:01:05.519> the<00:01:05.600> deepest
years we realized we're in the deepest
years we realized we're in the deepest
crisis
crisis
crisis
of<00:01:07.840> medicine's<00:01:08.479> existence<00:01:09.680> due<00:01:09.840> to<00:01:10.000> something
of medicine's existence due to something
of medicine's existence due to something
you<00:01:10.560> don't<00:01:10.880> normally<00:01:11.280> think<00:01:11.520> about
you don't normally think about
you don't normally think about
when<00:01:12.640> you're<00:01:13.200> a<00:01:13.360> doctor<00:01:14.080> concerned<00:01:14.560> with<00:01:15.040> how
when you're a doctor concerned with how
when you're a doctor concerned with how
you<00:01:15.280> do<00:01:15.439> good<00:01:15.680> for<00:01:15.840> people
you do good for people
you do good for people
which<00:01:17.040> is<00:01:17.200> the<00:01:17.439> cost<00:01:18.479> of<00:01:19.119> health<00:01:19.439> care
which is the cost of health care
which is the cost of health care
there's<00:01:21.680> not<00:01:22.000> a<00:01:22.159> country<00:01:22.960> in<00:01:23.040> the<00:01:23.200> world<00:01:23.520> that
there's not a country in the world that
there's not a country in the world that
now<00:01:24.080> is<00:01:24.240> not<00:01:24.479> asking
now is not asking
now is not asking
whether<00:01:26.320> we<00:01:26.479> can<00:01:26.720> afford<00:01:27.200> what<00:01:27.439> doctors<00:01:28.320> do
whether we can afford what doctors do
whether we can afford what doctors do
the<00:01:30.079> political<00:01:30.640> fight<00:01:30.880> that<00:01:31.040> we've<00:01:31.280> developed
the political fight that we've developed
the political fight that we've developed
has<00:01:31.759> become<00:01:32.079> one<00:01:32.320> around
has become one around
has become one around
whether<00:01:33.840> it's<00:01:34.159> the<00:01:34.320> government<00:01:35.360> that's<00:01:35.680> the
whether it's the government that's the
whether it's the government that's the
problem<00:01:36.400> or<00:01:36.720> is<00:01:36.880> it
problem or is it
problem or is it
insurance<00:01:37.840> companies<00:01:38.720> that<00:01:38.880> are<00:01:39.040> the<00:01:39.200> problem
insurance companies that are the problem
insurance companies that are the problem
and<00:01:42.159> the<00:01:42.399> answer<00:01:42.720> is<00:01:42.880> yes
and the answer is yes
and the answer is yes
and<00:01:44.960> no<00:01:46.000> it's<00:01:46.240> deeper<00:01:46.560> than<00:01:46.799> all<00:01:46.960> of<00:01:47.040> that<00:01:47.439> the
and no it's deeper than all of that the
and no it's deeper than all of that the
cause<00:01:48.000> of<00:01:48.159> our<00:01:48.399> troubles<00:01:48.880> is<00:01:49.119> actually
cause of our troubles is actually
cause of our troubles is actually
the<00:01:50.560> complexity<00:01:51.280> that<00:01:51.520> science<00:01:52.640> has<00:01:52.799> given<00:01:53.119> us
the complexity that science has given us
the complexity that science has given us
in<00:01:53.439> order<00:01:53.600> to<00:01:53.680> understand
in order to understand
in order to understand
this<00:01:54.399> i'm<00:01:54.479> going<00:01:54.640> to<00:01:54.720> take<00:01:54.960> you<00:01:55.119> back<00:01:56.000> a<00:01:56.079> couple
this i'm going to take you back a couple
this i'm going to take you back a couple
of<00:01:56.960> generations
of generations
of generations
i<00:01:58.640> want<00:01:58.799> to<00:01:58.880> take<00:01:59.040> you<00:01:59.280> back<00:01:59.600> to<00:02:00.159> a<00:02:00.320> time<00:02:00.640> when
i want to take you back to a time when
i want to take you back to a time when
louis<00:02:01.200> thomas<00:02:01.600> was<00:02:01.759> writing<00:02:02.159> in<00:02:02.240> his<00:02:02.479> book
louis thomas was writing in his book
louis thomas was writing in his book
the<00:02:03.600> youngest<00:02:03.920> science<00:02:04.159> lewis<00:02:04.399> thomas<00:02:05.040> was<00:02:05.200> a
the youngest science lewis thomas was a
the youngest science lewis thomas was a
physician<00:02:05.759> writer<00:02:06.079> one<00:02:06.240> of<00:02:06.320> my<00:02:06.560> one<00:02:06.719> of<00:02:06.799> my
physician writer one of my one of my
physician writer one of my one of my
favorite<00:02:07.280> writers
favorite writers
favorite writers
and<00:02:08.399> he<00:02:08.560> wrote<00:02:08.800> this<00:02:09.039> book<00:02:09.599> to<00:02:09.679> explain<00:02:10.080> among
and he wrote this book to explain among
and he wrote this book to explain among
other<00:02:10.560> things<00:02:10.800> what<00:02:10.959> it<00:02:11.039> was<00:02:11.280> like
other things what it was like
other things what it was like
to<00:02:12.239> be<00:02:12.480> a<00:02:12.560> medical<00:02:13.040> intern<00:02:13.840> at<00:02:13.920> the<00:02:14.080> boston
to be a medical intern at the boston
to be a medical intern at the boston
city<00:02:15.040> hospital
city hospital
city hospital
in<00:02:16.080> the<00:02:16.360> pre-penicillin<00:02:17.360> year<00:02:18.239> of<00:02:18.760> 1937.
in the pre-penicillin year of 1937.
in the pre-penicillin year of 1937.
it<00:02:20.959> was<00:02:21.120> a<00:02:21.280> time<00:02:21.520> when<00:02:22.239> medicine<00:02:22.720> was<00:02:22.959> cheap
it was a time when medicine was cheap
it was a time when medicine was cheap
and<00:02:24.720> very<00:02:25.200> ineffective
if<00:02:29.280> you<00:02:29.440> were<00:02:30.080> in<00:02:30.239> a<00:02:30.319> hospital<00:02:30.879> he<00:02:31.040> said<00:02:32.160> it<00:02:32.319> was
if you were in a hospital he said it was
if you were in a hospital he said it was
going<00:02:33.760> to<00:02:33.840> do<00:02:34.080> you<00:02:34.400> good<00:02:35.200> only<00:02:35.519> because<00:02:35.920> it
going to do you good only because it
going to do you good only because it
offered<00:02:36.400> you
offered you
offered you
some<00:02:37.120> warmth<00:02:38.640> some<00:02:38.879> food
some warmth some food
some warmth some food
shelter<00:02:41.280> and<00:02:41.440> maybe<00:02:41.760> the<00:02:42.319> caring<00:02:42.720> attention
shelter and maybe the caring attention
shelter and maybe the caring attention
of<00:02:43.760> a<00:02:43.920> nurse<00:02:45.120> doctors<00:02:46.080> and<00:02:46.319> medicine
made<00:02:49.120> no<00:02:49.280> difference<00:02:49.680> at<00:02:49.840> all<00:02:51.360> that<00:02:51.519> didn't
made no difference at all that didn't
made no difference at all that didn't
seem<00:02:52.000> to<00:02:52.160> prevent<00:02:52.480> the<00:02:52.640> doctors<00:02:53.040> from<00:02:53.200> being
seem to prevent the doctors from being
seem to prevent the doctors from being
frantically
frantically
frantically
busy<00:02:54.959> in<00:02:55.040> their<00:02:55.280> days<00:02:55.840> as<00:02:56.000> he<00:02:56.160> explained<00:02:56.879> what
busy in their days as he explained what
busy in their days as he explained what
they<00:02:57.200> were<00:02:57.440> trying<00:02:57.680> to<00:02:57.840> do
they were trying to do
they were trying to do
was<00:02:58.640> figure<00:02:58.959> out<00:02:59.120> whether<00:02:59.440> you<00:02:59.680> might<00:03:00.000> have
was figure out whether you might have
was figure out whether you might have
one<00:03:01.440> of<00:03:01.599> the<00:03:01.680> diagnoses<00:03:02.480> for<00:03:02.640> which<00:03:02.959> they
one of the diagnoses for which they
one of the diagnoses for which they
could<00:03:03.280> do<00:03:03.519> something
could do something
could do something
and<00:03:04.720> there<00:03:04.879> were<00:03:05.440> a<00:03:05.519> few<00:03:06.879> you<00:03:07.040> might<00:03:07.280> have<00:03:07.440> a
and there were a few you might have a
and there were a few you might have a
low<00:03:07.760> bar<00:03:08.000> pneumonia<00:03:08.560> for<00:03:08.720> example
low bar pneumonia for example
low bar pneumonia for example
and<00:03:09.599> they<00:03:09.760> could<00:03:09.920> give<00:03:10.159> you<00:03:10.640> an<00:03:11.040> anti-serum<00:03:11.680> an
and they could give you an anti-serum an
and they could give you an anti-serum an
injection
injection
injection
of<00:03:13.120> rabid<00:03:13.519> antibodies<00:03:15.840> to<00:03:16.000> the<00:03:16.319> bacterium
of rabid antibodies to the bacterium
of rabid antibodies to the bacterium
streptococcus
streptococcus
streptococcus
if<00:03:19.200> the<00:03:19.440> intern<00:03:20.319> subtyped<00:03:21.040> it<00:03:21.360> correctly
