Today, we continue to honor graduation across the United States by highlighting another thought-provoking commencement address.
Atul Gawande, a general and endocrine surgeon and associate professor, spoke at Harvard Medical School’s graduation ceremony this May. Many of his ideas about the challenges facing medical care, and the reforms needed to tackle those challenges, have been studied carefully by some school reformers, who view his thoughts as analogous to the big ideas being debated in K-12 public education recently. An excerpt from his speech is provided below:
Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that make it possible. Partly, it is because the work is rooted in different values than the ones we’ve had. They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.
These values are the opposite of autonomy, independency, self-sufficiency. Many doctors fear the future will end daring, creativity, and the joys of thinking that medicine has had. But nothing says teams cannot be daring or creative or that your work with others will not require hard thinking and wise judgment. Success under conditions of complexity still demands these qualities. Resistance also surfaces because medicine is not structured for group work. Even just asking clinicians to make time to sit together and agree on plans for complex patients feels like an imposition. “I’m not paid for this!” people object, and it’s true right up to the highest levels.