I've just finished the best story on health care that I expect to read this year--unless its author, Atul Gawande, decides to write another one.
In a piece in the current issue of The New Yorker, Gawande begins in an unlikely setting--at dinner on a Saturday night at The Cheesecake Factory with his two teenage daughters and three of their friends. He marvels at the restaurant. It has something for everyone--wasabi-crusted ahi tuna, and Bud Light and buffalo wings. The food is inexpensive, the place is packed, the atmosphere is Disney-like, and the staff is neatly dressed and attentive. "As for the food--can I say this without losing forever my chance of getting a reservation at Per Se?--it was delicious," Gawande writes.
Expensive restaurants serve as test kitchens for the restaurant chains, he writes, and some of the best high-end dishes are re-engineered by the chains for affordable mass delivery. While finishing his miso salmon, he asks himself: "Does health care need something like this?"
Medicine has always been a business of small shopkeepers, but that is changing as hospital chains and medical practices form or are bought by large corporations. Gawande, a surgeon, admits to being nervous about the corporate takeovers, but the tast he sets himself here is to take an honest look at what they might accomplish.
He takes us to the kitchen of a Cheesecake Factory in Boston, where we see chefs following computer monitors that display recipes, manage the prep and cooking, and track the time it takes each station to produce a dish. A kitchen manager monitors everything coming off the line, and if a particular dish doesn't score well--a six out of ten--it is sent back. Computer forecasting programs are used to predict what customers will order based on historical data, and purchases of groceries are fine-tuned to those predictions, to reduce waste to a minimum.
"As a doctor, I found such control alien--possibly from a hostile planet," Gawande writes. But stay with him as he looks for parallels in medicine, including a tele-ICU center that spots mistakes in care in its hospitals' ICUs, and negotiates with sometimes hostile staff to correct them.
Gawande is unmatched in breaking down complex questions into simple, direct analyses. And he makes appropriate use of his personal experience, without letting it overshadow what he's writing about.
Read this story to learn something about making health care more efficient without Draconian limits, and read it to learn how to write a clear and compelling story about an almost hopelessly complicated subject.