if the intern subtyped it correctly
if the intern subtyped it correctly
if<00:03:23.040> you<00:03:23.200> had<00:03:23.360> an<00:03:23.599> acute<00:03:24.480> congestive<00:03:25.120> heart
if you had an acute congestive heart
if you had an acute congestive heart
failure
failure
failure
they<00:03:26.400> could<00:03:26.720> bleed<00:03:27.360> a<00:03:27.519> pint<00:03:27.840> of<00:03:28.000> blood<00:03:28.319> from
they could bleed a pint of blood from
they could bleed a pint of blood from
you<00:03:29.120> by<00:03:29.360> opening<00:03:29.840> up<00:03:30.000> an<00:03:30.159> arm<00:03:30.400> vein
you by opening up an arm vein
you by opening up an arm vein
giving<00:03:31.840> you<00:03:32.000> a<00:03:32.239> crude<00:03:32.640> leaf<00:03:33.040> preparation<00:03:34.080> of
giving you a crude leaf preparation of
giving you a crude leaf preparation of
digitalis
digitalis
digitalis
and<00:03:35.680> then<00:03:35.920> giving<00:03:36.159> you<00:03:36.480> oxygen<00:03:37.360> by<00:03:37.680> tent
and then giving you oxygen by tent
and then giving you oxygen by tent
if<00:03:39.920> you<00:03:40.000> had<00:03:40.400> early<00:03:40.799> signs<00:03:41.120> of<00:03:41.200> paralysis<00:03:41.920> and
if you had early signs of paralysis and
if you had early signs of paralysis and
you<00:03:42.400> were<00:03:42.560> really<00:03:42.879> good<00:03:43.120> at<00:03:43.280> asking<00:03:43.760> personal
you were really good at asking personal
you were really good at asking personal
questions<00:03:44.799> you<00:03:44.959> might<00:03:45.280> figure<00:03:45.599> out<00:03:45.760> that
questions you might figure out that
questions you might figure out that
this<00:03:46.319> paralysis<00:03:47.440> someone<00:03:47.840> has<00:03:48.159> is<00:03:48.319> from
this paralysis someone has is from
this paralysis someone has is from
syphilis
syphilis
syphilis
in<00:03:50.400> which<00:03:50.640> case<00:03:50.879> you<00:03:51.040> could<00:03:51.120> give<00:03:51.280> this<00:03:51.760> nice
in which case you could give this nice
in which case you could give this nice
concoction<00:03:52.879> of
concoction of
concoction of
mercury<00:03:54.159> and<00:03:54.400> arsenic
as<00:03:57.200> long<00:03:57.439> as<00:03:57.519> you<00:03:57.599> didn't<00:03:58.000> overdose<00:03:58.480> them<00:03:58.640> and
as long as you didn't overdose them and
as long as you didn't overdose them and
kill<00:03:58.959> them
kill them
kill them
beyond<00:04:02.159> these<00:04:02.319> sorts<00:04:02.560> of<00:04:02.720> things<00:04:03.120> a<00:04:03.599> medical
beyond these sorts of things a medical
beyond these sorts of things a medical
doctor<00:04:05.439> didn't<00:04:05.760> have<00:04:06.080> a<00:04:06.159> lot<00:04:06.400> that<00:04:06.560> they<00:04:06.720> could
doctor didn't have a lot that they could
doctor didn't have a lot that they could
do
do
do
this<00:04:08.959> was<00:04:09.200> when<00:04:09.439> the<00:04:09.599> core<00:04:09.920> structure<00:04:11.280> of
this was when the core structure of
this was when the core structure of
medicine<00:04:11.920> was<00:04:12.159> created<00:04:12.640> what
medicine was created what
medicine was created what
what<00:04:13.360> it<00:04:13.599> meant<00:04:13.920> to<00:04:14.080> be<00:04:14.239> good<00:04:14.480> at<00:04:14.640> what<00:04:14.799> we<00:04:15.040> did
what it meant to be good at what we did
what it meant to be good at what we did
and<00:04:15.920> and<00:04:16.160> how<00:04:16.320> we<00:04:16.560> wanted<00:04:16.880> to<00:04:17.040> build<00:04:17.359> medicine
and and how we wanted to build medicine
and and how we wanted to build medicine
to<00:04:18.000> be<00:04:18.160> it<00:04:18.239> was
to be it was
to be it was
at<00:04:18.880> a<00:04:19.040> time<00:04:19.759> when<00:04:20.079> what<00:04:20.320> was<00:04:20.639> known<00:04:21.280> you<00:04:21.519> could
at a time when what was known you could
at a time when what was known you could
know
know
know
you<00:04:22.560> could<00:04:22.800> hold<00:04:23.040> it<00:04:23.199> all<00:04:23.440> in<00:04:23.600> your<00:04:23.759> head<00:04:24.000> and
you could hold it all in your head and
you could hold it all in your head and
you<00:04:24.240> could<00:04:24.479> do<00:04:24.720> it<00:04:24.880> all<00:04:25.360> if<00:04:25.520> you<00:04:25.600> had<00:04:25.759> a
you could do it all if you had a
you could do it all if you had a
prescription<00:04:26.560> pad
prescription pad
prescription pad
if<00:04:27.680> you<00:04:27.840> had<00:04:28.400> a<00:04:28.639> nurse<00:04:28.960> if<00:04:29.120> you<00:04:29.280> had<00:04:29.520> a<00:04:30.240> hospital
if you had a nurse if you had a hospital
if you had a nurse if you had a hospital
that<00:04:30.800> would<00:04:30.960> give<00:04:31.120> you<00:04:31.280> a<00:04:31.360> place<00:04:31.680> to
that would give you a place to
that would give you a place to
convalesce<00:04:32.400> maybe<00:04:32.720> some<00:04:32.960> basic<00:04:33.360> tools<00:04:33.680> you
convalesce maybe some basic tools you
convalesce maybe some basic tools you
really<00:04:34.160> could<00:04:34.320> do<00:04:34.560> it<00:04:34.720> all
really could do it all
really could do it all
you<00:04:35.680> set<00:04:36.000> the<00:04:36.160> fracture<00:04:36.960> you<00:04:37.919> drew<00:04:38.240> the<00:04:38.400> blood
you set the fracture you drew the blood
you set the fracture you drew the blood
you<00:04:39.440> spun<00:04:39.919> the<00:04:40.080> blood<00:04:40.400> and<00:04:40.479> looked<00:04:40.800> at<00:04:40.960> it
you spun the blood and looked at it
you spun the blood and looked at it
under<00:04:41.280> the<00:04:41.440> microscope<00:04:42.080> you<00:04:42.240> plated<00:04:42.639> the
under the microscope you plated the
under the microscope you plated the
culture<00:04:43.280> you
culture you
culture you
injected<00:04:44.560> the<00:04:44.800> anti-serum<00:04:45.600> this<00:04:45.840> was
injected the anti-serum this was
injected the anti-serum this was
a<00:04:48.320> life<00:04:48.960> as<00:04:49.360> a<00:04:49.600> craftsman
a life as a craftsman
a life as a craftsman
as<00:04:51.440> a<00:04:51.520> result<00:04:52.320> we<00:04:52.880> built<00:04:53.360> it<00:04:53.600> around
as a result we built it around
as a result we built it around
a<00:04:54.479> culture<00:04:54.880> and<00:04:55.040> set<00:04:55.280> of<00:04:55.360> values<00:04:55.759> that<00:04:56.000> said
a culture and set of values that said
a culture and set of values that said
what<00:04:56.479> you<00:04:57.040> were<00:04:57.280> good<00:04:57.520> at
what you were good at
what you were good at
was<00:04:58.720> being<00:04:59.040> daring<00:05:00.800> at<00:05:00.960> being
was being daring at being
was being daring at being
courageous<00:05:03.520> at<00:05:03.840> being<00:05:04.639> independent
courageous at being independent
courageous at being independent
and<00:05:05.840> self-sufficient<00:05:07.360> autonomy
and self-sufficient autonomy
and self-sufficient autonomy
was<00:05:09.120> our<00:05:09.520> highest<00:05:10.400> value
go<00:05:13.680> a<00:05:13.759> couple<00:05:14.080> generations<00:05:14.720> forward<00:05:15.039> to<00:05:15.199> where
go a couple generations forward to where
go a couple generations forward to where
we<00:05:15.680> are<00:05:15.840> though
we are though
we are though
and<00:05:16.880> it<00:05:16.960> looks<00:05:17.280> like<00:05:17.520> a<00:05:17.600> completely<00:05:18.080> different
and it looks like a completely different
and it looks like a completely different
world<00:05:19.199> we<00:05:19.360> have<00:05:19.680> now
world we have now
world we have now
found<00:05:20.400> treatments<00:05:21.919> for<00:05:22.479> nearly<00:05:22.960> all<00:05:23.280> of<00:05:23.360> the
found treatments for nearly all of the
found treatments for nearly all of the
tens<00:05:23.919> of<00:05:24.080> thousands<00:05:24.560> of<00:05:24.639> conditions
tens of thousands of conditions
tens of thousands of conditions
that<00:05:25.919> a<00:05:26.000> human<00:05:26.320> being<00:05:26.720> can<00:05:26.960> have<00:05:27.680> we<00:05:27.840> can't
that a human being can have we can't
that a human being can have we can't
cure<00:05:28.320> it<00:05:28.479> all
cure it all
cure it all
we<00:05:28.800> can't<00:05:29.039> guarantee<00:05:29.520> that<00:05:29.680> everybody<00:05:30.000> will
we can't guarantee that everybody will
