Of all the medical students Dr. Michael J. Zinner interviewed for his surgical residency program, none impressed him more than a tall fellow with a toothy smile who came to Brigham and Women’s Hospital in 1994.
“Here I am interviewing a young man to do a blood-and-guts surgical residency,” Zinner recalled in a phone call last week, and instead of puzzling over whether he wanted to operate on abdomens or hearts, the prospective surgeon launched into a deeply informed conversation about health care policy.
Atul Gawande, though not yet 30, knew what he was talking about. In addition to attending Harvard Medical School, he’d studied philosophy as a Rhodes Scholar at Oxford University and spent two years working on health policy for the Bill Clinton/Al Gore presidential campaign and for the Clinton administration.
“I thought he could have an impact on the field of medicine more than many of the people we had on faculty,” said Zinner, who was surgeon-in-chief at the Brigham and is now CEO executive medical director of the Miami Cancer Institute at Baptist Health South Florida.
A quarter-century later, Zinner realized the extent of his prescience when Gawande called Wednesday to tell him about his new job as the CEO of a health care company that three business leaders — investor Warren Buffett, Amazon’s Jeff Bezos, and JPMorgan Chase CEO Jamie Dimon — have formed in the hope of transforming health care.
Zinner said he felt an almost fatherly pride.
The New York Times called Gawande a “marquee name,” yet his fame doesn’t derive from the flashy feats typically associated with celebrity doctors. He has discovered no life-saving medicines, invented no bionic organs, separated no conjoined twins.
Instead Gawande, a best-selling author and surgeon, frets over processes and systems that others might find tedious, but that can make the difference between life and death. His signature innovation is a drab slip of paper called the surgical checklist, 19 steps intended to prevent mistakes by having the operating-room staff pause and check at critical junctures.
That’s why the public health and health policy world erupted in jubilation at Gawande’s appointment, with many calling it “inspired” and “brilliant” on Twitter. The choice of someone with a wonky understanding of the health care system put to rest fears that the Amazon/Berkshire/JPM venture, in naive eagerness to “disrupt” health care, would steamroll costs in ineffective or harmful ways.
No one knows what the new venture will do. But Gawande’s appointment hints at its likely direction.
Gawande’s four best-selling books focus on how fallible clinicians can get things right amid complexity and uncertainty. His most popular book, the 2014 “Being Mortal,” addresses the need to learn and honor each patient’s personal goals when faced with a deadly illness.
One of his recent articles, titled “The heroism of incremental care,” argues that more lives are transformed by small, caring measures over time than by thunderclap interventions like surgery. The article celebrates the step-by-step caretaking of a headache specialist who spent five years finding a way to relieve a patient’s disabling pain, and the year-after-year attentiveness of a cardiologist who ensured that Gawande’s own son made it to college, despite a heart defect that might otherwise have impaired him.
Gawande, who is married and a father of three, was born 52 years ago in Brooklyn, N.Y., the son of physicians who emigrated from India. He grew up in the small college town of Athens, Ohio. Since his appointment to the new venture, he has declined requests for interviews.
In a 2013 interview with Medscape, Gawande said he always knew he’d be a doctor, like his parents, but never expected to end up doing surgery. “Then I got into an operating room, and I fell in love with it,” he said.
Zinner said that during his residency, Gawande “turned out to be a terrific clinical surgeon.”
And while still a resident working 100 hours a week, he found his second calling, the one that made him a household name: writing.
His work blogging for Slate magazine caught the attention of an editor at The New Yorker. When Gawande was offered a staff position at The New Yorker in 1998, the Brigham’s communications department insisted on approving every article, a policy unacceptable to the magazine. Zinner stepped in, offering to take responsibility for vetting Gawande’s work. “I went back to Atul and said, ‘Write whatever you want. Just let me know,’ ” he said.
Gawande’s reporting on missteps in care — many that he had committed himself — raised eyebrows at the Brigham. But the measured way he described the errors, and his thoughts on preventing them, eventually earned his work credibility at the hospital, Zinner said.
Gawande’s longtime editor at The New Yorker, editorial director Henry Finder, recalled that it took about nine drafts to get Gawande’s first article fit for publication. But Gawande was self-critical and receptive to editing, and each draft came back stronger.
“His very first piece, I could see he was going to be what we call a self-cleaning oven — someone who can see what’s working and not working and attend to it,” Finder said. “He has a natural instinct for storytelling, and he’s just curious and self-challenging.”
His writing focused on the failures in health care that he witnessed as a surgeon — preventable errors, unnecessary procedures, and high costs — and on possible solutions, often drawing ideas from other industries such as aviation and even from a restaurant chain.
Andrew Dreyfus, the president and CEO of Blue Cross Blue Shield of Massachusetts, said Gawande has a rare ability to tie policy to clinical evidence.
“There’s a kind of radical simplicity to some of his work, and that is part of the antidote that health care needs, because health care is searingly complex,” he said.
In 2012, Gawande approached Dr. Elizabeth G. Nabel, the Brigham’s president, and Dr. Julio Frenk, then dean of the Harvard School of Public Health, with a proposal to create a research center that would hone and test his ideas on improving health care.
“Atul is visionary,” Nabel said. “He looks at the big picture and thrives on big challenges.”
The result was Ariadne Labs, named for the Greek goddess who showed Theseus the way out of a maze with a thread. The idea was to find simple solutions at critical moments — being born, needing surgery, facing death.
Five years ago, Gawande approached the South Carolina Hospital Association with a plan to improve surgical safety across the state, using the checklist developed at Ariadne Labs along with the World Health Organization. Fourteen hospitals agreed to participate.
“Atul rolled up his sleeves and helped us do that,” said Thornton Kirby, association president. Gawande was able to persuade surgeons — typically prickly about anyone telling them what to do — to change their operating room procedures. “He’s talking to clinical leaders as a peer,” Kirby said. “He listens. He doesn’t just tell, he listens. He has a temperament that acknowledges that he doesn’t have all the answers.”
But another checklist experiment — an attempt to improve childbirth outcomes in India — proved a disappointment, failing to reduce stillbirths and deaths of mothers and babies in the days after birth.
Frenk, the former public health dean who is now president of the University of Miami, said Gawande’s selection to head the new health care company shows “they intend to really make this a very innovative venture.”
Asked what Gawande’s detractors say about him, Frenk said he hasn’t met any.
“Atul is a person that communicates goodness of heart,” he said. “It’s very difficult to dislike him. I’m sure it’s easy to envy him, but it’s very hard to dislike him.”