Atul Gawande, surgeon and storyteller, on health care’s ‘dramatic transformation’
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I arrived in Boston in the snow-sieged winter as employee No. 1 on a venture, as executive editor, to create STAT. After decades as a journalist in Washington and New York, I knew little of the thriving health, medicine, and life sciences ecosystem in Boston. I knew one name, though: Dr. Atul Gawande.

If anyone could help me figure out how to make STAT important and urgent, it would be the famed surgeon, journalist, and public health researcher at Brigham and Women’s Hospital and Harvard Medical School. We met at Ariadne Labs, where he is executive director. The conversation that follows has been edited and condensed.

What’s the biggest overlooked story today in health and medicine?

There’s a lot of coverage about what goes on inside the Beltway, a lot of coverage around drug pricing, and things like that. But the biggest story that’s going on is what it’s like to actually try to get health care. The American health care system is going from being designed to deliver on pills and procedures to being designed to deliver on outcomes. That is a dramatic transformation, and we don’t know how to do it.

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Why is there this journalistic void when you’ve shown that there’s wild interest in this topic?

Well, I hope STAT can answer that question. I do have a lucky vantage point being a practicing clinician, having worked in politics and policy for a while, and being a public health professor. But other writers have dug in on some of these issues in a pretty spectacular way. Ultimately, what you want to do is park yourself in a clinic or in a hospital long enough to start seeing what really happens, and then trace the threads down.

Are you ever worried about being scooped on these stories?

No. You know, I wrote about McAllen, Texas — the most expensive county for Medicare in the country — and it seemed like an obvious thing to go and talk to people and interview them. Then it was an obvious thing to go back six years later and say, “What happened?” I told people the idea, I told people this is what I’m doing, I wasn’t hiding it, and I never worried I was ever going to get scooped.

You’re no stranger to politics, having worked on health care policy for Bill Clinton. How do you see health-related issues playing out in this year’s presidential campaign?

In general this year, health care is not a major player in the presidential campaign. It’s not nearly as big issue as stagnating wages for the middle class and income inequality, or the dysfunction of government — and that’s not a bad thing. I’m very glad to see other issues like the delivery of health care, improving our management of end-of-life care, and things like that have been kept off the table as major partisan political issues. It made me really angry when CNN injected into the Republican debate, asking: “What do you think about vaccines?” There’s no good direction where those answers could go from a public health point of view.

Has any good come from the emergence of Martin Shkreli and his tactics of raising drug prices?

Yeah, I think that’s an example of digging in deeply enough to actually see how the mechanics of drug pricing really work. There’s the Martin Shkreli version of the story, which is, as far as what I can see, pure profiteering. But then there is the whole business of pricing a drug that is completely lifesaving — and this is not a competitive marketplace. So, how does it work? I’d love to know much more about it.

What’s harder, being a surgeon or being a writer?

By far, the least stressful day of my week is the day I’m in the operating room. There are no phone calls, no email, you’re focused in one direction, and once you start, you have to finish. But when it comes to writing, any number of things can go wrong, and it can be never-ending. With the kind of long-form journalism that I do, I’m also trying to make even the structure and form feel new every time. So, I can’t fall back into a formula — whereas in surgery, you’re always trying to fall back into a formula, it’s exactly what you want to achieve each time.

You write both magazine articles and academic papers. How does the editing process compare?

The editing process in journalism, I think, sometimes offers better protection for the quality of the ideas and writing than our peer review process. At The New Yorker, they will not only look to see if I have references and sources for everything I say, they will look up the references and call the sources. And they will also search themselves to make sure I haven’t cherry-picked the information. It’s a much more rigorous process than the one I go through with my scientific work.

That’s fascinating, but it’s also The New Yorker.

Yes, The New Yorker’s fact-checking process is legendary. They even fact-check the jokes that I write. In a piece I wrote about childbirth, I told a joke that Bill Cosby had said. They fact-checked the joke, and it turned out that Carol Burnett had told it first. And so they called up Carol Burnett, who picked up the phone and was like, “Bill Cosby has been telling that joke wrong for 20 years. This is the way I said the joke.”

Did you put all that in the piece?

No, it’s too complicated. I just put in Carol Burnett’s properly told joke.

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