we can't guarantee that everybody will
live<00:05:30.400> a<00:05:30.560> long<00:05:31.360> and<00:05:31.520> healthy<00:05:32.000> life
live a long and healthy life
live a long and healthy life
but<00:05:33.360> we<00:05:33.520> can<00:05:33.680> make<00:05:33.919> it<00:05:34.080> possible<00:05:34.800> for<00:05:35.039> most
but we can make it possible for most
but we can make it possible for most
but<00:05:37.600> what<00:05:37.840> does<00:05:38.000> it<00:05:38.160> take<00:05:39.520> well<00:05:39.919> we've<00:05:40.160> now
but what does it take well we've now
but what does it take well we've now
discovered<00:05:42.160> 4<00:05:42.639> 000<00:05:43.199> medical<00:05:43.600> and<00:05:43.759> surgical
discovered 4 000 medical and surgical
discovered 4 000 medical and surgical
procedures
procedures
procedures
we've<00:05:46.160> discovered<00:05:46.800> 6<00:05:47.280> 000<00:05:48.240> drugs<00:05:48.639> that<00:05:48.800> i'm
we've discovered 6 000 drugs that i'm
we've discovered 6 000 drugs that i'm
now<00:05:49.199> licensed<00:05:49.759> to<00:05:50.840> prescribe
now licensed to prescribe
now licensed to prescribe
and<00:05:52.400> we're<00:05:52.560> trying<00:05:52.800> to<00:05:52.880> deploy<00:05:53.360> this
and we're trying to deploy this
and we're trying to deploy this
capability<00:05:54.320> town<00:05:54.639> by<00:05:54.960> town
capability town by town
capability town by town
to<00:05:56.560> every<00:05:56.800> person<00:05:57.199> alive
in<00:06:00.240> our<00:06:00.400> own<00:06:00.560> country<00:06:01.199> let<00:06:01.360> alone<00:06:02.160> around<00:06:02.479> the
in our own country let alone around the
in our own country let alone around the
world
world
world
and<00:06:04.000> we've<00:06:04.160> reached<00:06:04.479> the<00:06:04.560> point<00:06:04.800> where<00:06:04.960> we've
and we've reached the point where we've
and we've reached the point where we've
realized<00:06:06.400> as<00:06:06.639> doctors
realized as doctors
realized as doctors
we<00:06:09.120> can't<00:06:09.440> know<00:06:09.680> it<00:06:09.840> all<00:06:10.960> we<00:06:11.280> can't
we can't know it all we can't
we can't know it all we can't
do<00:06:12.560> it<00:06:12.720> all<00:06:14.319> by<00:06:14.479> ourselves
do it all by ourselves
do it all by ourselves
there<00:06:15.919> was<00:06:16.000> a<00:06:16.160> study<00:06:16.479> where<00:06:16.720> they<00:06:16.880> looked<00:06:17.120> at
there was a study where they looked at
there was a study where they looked at
how<00:06:18.479> many<00:06:18.720> clinicians<00:06:19.280> it<00:06:19.440> took<00:06:19.600> to<00:06:19.759> take
how many clinicians it took to take
how many clinicians it took to take
care<00:06:20.240> of<00:06:20.400> you<00:06:20.639> if<00:06:20.720> you<00:06:20.960> came<00:06:21.199> into<00:06:21.440> a<00:06:21.600> hospital
care of you if you came into a hospital
care of you if you came into a hospital
as<00:06:22.560> it<00:06:22.720> changed<00:06:23.120> over<00:06:23.360> time
as it changed over time
as it changed over time
and<00:06:24.000> in<00:06:24.160> the<00:06:24.240> year<00:06:24.400> 1970<00:06:25.680> it<00:06:25.840> took<00:06:26.080> just<00:06:26.319> over
and in the year 1970 it took just over
and in the year 1970 it took just over
two<00:06:26.960> full-time<00:06:27.600> equivalents
two full-time equivalents
two full-time equivalents
of<00:06:28.560> clinicians<00:06:29.360> that<00:06:29.600> is<00:06:29.759> to<00:06:29.919> say<00:06:30.479> it<00:06:30.639> took
of clinicians that is to say it took
of clinicians that is to say it took
basically
basically
basically
the<00:06:31.840> nursing<00:06:32.240> time<00:06:33.759> and<00:06:33.840> then<00:06:34.240> just<00:06:34.479> a<00:06:34.560> little
the nursing time and then just a little
the nursing time and then just a little
bit<00:06:34.880> of<00:06:35.039> time<00:06:35.199> for<00:06:35.360> a<00:06:35.440> doctor<00:06:35.759> who<00:06:35.919> more<00:06:36.080> or
bit of time for a doctor who more or
bit of time for a doctor who more or
less<00:06:36.479> checked<00:06:36.720> in<00:06:36.880> on<00:06:37.039> you
less checked in on you
less checked in on you
once<00:06:38.319> a<00:06:38.400> day<00:06:39.680> by<00:06:39.919> the<00:06:40.080> end<00:06:40.400> of<00:06:40.479> the<00:06:40.720> 20th
once a day by the end of the 20th
once a day by the end of the 20th
century
century
century
it<00:06:42.639> had<00:06:42.880> become<00:06:43.440> more<00:06:43.680> than<00:06:43.919> 15<00:06:44.960> clinicians
it had become more than 15 clinicians
it had become more than 15 clinicians
for<00:06:46.240> the<00:06:46.479> same<00:06:46.880> typical<00:06:47.680> hospital<00:06:48.160> patient
for the same typical hospital patient
for the same typical hospital patient
specialists<00:06:50.639> physical<00:06:51.120> therapists
specialists physical therapists
specialists physical therapists
the<00:06:52.560> nurses<00:06:54.880> we're<00:06:55.199> all<00:06:55.440> specialists<00:06:56.080> now
the nurses we're all specialists now
the nurses we're all specialists now
even<00:06:57.440> the<00:06:57.599> primary<00:06:58.000> care<00:06:58.240> physicians
even the primary care physicians
even the primary care physicians
everyone<00:06:59.120> just<00:06:59.360> has<00:07:00.080> a<00:07:00.319> piece
everyone just has a piece
everyone just has a piece
of<00:07:01.280> the<00:07:01.520> care<00:07:03.680> but<00:07:03.840> holding<00:07:04.319> on<00:07:04.479> to<00:07:04.639> that
of the care but holding on to that
of the care but holding on to that
structure<00:07:05.280> we<00:07:05.520> built<00:07:05.759> around<00:07:06.160> the
structure we built around the
structure we built around the
daring<00:07:07.120> independence<00:07:08.680> self-sufficiency
daring independence self-sufficiency
daring independence self-sufficiency
of<00:07:10.240> each<00:07:10.479> of<00:07:10.639> those<00:07:10.960> people<00:07:12.319> has<00:07:12.479> become<00:07:12.800> a
of each of those people has become a
of each of those people has become a
disaster
disaster
disaster
we<00:07:15.440> have<00:07:16.160> trained<00:07:17.039> hired<00:07:17.680> and<00:07:17.840> rewarded
we have trained hired and rewarded
we have trained hired and rewarded
people
people
people
to<00:07:19.360> be<00:07:19.520> cowboys<00:07:21.759> but<00:07:22.000> it's
to be cowboys but it's
to be cowboys but it's
pit<00:07:22.639> crews<00:07:23.440> that<00:07:23.680> we<00:07:23.840> need<00:07:24.960> pit<00:07:25.199> crews
pit crews that we need pit crews
pit crews that we need pit crews
for<00:07:26.400> patients<00:07:27.520> there's<00:07:27.840> evidence<00:07:28.240> all<00:07:28.400> around
for patients there's evidence all around
for patients there's evidence all around
us
us
us
forty<00:07:29.759> percent<00:07:30.479> of<00:07:30.639> our<00:07:30.880> coronary<00:07:31.360> artery
forty percent of our coronary artery
forty percent of our coronary artery
disease<00:07:32.080> patients<00:07:32.479> in<00:07:32.560> our<00:07:32.720> communities
disease patients in our communities
disease patients in our communities
receive<00:07:34.240> incomplete<00:07:35.280> or<00:07:35.599> inappropriate<00:07:36.400> care
receive incomplete or inappropriate care
receive incomplete or inappropriate care
sixty<00:07:38.560> percent<00:07:39.919> of<00:07:40.160> our<00:07:40.400> asthma
sixty percent of our asthma
sixty percent of our asthma
stroke<00:07:41.919> patients<00:07:42.639> receive<00:07:43.120> incomplete<00:07:43.919> or
stroke patients receive incomplete or
stroke patients receive incomplete or
inappropriate<00:07:44.800> care
inappropriate care
inappropriate care
two<00:07:47.280> million<00:07:48.720> people<00:07:49.039> come<00:07:49.360> into<00:07:49.680> hospitals
two million people come into hospitals
two million people come into hospitals
and<00:07:50.479> pick
and pick
and pick
up<00:07:51.039> an<00:07:51.199> infection<00:07:51.759> they<00:07:51.919> didn't<00:07:52.240> have
up an infection they didn't have
up an infection they didn't have
because<00:07:54.479> someone<00:07:55.759> failed<00:07:56.240> to<00:07:56.400> follow<00:07:56.879> the
because someone failed to follow the
because someone failed to follow the
basic<00:07:57.520> practices<00:07:58.160> of<00:07:58.319> hygiene
basic practices of hygiene
basic practices of hygiene
