Dr. Atul Gawande calls for students to act with courage in the face of fear

Dr. Atul Gawande, despite his success, stressed the need to learn from failure and to have courage.  Ryan Doan/Staff Photographer

Dr. Atul Gawande, despite his success, stressed the need to learn from failure and to have courage. Ryan Doan/Staff Photographer

On Feb. 8, the Great Issues Committee presented Dr. Atul Gawande to the SLU community to a packed house. The Wool Ballroom at the Busch Student Center was packed with students, faculty, staff and visitors to hear Gawande speak. People were crammed up against the walls and standing anywhere they could find room to hear one of the “world’s greatest thinkers” impart his wisdom.

Dr. Atul Gawande, despite his success, stressed the need to learn from failure and to have courage. Ryan Doan/Staff Photographer

Gawande is one of the most influential speakers on healthcare reform in America, and leads the World Health Organization’s global campaign to reduce avoidable deaths and complications in surgery and the reduction of child deaths during delivery. His presentation did not focus on his accomplishments, however.

Gawande spoke on the subject of  failure, the nature of human fallibility in medicine and in life, and how to learn from failure.

His message revolved around the case of a 17-year-old cystic fibrosis patient, Janelle, and her attending doctor, Dr. Warwick. Cystic fibrosis is a deadly disease that damages both lung functions and the ability of the digestive tract to absorb nutrients. Doctors treating cystic fibrosis patients focus on two factors: lung function and weight to height ratio.

Janelle, until this particular visit, had excellent lung function numbers for a cystic fibrosis patient.

Since her last visit, Janelle’s numbers had slipped down from normal to 90% and Dr. Warwick wanted to know why. As with all teenagers, Warwick encountered resistance to his questioning of this precocious teenager. After repeated failure to elicit a response from Janelle, Dr. Warwick discovered that Janelle had not been taking her treatments for the past three months due to some changes in her life that made taking her treatments inconvenient.

Dr. Warwick convinced Janelle to agree to begin taking her medicines again, and he wanted Janelle to spend a few days in the hospital to recover .

“Today?” Janelle asked. “Why not tomorrow?”

Dr. Warwick replied, “Yes, today. Janelle, we have failed and it is important that we acknowledge our failure so that we can do something about it.”

It was at this moment that Gawande began hammering home his message concerning failure.

“We must have the willingness to fail, and the courage to act. We know there are terrible risks, but we must have the courage to act in spite of fear…and the willingness to live with the consequences,” Gawande said.

Gawande discussed how our current healthcare system is fraught with failure and lacks leadership. Instead of focusing on quantity and filling hospital beds, the American healthcare system needs to focus on quality. Gawande said quantity is expensive and by focusing on more tests and procedures, we are placing strain on the system, bankrupting ourselves in the process. Gawande emphasized that preventative care and quality of care needs to be maximized. He related two shocking facts to emphasize his point: of all coronary or heart attack patients, 40% receive inadequate care. In addition, 60% of all pneumonia and stroke patients receive inadequate care.

Gawande said the problem with our system is not inadequate medical education, but the culture of the healthcare system needs to change. He stated the importance of medical schools teaching leadership and team building when educating our future health professionals. Gawande said that so much complexity has been created and that many doctors specialize and rely solely upon themselves, when they could instead allow themselves to rely on others so that they are able to, in their terms, “have it all.”

John Hefner, a junior pre-med student, feels that many doctors are focused on specialization and independence and that the business side of medicine has influenced healthcare.

“We’ve allowed complexity to scare us,” Hefner said. “We’ve stopped working together.”

Gawande’s remarks were not limited to the medical field. His message of courage in the face of failure and complexity applies to all professions. According to junior Natalie Tjaden, Gawande’s words are influential across all fields of study.

“[Gawande’s message] transcends the medical field and can be used in any job, especially the willingness to fail and acting instead of being afraid,” Tjaden said.

Gawande’s speech echoes a quote from Winston Churchill. “Success is not final, failure is not fatal: it is the courage to continue that counts.”