Question

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine—with fewer cowboys and more pit crews. Explore the following. What can you learn from them? Search the web for a similar resource. give a few paragraphs explanation of how it fits into the chapter 10 content Health Institutions (Public Health 101)

Answer 1

Cow boys and pit crews

Atul Gawande, MD, is a brilliant writer, no doubt an excellent surgeon, and many would say a physician-visionary for all that ails America’s health care system. He speaks first-hand of the changes that have occurred in American health care and offered his perspective for fixing our health care system to the fertile minds of Harvard’s graduating class of 2011. In his graduation speech, published front and center in the New Yorkermagazine, he compares a “pit crew” model of health care delivery to an earlier day of individualized health care delivered by those he calls “cowboys.” In his piece, he dismisses the attributes of the independent-thinking physician “cowboy” because he claims, quite correctly, that no one doctor can possibly comprehend every aspect of medicine these days. He implies that people who work in a larger, bureaucratic centralized locales in specialized and coordinated "pit crews" implicitly save costs and improves efficiencies. He posits that by dividing the vast medical knowledge base amongst individuals that refine and practice a multitude of specalized skills on an individual, that health care for the masses will succeed.  

So what could possibly be the problem with such a vision? After all, this vision seems so comfortable and reassuring given our health care system's need to save money while extending coverage to a larger portion of our populace.

To answer this question, perhaps Dr. Gawande should have delved into his “pit crew” metaphor a bit further.

Pit crews, by their definition, are highly trained, highly selected individuals that work on a specially formulated race car that would be the envy of any race car enthusiast. These professionals understand the very real value of working as a team: so their particular race car can complete a certain number of laps around a single racetrack in the shortest amount of time. Pit crew members, then, are highly committed to working faster and faster while streamlining their processes.  They have an intimate working knowledge of their highly specialized race car; they know each lug nut, each brake pad, each tiny screw down to its finest detail. In that sense, there are only a limited number of permutations of possible variables that are available for tweaking pit times. So they hone their efforts and as they gain confidence, their driver gains confidence in them, too.  He sees their speed, he sees their safety checks, so his confidence builds, too. Hour after tireless hour, the car, the training, the track, is the same.

But what happens when there is not one car or one track, but an infinite variety of cars entering the pit from all directions?

Suddenly, the pit crew is thrown into disarray. The benefits and safety aspects of the predicable “pit crew” model quickly dissolves. The pit crew isn’t sure which wheel or lug nut or brake pad to apply to each new-model car since their available supplies are limited to only their model of race car. Speed, however, remains of the essence. Consequently, the whole mentality for car care shifts from a specialized "pit crew" to that of an assembly line approach: grab what you can, slap it on, and hope it works. Throughput, you see, is the real goal. No longer is there an allegiance to the car or the driver. The pit crew becomes disenchanted and before the driver takes the first lap, the Indy 500 “pit crew” morphs into the old failed Chrysler production line crisis of 2009. Pit crew members’ judgment is quickly superseded by a Pit Boss or car owner who has no clue of the frontline challenges. Just get 'em in and get 'em out as cheaply and as quickly as you can. It’s all about winning, remember?

Contrast this to the American cowboy.

Cowboys are free to roam, to place themselves wherever they are needed, even if it’s in the most remote region of the land. They are not bound to a single track or the big city. They certainly don’t need a multi-billion-dollar roof over their head when a tent will do.  They prefer the stars rather than a big-screen TV. In this respect, they are highly cost-efficient. They don't need bureaucrats to tell them how to ride, how to rope, or how to bring the cattle home. They are free to lead their herd from harm’s way, even if it means crossing a fenceline or two. They are the also the ones who slow their herd’s migration to deliver a calf because it’s the right thing to do, not because it's efficient. They are the innovators and skilled improvisers who may not have every expensive widget at their disposal, but have learned the skills to do things far safer, cheaper, and faster nonetheless. Sure, they use new data and technology when it comes their way (or maybe a specialized vet if needed), but the cattle are the priority rather than the marketing team. Perhaps most important, cowboys are humble, realizing that no real cowboy has everknown everything there is to know about ranching, nor has pretended they ever will. The cowboy understands that the learning never ends.

I am convinced that Americans want their doctor to be cowboys and not pit crews. They look for someone who’s a leader, autonomous, brave, empathic, and isn’t afraid to take a risky trail if their life depended on it. They trust their cowboys. They know their cowboy would seek out professional resources unavailable to his local ranch if it was the right thing to do. They'd even let the cowboy care for their kids because they know him or her. Our task is to train and inspire more cowboys so they can be with us when we receive the diagnosis. We don't want assembly line workers in such a moment. This is common sense. Re-direct the money. In their hearts, the medical students of today want to be on their horse, not standing with power tool in hand, waiting for the next roll-out.

The Public Health 101 Series provides an introduction to public health and covers the sciences essential to public health practice. The fundamental scientific components span topics in epidemiology, public health informatics and surveillance, health economics, public health laboratory science, and related fields.

This series is designed for

• Public health professionals who have not had formal training in a particular core area or who would like a refresher
• Persons new to public health
• Public health educators and instructors

Persons interested in pursuing public health careers

Chapter 10 of health institution consists the topics related to this problem

• Provider

wide range of health professionals/ providers

• Healthcare Delivery System

  linkage of institutions/ healthcare facilities (emergency response work)

• Negligence Law

  body of law designed to protect individuals

• System Errors

  problems resulting in defiencies in healthcare system

• Qualified Providers

  credentialing system (outcome measures)

• Coordination of Healthcare

  institutional coordination- relies on financial coordination, linkage of of institutions (Healthcare professionals) emergency work is resulting good

• Malpractice

  duty was owed (provider will treat patients) Duty ws breached (Failure of provider to meet standard of care), Breach caused an injury, damages occurred (direct, indirect, punitive)

This contents are directly relating the cow boys and pit crews