our<00:08:00.479> experience<00:08:01.520> as<00:08:02.560> people<00:08:02.960> who
our experience as people who
our experience as people who
get<00:08:03.919> sick<00:08:04.560> need<00:08:04.800> help<00:08:05.280> from<00:08:05.520> other<00:08:05.680> people<00:08:06.319> is
get sick need help from other people is
get sick need help from other people is
that<00:08:06.639> we<00:08:06.879> have
that we have
that we have
amazing<00:08:08.960> clinicians<00:08:09.599> that<00:08:09.759> we<00:08:09.840> can<00:08:10.080> turn<00:08:10.319> to
amazing clinicians that we can turn to
amazing clinicians that we can turn to
hard<00:08:10.800> working
hard working
hard working
incredibly<00:08:12.240> well<00:08:12.479> trained<00:08:12.879> very<00:08:13.199> smart<00:08:14.000> that
incredibly well trained very smart that
incredibly well trained very smart that
we<00:08:14.319> have<00:08:14.479> access<00:08:14.879> to
we have access to
we have access to
incredible<00:08:16.400> technologies<00:08:17.599> that<00:08:17.759> give<00:08:17.919> us
incredible technologies that give us
incredible technologies that give us
great<00:08:18.319> hope
great hope
great hope
the<00:08:19.440> little<00:08:19.759> sense<00:08:20.879> that<00:08:21.120> it<00:08:21.280> consistently
the little sense that it consistently
the little sense that it consistently
all<00:08:22.879> comes<00:08:23.199> together<00:08:24.000> for<00:08:24.240> you<00:08:25.440> from<00:08:25.759> start
all comes together for you from start
all comes together for you from start
to<00:08:26.800> finish<00:08:28.479> in<00:08:28.639> a<00:08:28.720> successful<00:08:29.440> way
to finish in a successful way
to finish in a successful way
there's<00:08:30.960> another<00:08:31.440> sign<00:08:32.719> that<00:08:32.880> we<00:08:33.039> need<00:08:33.279> pit
there's another sign that we need pit
there's another sign that we need pit
crews
crews
crews
and<00:08:34.880> that's<00:08:35.440> the<00:08:35.599> unmanageable<00:08:36.719> cost
and that's the unmanageable cost
and that's the unmanageable cost
of<00:08:38.719> our<00:08:38.959> care<00:08:40.640> now<00:08:41.120> we<00:08:41.360> in<00:08:41.519> medicine<00:08:42.000> i<00:08:42.080> think
of our care now we in medicine i think
of our care now we in medicine i think
are<00:08:43.360> baffled<00:08:43.839> by<00:08:44.080> this<00:08:44.320> question<00:08:44.640> of<00:08:44.800> cost<00:08:45.360> we
are baffled by this question of cost we
are baffled by this question of cost we
want<00:08:45.600> to<00:08:45.760> say
want to say
want to say
this<00:08:46.480> is<00:08:46.720> just<00:08:47.040> the<00:08:47.200> way<00:08:47.440> it<00:08:47.680> is<00:08:48.880> this<00:08:49.040> is<00:08:49.200> just
this is just the way it is this is just
this is just the way it is this is just
what
what
what
medicine<00:08:50.640> requires<00:08:51.120> when<00:08:51.279> you<00:08:51.360> go<00:08:51.519> from<00:08:51.760> a
medicine requires when you go from a
medicine requires when you go from a
world<00:08:52.160> where<00:08:52.959> you<00:08:53.200> treated<00:08:53.519> arthritis
world where you treated arthritis
world where you treated arthritis
with<00:08:54.320> aspirin<00:08:55.360> that<00:08:56.240> mostly<00:08:56.560> didn't
with aspirin that mostly didn't
with aspirin that mostly didn't
do<00:08:57.440> the<00:08:57.600> job<00:08:58.560> to<00:08:58.720> one<00:08:59.040> where<00:08:59.279> if<00:08:59.440> it<00:08:59.519> gets<00:08:59.760> bad
do the job to one where if it gets bad
do the job to one where if it gets bad
enough<00:09:00.240> we<00:09:00.399> can<00:09:00.560> do<00:09:00.800> a<00:09:00.880> hip<00:09:01.120> replacement<00:09:01.760> a
enough we can do a hip replacement a
enough we can do a hip replacement a
knee<00:09:02.080> replacement
knee replacement
knee replacement
that<00:09:03.200> gives<00:09:03.519> you<00:09:04.480> years<00:09:04.959> maybe<00:09:05.519> decades
that gives you years maybe decades
that gives you years maybe decades
without<00:09:07.279> disability<00:09:08.480> a<00:09:08.640> dramatic<00:09:09.120> change
without disability a dramatic change
without disability a dramatic change
well
well
well
is<00:09:10.640> it<00:09:10.800> any<00:09:10.959> surprise<00:09:12.399> that<00:09:12.560> that<00:09:12.800> forty
is it any surprise that that forty
is it any surprise that that forty
thousand<00:09:13.519> dollar<00:09:13.760> hip<00:09:13.920> replacement
thousand dollar hip replacement
thousand dollar hip replacement
replacing<00:09:15.120> that<00:09:15.360> the<00:09:15.519> ten<00:09:15.760> cent<00:09:16.080> aspirin<00:09:16.560> is
replacing that the ten cent aspirin is
replacing that the ten cent aspirin is
is<00:09:17.600> more<00:09:17.839> expensive<00:09:19.440> it's<00:09:19.680> just<00:09:20.000> the<00:09:20.080> way<00:09:20.320> it
is more expensive it's just the way it
is more expensive it's just the way it
is<00:09:21.760> but<00:09:21.920> i<00:09:22.000> think<00:09:22.160> we're<00:09:22.399> ignoring<00:09:22.880> certain
is but i think we're ignoring certain
is but i think we're ignoring certain
facts<00:09:23.680> that<00:09:23.839> tell<00:09:24.080> us<00:09:24.240> something
facts that tell us something
facts that tell us something
about<00:09:25.200> what<00:09:25.440> we<00:09:25.600> can<00:09:25.839> do
as<00:09:28.959> we've<00:09:29.600> looked<00:09:29.839> at<00:09:30.000> the<00:09:30.160> data<00:09:30.720> about<00:09:31.120> the
as we've looked at the data about the
as we've looked at the data about the
results
results
results
that<00:09:32.959> have<00:09:33.040> come<00:09:33.360> as<00:09:33.519> the<00:09:33.680> complexity<00:09:34.240> of
that have come as the complexity of
that have come as the complexity of
increased<00:09:35.680> we<00:09:35.920> found
increased we found
increased we found
that<00:09:36.800> the<00:09:37.040> most<00:09:37.600> expensive<00:09:38.160> care
that the most expensive care
that the most expensive care
is<00:09:40.160> not<00:09:40.399> necessarily<00:09:41.360> the<00:09:41.519> best<00:09:41.839> care<00:09:42.800> and
is not necessarily the best care and
is not necessarily the best care and
vice<00:09:43.360> versa
vice versa
vice versa
the<00:09:44.399> best<00:09:44.720> care<00:09:46.399> often<00:09:46.880> turns<00:09:47.200> out<00:09:47.360> to<00:09:47.519> be<00:09:47.760> the
the best care often turns out to be the
the best care often turns out to be the
least
least
least
expensive<00:09:50.240> it<00:09:50.480> has<00:09:50.720> fewer<00:09:51.040> complications
expensive it has fewer complications
expensive it has fewer complications
the<00:09:52.640> people<00:09:52.880> get<00:09:53.040> more<00:09:53.279> efficient<00:09:53.839> at<00:09:54.000> what
the people get more efficient at what
the people get more efficient at what
they<00:09:54.399> do
they do
they do
and<00:09:56.480> what<00:09:56.720> that<00:09:56.959> means<00:09:57.279> is<00:09:58.320> there's<00:09:59.200> hope
and what that means is there's hope
and what that means is there's hope
because<00:10:02.079> to<00:10:02.320> have<00:10:02.480> the<00:10:02.640> best<00:10:02.959> results<00:10:03.760> you
because to have the best results you
because to have the best results you
really<00:10:04.320> needed
really needed
really needed
the<00:10:05.360> most<00:10:05.760> expensive<00:10:06.320> care<00:10:06.640> in<00:10:06.720> the<00:10:06.800> country
the most expensive care in the country
the most expensive care in the country
or<00:10:07.360> in<00:10:07.440> the<00:10:07.519> world
or in the world
or in the world
well<00:10:09.120> then<00:10:09.279> we<00:10:09.440> really<00:10:09.680> would<00:10:09.920> be<00:10:10.079> talking
well then we really would be talking
well then we really would be talking
about<00:10:10.640> rationing
about rationing
about rationing
who<00:10:12.480> we're<00:10:12.640> going<00:10:12.800> to<00:10:12.959> cut<00:10:13.200> off<00:10:13.440> a<00:10:13.519> medicare
that<00:10:16.320> would<00:10:16.480> be<00:10:16.640> really<00:10:17.200> our<00:10:17.440> only<00:10:17.600> choice
that would be really our only choice
that would be really our only choice
but<00:10:20.399> when<00:10:20.560> we<00:10:20.720> look<00:10:20.959> at<00:10:21.040> the<00:10:21.279> positive
but when we look at the positive
but when we look at the positive
deviants<00:10:22.240> the<00:10:22.320> ones<00:10:22.560> who<00:10:22.720> are
deviants the ones who are
deviants the ones who are
getting<00:10:23.519> the<00:10:23.600> best<00:10:23.920> results<00:10:24.720> at<00:10:24.880> the<00:10:25.040> lowest
getting the best results at the lowest
getting the best results at the lowest
costs
costs
costs
we<00:10:27.600> find<00:10:28.399> the<00:10:28.560> ones<00:10:28.800> that<00:10:29.040> look<00:10:29.360> most<00:10:29.600> like
we find the ones that look most like
we find the ones that look most like
systems<00:10:30.480> are<00:10:30.640> the<00:10:30.880> most
systems are the most
systems are the most
successful<00:10:32.480> that<00:10:32.720> is<00:10:32.800> to<00:10:32.959> say<00:10:33.519> they<00:10:33.760> found
successful that is to say they found
successful that is to say they found
ways<00:10:34.320> to<00:10:34.480> get
ways to get
ways to get
all<00:10:35.360> of<00:10:35.440> the<00:10:35.600> different<00:10:36.079> pieces<00:10:36.959> all<00:10:37.120> of<00:10:37.200> the
all of the different pieces all of the
all of the different pieces all of the
different<00:10:37.519> components
different components
different components
to<00:10:38.880> come<00:10:39.120> together<00:10:40.079> into<00:10:40.480> a<00:10:40.640> hole
to come together into a hole
to come together into a hole
having<00:10:43.200> great<00:10:43.600> components<00:10:44.320> is<00:10:44.480> not<00:10:44.720> enough
having great components is not enough
having great components is not enough
and<00:10:45.200> yet<00:10:45.440> we've<00:10:45.600> been
and yet we've been
and yet we've been
been<00:10:46.240> obsessed<00:10:46.800> in<00:10:46.880> medicine<00:10:47.600> with
been obsessed in medicine with
been obsessed in medicine with
components<00:10:48.480> we<00:10:48.959> want<00:10:49.200> the<00:10:49.279> best<00:10:49.519> drugs
components we want the best drugs
components we want the best drugs
the<00:10:50.720> best<00:10:50.959> technologies<00:10:52.160> the<00:10:52.320> best
the best technologies the best
the best technologies the best
specialists
specialists
specialists
but<00:10:54.800> we<00:10:54.959> don't<00:10:55.600> think<00:10:55.920> too<00:10:56.079> much<00:10:56.320> about<00:10:56.959> how
but we don't think too much about how
but we don't think too much about how
it<00:10:57.920> all<00:10:58.240> comes<00:10:58.640> together<00:10:59.680> it's<00:10:59.920> a<00:11:00.079> terrible
it all comes together it's a terrible
it all comes together it's a terrible
design<00:11:01.360> strategy<00:11:01.920> actually
design strategy actually
design strategy actually
if<00:11:04.079> you<00:11:04.640> well<00:11:04.880> there's<00:11:05.040> a<00:11:05.120> famous<00:11:05.440> thought
if you well there's a famous thought
if you well there's a famous thought
experiment<00:11:06.640> that<00:11:06.880> touches<00:11:07.279> exactly<00:11:07.760> on<00:11:07.920> this
experiment that touches exactly on this
experiment that touches exactly on this
they<00:11:08.959> said<00:11:09.279> what<00:11:09.519> if<00:11:09.600> you<00:11:09.760> built<00:11:10.000> a<00:11:10.160> car<00:11:10.640> from
they said what if you built a car from
they said what if you built a car from
the<00:11:11.040> very<00:11:11.360> best
the very best
the very best
car<00:11:12.839> parts<00:11:14.079> well<00:11:14.320> it<00:11:14.399> would<00:11:14.480> lead<00:11:14.720> you<00:11:14.880> to<00:11:14.959> put
car parts well it would lead you to put
car parts well it would lead you to put
in<00:11:16.160> porsche<00:11:16.560> brakes<00:11:17.680> a<00:11:17.760> ferrari<00:11:18.399> engine<00:11:18.959> a
in porsche brakes a ferrari engine a
in porsche brakes a ferrari engine a
volvo<00:11:19.680> body
volvo body
volvo body
a<00:11:20.480> bmw<00:11:21.200> chassis<00:11:21.600> and<00:11:21.680> you<00:11:21.760> put<00:11:22.000> it<00:11:22.079> all
a bmw chassis and you put it all
a bmw chassis and you put it all
together<00:11:22.560> and<00:11:22.720> what<00:11:22.880> do<00:11:22.959> you<00:11:23.120> get
together and what do you get
together and what do you get
a<00:11:24.720> very<00:11:24.959> expensive<00:11:25.519> pile<00:11:25.760> of<00:11:25.839> junk<00:11:26.160> that<00:11:26.320> does
a very expensive pile of junk that does
a very expensive pile of junk that does
not<00:11:26.640> go<00:11:26.880> anywhere
not go anywhere
not go anywhere
and<00:11:28.880> that<00:11:29.680> is<00:11:29.760> what<00:11:30.000> medicine<00:11:30.800> can<00:11:30.959> feel<00:11:31.200> like
and that is what medicine can feel like
and that is what medicine can feel like
sometimes<00:11:34.240> it's<00:11:34.480> not<00:11:34.800> a<00:11:35.040> system
sometimes it's not a system
sometimes it's not a system
now<00:11:37.279> a<00:11:37.440> system<00:11:37.839> however<00:11:39.360> when<00:11:39.519> things<00:11:39.839> start
now a system however when things start
now a system however when things start
to<00:11:40.160> come<00:11:40.839> together
to come together
to come together
you<00:11:42.320> realize<00:11:42.880> it<00:11:43.040> has<00:11:43.440> certain<00:11:44.079> skills<00:11:45.120> for
you realize it has certain skills for
you realize it has certain skills for
acting<00:11:45.839> and<00:11:46.000> looking<00:11:46.320> that<00:11:46.560> way
acting and looking that way
acting and looking that way
skill<00:11:48.079> number<00:11:48.399> one<00:11:49.120> is<00:11:49.440> the<00:11:49.600> ability<00:11:50.320> to
skill number one is the ability to
skill number one is the ability to
recognize<00:11:51.279> success<00:11:51.839> and<00:11:52.000> the<00:11:52.160> ability<00:11:52.560> to
recognize success and the ability to
recognize success and the ability to
recognize
recognize
recognize
failure<00:11:54.399> when<00:11:54.560> you<00:11:54.800> are<00:11:55.120> a<00:11:55.279> specialist<00:11:55.920> you
failure when you are a specialist you
failure when you are a specialist you
can't<00:11:56.399> see
can't see
can't see
the<00:11:57.600> end<00:11:57.920> result<00:11:58.800> very<00:11:59.120> well<00:11:59.600> you<00:11:59.760> have<00:11:59.920> to
the end result very well you have to
the end result very well you have to
become<00:12:00.320> really<00:12:00.720> interested
become really interested
become really interested
in<00:12:01.920> data<00:12:03.200> unsexy<00:12:03.920> as<00:12:04.000> that<00:12:04.240> sounds
in data unsexy as that sounds
in data unsexy as that sounds
one<00:12:05.760> of<00:12:05.839> my<00:12:06.000> colleagues<00:12:06.399> is<00:12:06.560> a<00:12:06.639> surgeon<00:12:07.040> in
one of my colleagues is a surgeon in
one of my colleagues is a surgeon in
cedar<00:12:07.360> rapids<00:12:07.760> iowa<00:12:08.399> and<00:12:08.560> he<00:12:08.720> got<00:12:08.959> interested
cedar rapids iowa and he got interested
cedar rapids iowa and he got interested
in
in
in
the<00:12:10.240> question<00:12:10.800> of<00:12:11.360> well<00:12:11.839> how<00:12:12.000> many<00:12:12.240> ct<00:12:12.720> scans
the question of well how many ct scans
the question of well how many ct scans
did<00:12:13.279> they<00:12:13.440> do<00:12:13.680> for<00:12:13.839> their<00:12:14.079> community
did they do for their community
did they do for their community
in<00:12:15.200> cedar<00:12:15.519> rapids<00:12:16.399> he<00:12:16.480> got<00:12:16.720> interested<00:12:16.959> in
in cedar rapids he got interested in
in cedar rapids he got interested in
this<00:12:17.279> because<00:12:17.519> there<00:12:17.680> had<00:12:17.760> been
this because there had been
this because there had been
government<00:12:18.880> reports<00:12:19.680> newspaper<00:12:20.240> reports<00:12:20.560> a
government reports newspaper reports a
government reports newspaper reports a
journal<00:12:20.959> article<00:12:21.360> saying<00:12:21.600> that<00:12:21.760> there<00:12:22.000> had
journal article saying that there had
journal article saying that there had
been
been
been
too<00:12:22.959> many<00:12:23.279> ct<00:12:23.760> scans<00:12:24.240> done<00:12:25.440> we<00:12:25.600> didn't<00:12:25.920> see<00:12:26.160> it
too many ct scans done we didn't see it
too many ct scans done we didn't see it
in<00:12:27.440> his<00:12:27.600> own<00:12:27.760> patients<00:12:29.200> and<00:12:29.360> so<00:12:29.920> he<00:12:30.160> asked<00:12:30.399> the
in his own patients and so he asked the
in his own patients and so he asked the
question<00:12:30.800> how<00:12:30.959> many<00:12:31.200> did<00:12:31.360> we<00:12:31.519> do<00:12:31.680> and<00:12:31.760> he
question how many did we do and he
question how many did we do and he
wanted<00:12:32.480> to<00:12:32.560> get<00:12:32.720> the<00:12:32.800> data<00:12:33.200> it<00:12:33.279> took<00:12:33.519> him<00:12:33.680> three
wanted to get the data it took him three
wanted to get the data it took him three
months<00:12:34.240> no<00:12:34.399> one<00:12:34.480> had<00:12:34.720> asked<00:12:34.959> this<00:12:35.200> question
months no one had asked this question
months no one had asked this question
in<00:12:35.760> his<00:12:36.000> community<00:12:36.639> before<00:12:37.760> and<00:12:37.920> what<00:12:38.079> he
in his community before and what he
in his community before and what he
found<00:12:38.480> was<00:12:38.639> that<00:12:38.800> for<00:12:39.040> the
found was that for the
found was that for the
300<00:12:40.160> 000<00:12:40.480> people<00:12:40.800> in<00:12:40.880> their<00:12:41.040> community<00:12:41.920> in<00:12:42.079> the
300 000 people in their community in the
300 000 people in their community in the
previous<00:12:42.639> year<00:12:42.880> they<00:12:43.120> had<00:12:43.279> done
previous year they had done
previous year they had done
52<00:12:44.800> 000<00:12:45.600> ct<00:12:46.079> scans
they<00:12:48.880> had<00:12:49.040> found<00:12:50.079> a<00:12:50.839> problem
they had found a problem
they had found a problem
which<00:12:52.399> brings<00:12:52.720> us<00:12:52.880> to<00:12:53.839> skill<00:12:54.240> number<00:12:54.639> two
which brings us to skill number two
which brings us to skill number two
a<00:12:55.440> system<00:12:55.839> has<00:12:57.200> skill<00:12:57.519> one<00:12:57.839> find
a system has skill one find
a system has skill one find
whether<00:12:59.040> where<00:12:59.279> your<00:12:59.519> failures<00:13:00.000> are<00:13:00.240> skill
whether where your failures are skill
whether where your failures are skill
two<00:13:00.880> is<00:13:01.040> devise
two is devise
two is devise
solutions<00:13:04.240> i<00:13:04.399> get<00:13:04.639> interested<00:13:05.040> in<00:13:05.120> this<00:13:05.360> when
solutions i get interested in this when
solutions i get interested in this when
the<00:13:05.680> world
the world
the world
health<00:13:06.320> organization<00:13:07.120> came<00:13:07.279> to<00:13:07.440> my<00:13:07.600> team
health organization came to my team
health organization came to my team
asking<00:13:08.320> if<00:13:08.399> we<00:13:08.480> could<00:13:08.639> help<00:13:08.800> with<00:13:08.959> a<00:13:09.040> project
asking if we could help with a project
asking if we could help with a project
to<00:13:09.519> reduce
to reduce
to reduce
deaths<00:13:10.720> in<00:13:10.880> surgery<00:13:11.600> the<00:13:11.760> volume<00:13:12.160> of<00:13:12.320> surgery
deaths in surgery the volume of surgery
deaths in surgery the volume of surgery
had<00:13:13.440> spread<00:13:13.920> around<00:13:14.320> the<00:13:14.480> world
had spread around the world
had spread around the world
but<00:13:15.839> the<00:13:16.079> safety<00:13:17.040> of<00:13:17.200> surgery<00:13:18.160> had<00:13:18.839> not
but the safety of surgery had not
but the safety of surgery had not
now<00:13:20.399> our<00:13:20.560> usual<00:13:20.959> tactics<00:13:21.440> for<00:13:21.600> tackling
now our usual tactics for tackling
now our usual tactics for tackling
problems<00:13:22.399> like<00:13:22.560> these<00:13:22.880> are
problems like these are
problems like these are
to<00:13:24.720> do<00:13:24.959> more<00:13:25.120> training<00:13:25.600> give<00:13:25.839> people<00:13:26.079> more
to do more training give people more
to do more training give people more
specialization
specialization
specialization
or<00:13:28.160> bring<00:13:28.399> in<00:13:28.560> more<00:13:28.800> technology<00:13:30.399> well<00:13:30.639> in
or bring in more technology well in
or bring in more technology well in
surgery<00:13:31.279> you<00:13:31.360> couldn't<00:13:31.680> have<00:13:31.920> people<00:13:32.160> who<00:13:32.399> are
surgery you couldn't have people who are
surgery you couldn't have people who are
more<00:13:32.720> specialized<00:13:33.519> and<00:13:33.600> you<00:13:33.760> couldn't<00:13:34.160> have
more specialized and you couldn't have
more specialized and you couldn't have
people<00:13:34.720> who<00:13:34.880> are<00:13:35.040> better<00:13:35.360> trained
people who are better trained
people who are better trained
and<00:13:36.880> yet<00:13:37.279> we<00:13:37.519> see<00:13:38.560> unconscionable<00:13:39.279> levels
and yet we see unconscionable levels
and yet we see unconscionable levels
of<00:13:42.000> death<00:13:42.720> disability
of death disability
of death disability
that<00:13:44.079> could<00:13:44.240> be<00:13:44.399> avoided<00:13:45.680> and<00:13:45.839> so<00:13:46.000> we<00:13:46.079> looked
that could be avoided and so we looked
that could be avoided and so we looked
at<00:13:46.399> what<00:13:46.720> other<00:13:46.959> high-risk<00:13:47.519> industries
at what other high-risk industries
at what other high-risk industries
do<00:13:48.240> we<00:13:48.320> looked<00:13:48.560> at<00:13:48.720> skyscraper<00:13:49.440> construction
do we looked at skyscraper construction
do we looked at skyscraper construction
we<00:13:50.160> looked<00:13:50.399> at<00:13:50.720> the<00:13:50.959> aviation
we looked at the aviation
we looked at the aviation
world<00:13:52.959> and<00:13:53.120> we<00:13:53.279> found<00:13:53.519> that<00:13:53.760> they<00:13:54.720> have
world and we found that they have
world and we found that they have
technology<00:13:56.079> they<00:13:56.240> have<00:13:56.399> training<00:13:56.800> and<00:13:56.880> then
technology they have training and then
technology they have training and then
they<00:13:57.279> have<00:13:58.320> one<00:13:58.560> other<00:13:58.800> thing
they have one other thing
they have one other thing
they<00:14:00.240> have<00:14:00.959> checklists
they have checklists
they have checklists
i<00:14:03.279> did<00:14:03.440> not<00:14:03.680> expect<00:14:04.160> to<00:14:04.320> be<00:14:04.480> spending<00:14:04.880> a
i did not expect to be spending a
i did not expect to be spending a
significant<00:14:05.519> part<00:14:05.760> of<00:14:05.920> my
significant part of my
significant part of my
time<00:14:07.199> as<00:14:07.360> a<00:14:08.160> harvard<00:14:08.560> surgeon<00:14:09.040> worrying<00:14:09.360> about
time as a harvard surgeon worrying about
time as a harvard surgeon worrying about
checklists
checklists
checklists
and<00:14:12.079> yet<00:14:12.480> what<00:14:12.800> we<00:14:12.959> found<00:14:13.360> were<00:14:14.000> that
and yet what we found were that
and yet what we found were that
these<00:14:15.600> were<00:14:16.160> tools<00:14:17.680> to<00:14:17.839> help<00:14:18.160> make
these were tools to help make
these were tools to help make
experts<00:14:18.959> better<00:14:19.600> we<00:14:20.079> got<00:14:20.560> the<00:14:21.040> lead
experts better we got the lead
experts better we got the lead
safety<00:14:22.240> engineer<00:14:22.720> for<00:14:22.880> boeing<00:14:23.279> to<00:14:23.440> help<00:14:23.760> us
safety engineer for boeing to help us
safety engineer for boeing to help us
could<00:14:24.480> we<00:14:24.639> design<00:14:25.040> a<00:14:25.199> checklist
could we design a checklist
could we design a checklist
for<00:14:26.240> surgery<00:14:26.720> not<00:14:26.959> for<00:14:27.120> the<00:14:27.199> lowest<00:14:27.519> people<00:14:27.760> on
for surgery not for the lowest people on
for surgery not for the lowest people on
the<00:14:28.000> total<00:14:28.240> bull<00:14:28.480> but<00:14:28.639> for
the total bull but for
the total bull but for
the<00:14:29.360> folks<00:14:30.079> who<00:14:30.320> were<00:14:31.120> all<00:14:31.360> the<00:14:31.519> way<00:14:31.760> around
the folks who were all the way around
the folks who were all the way around
the<00:14:32.320> chain<00:14:32.639> the<00:14:32.800> entire<00:14:33.279> team
the chain the entire team
the chain the entire team
including<00:14:34.399> the<00:14:34.560> surgeons<00:14:35.519> and<00:14:35.600> what<00:14:35.760> they
including the surgeons and what they
including the surgeons and what they
taught<00:14:36.160> us<00:14:36.320> was<00:14:36.560> that
taught us was that
taught us was that
designing<00:14:37.680> a<00:14:37.839> checklist<00:14:38.240> to<00:14:38.399> help<00:14:38.560> people
designing a checklist to help people
designing a checklist to help people
handle<00:14:39.360> complexity<00:14:40.000> actually
handle complexity actually
handle complexity actually
involves<00:14:41.680> more<00:14:42.320> difficulty<00:14:42.880> than<00:14:43.040> i'd
involves more difficulty than i'd
involves more difficulty than i'd
understood<00:14:44.000> you<00:14:44.160> have<00:14:44.240> to<00:14:44.399> think<00:14:44.560> about
understood you have to think about
understood you have to think about
things<00:14:45.199> like
things like
things like
pause<00:14:46.399> points<00:14:47.680> you<00:14:47.839> need<00:14:48.000> to<00:14:48.160> identify<00:14:48.639> the
pause points you need to identify the
pause points you need to identify the
moments<00:14:49.279> in<00:14:49.440> a<00:14:49.519> process
moments in a process
moments in a process
when<00:14:51.040> you<00:14:51.199> can<00:14:51.440> actually<00:14:51.839> catch<00:14:52.079> a<00:14:52.240> problem
when you can actually catch a problem
when you can actually catch a problem
before<00:14:52.880> it's<00:14:53.040> a<00:14:53.120> danger
before it's a danger
before it's a danger
and<00:14:53.680> do<00:14:53.920> something<00:14:54.240> about<00:14:54.560> it<00:14:55.279> you<00:14:55.360> have<00:14:55.519> to
and do something about it you have to
and do something about it you have to
identify<00:14:56.560> that<00:14:56.720> this<00:14:56.959> is<00:14:57.120> a<00:14:57.279> before
identify that this is a before
identify that this is a before
takeoff<00:14:58.800> checklist<00:14:59.839> and<00:15:00.000> then<00:15:00.480> you<00:15:00.639> need<00:15:00.880> to
takeoff checklist and then you need to
takeoff checklist and then you need to
focus<00:15:01.680> on<00:15:01.839> the<00:15:02.000> killer<00:15:02.399> items<00:15:03.120> an<00:15:03.360> aviation
focus on the killer items an aviation
focus on the killer items an aviation
checklist<00:15:04.560> like<00:15:04.720> this
checklist like this
checklist like this
one<00:15:05.279> for<00:15:05.440> a<00:15:05.519> single<00:15:05.839> engine<00:15:06.160> plane<00:15:06.639> isn't<00:15:06.880> a
one for a single engine plane isn't a
one for a single engine plane isn't a
recipe<00:15:07.440> for<00:15:07.600> how<00:15:07.760> to<00:15:07.920> fly<00:15:08.160> a<00:15:08.320> plane
recipe for how to fly a plane
recipe for how to fly a plane
it's<00:15:09.440> a<00:15:09.519> reminder<00:15:10.000> of<00:15:10.079> the<00:15:10.240> key<00:15:10.480> things<00:15:10.880> that
it's a reminder of the key things that
it's a reminder of the key things that
get<00:15:11.519> forgotten
get forgotten
get forgotten
or<00:15:13.519> missed<00:15:14.399> if<00:15:14.560> they're<00:15:14.720> not<00:15:15.120> checked
or missed if they're not checked
or missed if they're not checked
so<00:15:16.639> we<00:15:16.800> did<00:15:17.040> this<00:15:17.680> we<00:15:17.920> created<00:15:18.399> a<00:15:18.560> 19<00:15:18.959> item<00:15:19.360> two
so we did this we created a 19 item two
so we did this we created a 19 item two
minute
minute
minute
checklist<00:15:21.440> for<00:15:22.000> surgical<00:15:22.480> teams<00:15:23.199> we<00:15:23.360> had<00:15:23.519> the
checklist for surgical teams we had the
checklist for surgical teams we had the
pause<00:15:24.079> points
pause points
pause points
immediately<00:15:25.519> before<00:15:26.480> anesthesia<00:15:27.120> is<00:15:27.279> given
immediately before anesthesia is given
immediately before anesthesia is given
immediately<00:15:28.160> before
immediately before
immediately before
the<00:15:29.040> knife<00:15:29.440> hits<00:15:29.759> the<00:15:29.920> skin<00:15:30.639> immediately
the knife hits the skin immediately
the knife hits the skin immediately
before<00:15:31.759> the<00:15:31.920> patient<00:15:32.399> leaves<00:15:32.720> the<00:15:32.880> room
before the patient leaves the room
before the patient leaves the room
and<00:15:34.160> we<00:15:34.320> had<00:15:34.560> a<00:15:34.639> mix<00:15:34.880> of<00:15:35.360> dumb<00:15:35.680> stuff<00:15:36.000> on<00:15:36.079> there
and we had a mix of dumb stuff on there
and we had a mix of dumb stuff on there
making<00:15:36.639> sure<00:15:36.800> an<00:15:36.959> antibiotic
making sure an antibiotic
making sure an antibiotic
is<00:15:38.160> given<00:15:38.480> in<00:15:38.560> the<00:15:38.720> right<00:15:38.959> time<00:15:39.199> frame<00:15:39.440> because
is given in the right time frame because
is given in the right time frame because
that<00:15:39.920> cuts<00:15:40.240> the<00:15:40.399> infection<00:15:40.800> rate<00:15:41.120> by<00:15:41.279> half
that cuts the infection rate by half
that cuts the infection rate by half
and<00:15:42.000> then<00:15:42.240> interesting<00:15:42.639> stuff<00:15:42.959> because<00:15:43.199> you
and then interesting stuff because you
and then interesting stuff because you
can't<00:15:43.680> make<00:15:43.839> a<00:15:44.000> recipe<00:15:44.480> for<00:15:44.800> something<00:15:45.120> as
can't make a recipe for something as
can't make a recipe for something as
complicated<00:15:45.839> as<00:15:45.920> surgery
complicated as surgery
complicated as surgery
instead<00:15:47.360> you<00:15:47.519> can<00:15:47.600> make<00:15:47.839> a<00:15:47.920> recipe<00:15:48.399> for<00:15:48.560> how<00:15:48.800> to
instead you can make a recipe for how to
instead you can make a recipe for how to
have<00:15:49.040> a<00:15:49.199> team<00:15:49.440> that's<00:15:49.680> prepared<00:15:50.079> for<00:15:50.240> the
have a team that's prepared for the
have a team that's prepared for the
unexpected
unexpected
unexpected
and<00:15:51.600> we<00:15:51.759> had<00:15:52.160> items<00:15:52.639> like<00:15:53.360> making<00:15:53.680> sure
and we had items like making sure
and we had items like making sure
everyone<00:15:54.160> in<00:15:54.240> the<00:15:54.320> room<00:15:54.639> had<00:15:54.800> introduced
everyone in the room had introduced
everyone in the room had introduced
themselves<00:15:55.759> by<00:15:56.000> name<00:15:56.320> at<00:15:56.399> the<00:15:56.560> start<00:15:56.800> of<00:15:56.959> the
themselves by name at the start of the
themselves by name at the start of the
day
day
day
because<00:15:58.160> you<00:15:58.320> have<00:15:58.480> half<00:15:58.720> a<00:15:58.800> dozen<00:15:59.120> people<00:15:59.360> or
because you have half a dozen people or
because you have half a dozen people or
more<00:16:00.160> who<00:16:00.320> are<00:16:00.480> sometimes<00:16:00.880> coming<00:16:01.199> together
more who are sometimes coming together
more who are sometimes coming together
as<00:16:01.680> a<00:16:01.839> team
as a team
as a team
for<00:16:02.639> the<00:16:02.720> very<00:16:02.959> first<00:16:03.279> time<00:16:03.519> that<00:16:03.759> day<00:16:04.560> that
for the very first time that day that
for the very first time that day that
you're<00:16:04.959> coming<00:16:05.279> in
you're coming in
you're coming in
we<00:16:06.320> implemented<00:16:06.800> this<00:16:07.040> checklist<00:16:08.000> in<00:16:08.160> eight
we implemented this checklist in eight
we implemented this checklist in eight
hospitals<00:16:09.120> around<00:16:09.440> the<00:16:09.600> world
hospitals around the world
hospitals around the world
deliberately<00:16:11.600> in<00:16:11.680> places<00:16:12.079> from<00:16:12.399> rural
deliberately in places from rural
deliberately in places from rural
tanzania<00:16:13.759> to<00:16:13.920> the<00:16:14.000> university<00:16:14.399> of<00:16:14.480> washington
tanzania to the university of washington
tanzania to the university of washington
in<00:16:15.279> seattle<00:16:16.399> we<00:16:16.560> found<00:16:16.880> that<00:16:17.519> after<00:16:17.839> they
in seattle we found that after they
in seattle we found that after they
adopted<00:16:18.480> it
adopted it
adopted it
the<00:16:19.040> the<00:16:19.279> complication<00:16:19.920> rates<00:16:20.320> fell<00:16:21.120> 35
the the complication rates fell 35
the the complication rates fell 35
percent
percent
percent
it<00:16:23.519> fell<00:16:23.839> in<00:16:24.079> every<00:16:24.399> hospital<00:16:25.120> it<00:16:25.279> went<00:16:25.519> into
it fell in every hospital it went into
it fell in every hospital it went into
the<00:16:26.560> death<00:16:26.800> rates<00:16:27.199> fell<00:16:28.000> 47<00:16:28.880> percent
this<00:16:31.759> was<00:16:32.000> bigger<00:16:32.320> than<00:16:32.560> a<00:16:34.839> drug
and<00:16:39.600> that<00:16:39.839> brings<00:16:40.160> us<00:16:40.480> to<00:16:40.880> skill<00:16:41.360> number<00:16:41.839> three
and that brings us to skill number three
and that brings us to skill number three
the<00:16:43.839> ability<00:16:44.399> to<00:16:44.720> implement<00:16:45.199> this<00:16:45.920> to<00:16:46.079> get
the ability to implement this to get
the ability to implement this to get
colleagues<00:16:46.959> across<00:16:47.440> the<00:16:47.600> entire<00:16:48.079> chain
colleagues across the entire chain
colleagues across the entire chain
to<00:16:48.959> actually<00:16:49.440> do<00:16:49.600> these<00:16:49.920> things
to actually do these things
to actually do these things
and<00:16:52.399> it's<00:16:52.560> been<00:16:52.800> slow<00:16:53.120> to<00:16:53.279> spread<00:16:53.759> this<00:16:53.920> is<00:16:54.160> not
and it's been slow to spread this is not
and it's been slow to spread this is not
yet
yet
yet
our<00:16:55.759> norm<00:16:56.079> in<00:16:56.320> surgery<00:16:57.600> let<00:16:57.759> alone<00:16:58.160> making
our norm in surgery let alone making
our norm in surgery let alone making
checklists<00:16:58.959> to<00:16:59.120> go<00:16:59.360> on<00:16:59.600> to
checklists to go on to
checklists to go on to
childbirth<00:17:00.800> and<00:17:01.199> other<00:17:01.519> areas<00:17:02.639> there's<00:17:02.959> a
childbirth and other areas there's a
childbirth and other areas there's a
deep<00:17:03.279> resistance
deep resistance
deep resistance
because<00:17:04.799> using<00:17:05.199> these<00:17:05.520> tools<00:17:06.480> forces
because using these tools forces
because using these tools forces
us<00:17:08.000> to<00:17:08.160> confront<00:17:08.799> that<00:17:08.959> we're<00:17:09.199> not<00:17:09.439> a<00:17:09.520> system
us to confront that we're not a system
us to confront that we're not a system
forces
forces
forces
us<00:17:11.600> to<00:17:11.839> behave<00:17:12.559> with<00:17:12.799> a<00:17:12.959> different<00:17:13.360> set<00:17:13.520> of
us to behave with a different set of
us to behave with a different set of
values<00:17:14.160> just
values just
values just
using<00:17:14.799> a<00:17:14.959> checklist<00:17:15.679> requires<00:17:16.240> you<00:17:16.400> to
using a checklist requires you to
using a checklist requires you to
embrace<00:17:16.959> different<00:17:17.280> values<00:17:17.679> from<00:17:17.919> ones<00:17:18.160> we've
embrace different values from ones we've
embrace different values from ones we've
had<00:17:18.720> like
had like
had like
humility
discipline<00:17:25.679> teamwork
discipline teamwork
discipline teamwork
this<00:17:27.919> is<00:17:28.079> the<00:17:28.319> opposite<00:17:28.799> of<00:17:28.880> what<00:17:29.039> we<00:17:29.200> were
this is the opposite of what we were
this is the opposite of what we were
built<00:17:29.679> on<00:17:30.559> independence
built on independence
built on independence
self-sufficiency<00:17:33.280> autonomy
i<00:17:36.559> met<00:17:37.200> an<00:17:37.440> actual<00:17:37.840> cowboy<00:17:38.320> by<00:17:38.480> the<00:17:38.559> way
i met an actual cowboy by the way
i met an actual cowboy by the way
i<00:17:39.679> asked<00:17:40.000> him<00:17:40.400> what<00:17:40.640> was<00:17:40.880> it<00:17:41.039> like<00:17:41.280> to<00:17:41.440> actually
i asked him what was it like to actually
i asked him what was it like to actually
you<00:17:42.480> know
you know
you know
herd<00:17:43.440> a<00:17:43.600> thousand<00:17:44.000> cattle<00:17:44.400> across<00:17:44.799> hundreds
herd a thousand cattle across hundreds
herd a thousand cattle across hundreds
of<00:17:45.440> miles<00:17:45.760> how<00:17:45.919> did<00:17:46.080> you<00:17:46.240> do<00:17:46.400> that
of miles how did you do that
of miles how did you do that
and<00:17:47.200> he<00:17:47.360> said<00:17:48.160> we<00:17:48.320> have<00:17:48.559> the<00:17:48.720> cowboys
and he said we have the cowboys
and he said we have the cowboys
stationed<00:17:49.679> at
stationed at
stationed at
distinct<00:17:50.640> places<00:17:51.039> all<00:17:51.200> around<00:17:51.440> they
distinct places all around they
distinct places all around they
communicate<00:17:52.160> electronically<00:17:53.120> constantly
communicate electronically constantly
communicate electronically constantly
and<00:17:53.760> they<00:17:53.919> have<00:17:54.160> protocols<00:17:54.720> and<00:17:54.880> checklists
and they have protocols and checklists
and they have protocols and checklists
for
for
for
how<00:17:56.160> they<00:17:56.320> handle<00:17:56.720> everything<00:17:58.840> from
how they handle everything from
how they handle everything from
bad<00:18:00.480> weather<00:18:01.039> to<00:18:01.600> emergencies<00:18:02.400> or
bad weather to emergencies or
bad weather to emergencies or
inoculations<00:18:03.440> for<00:18:03.600> the<00:18:03.760> cattle
inoculations for the cattle
inoculations for the cattle
even<00:18:05.600> the<00:18:06.160> cowboys<00:18:06.720> are<00:18:06.880> pit<00:18:07.120> crews<00:18:07.440> now
even the cowboys are pit crews now
even the cowboys are pit crews now
and<00:18:08.960> it<00:18:09.039> seemed<00:18:09.280> like<00:18:09.520> time<00:18:10.160> that<00:18:10.400> we<00:18:10.880> become
and it seemed like time that we become
and it seemed like time that we become
that<00:18:11.520> way<00:18:11.760> ourselves
that way ourselves
that way ourselves
making<00:18:13.200> systems<00:18:14.160> work<00:18:14.799> is<00:18:14.960> the<00:18:15.120> great<00:18:15.360> task
making systems work is the great task
making systems work is the great task
of<00:18:16.320> my<00:18:16.559> generation<00:18:17.600> of<00:18:18.240> physicians<00:18:18.880> and
of my generation of physicians and
of my generation of physicians and
scientists
scientists
scientists
but<00:18:20.320> i<00:18:20.400> would<00:18:20.559> go<00:18:20.720> further<00:18:21.039> and<00:18:21.120> say<00:18:21.360> that
but i would go further and say that
but i would go further and say that
making<00:18:21.919> systems<00:18:22.480> work<00:18:23.120> whether<00:18:23.440> in<00:18:23.600> health
making systems work whether in health
making systems work whether in health
care
care
care
education<00:18:26.240> climate<00:18:26.720> change
education climate change
education climate change
making<00:18:28.000> a<00:18:28.080> pathway<00:18:28.720> out<00:18:28.799> of<00:18:28.960> poverty<00:18:29.919> is<00:18:30.160> the
making a pathway out of poverty is the
making a pathway out of poverty is the
great<00:18:30.559> task<00:18:30.880> of<00:18:31.039> our<00:18:31.200> generation<00:18:31.840> as<00:18:32.000> a<00:18:32.080> whole
great task of our generation as a whole
great task of our generation as a whole
in<00:18:33.919> every<00:18:34.240> field<00:18:34.880> knowledge<00:18:35.360> has<00:18:35.600> exploded
in every field knowledge has exploded
in every field knowledge has exploded
but<00:18:36.960> it<00:18:37.120> has<00:18:37.360> brought<00:18:37.840> complexity<00:18:38.799> it<00:18:39.039> has
but it has brought complexity it has
but it has brought complexity it has
brought<00:18:39.760> specialization
brought specialization
brought specialization
and<00:18:41.760> we've<00:18:42.000> come<00:18:42.160> to<00:18:42.320> a<00:18:42.400> place<00:18:42.640> where<00:18:42.799> we<00:18:42.960> have
and we've come to a place where we have
and we've come to a place where we have
no<00:18:43.360> choice<00:18:43.760> but<00:18:43.919> to<00:18:44.080> recognize
no choice but to recognize
no choice but to recognize
as<00:18:46.440> individualistic<00:18:47.840> as<00:18:48.000> we<00:18:48.160> want<00:18:48.400> to<00:18:48.640> be
as individualistic as we want to be
as individualistic as we want to be
complexity<00:18:50.799> requires<00:18:51.600> group<00:18:52.240> success
complexity requires group success
complexity requires group success
we<00:18:54.160> all<00:18:54.960> need<00:18:55.120> to<00:18:55.200> be<00:18:55.919> pit<00:18:56.160> crews<00:18:56.799> now
we all need to be pit crews now
we all need to be pit crews now
thank<00:19:08.840> you
you
Atul Gawande, medical, system, medicine, doctor, doctors, treat, people, TED, TED, Talk, TED-Ed, Ed, TEDEducation
