Atul Gawande: the writer shaking up US medicine

Atul Gawande © Getty images
That rare thing: a surgeon-journalist

Atul Gawande doesn’t have the sort of CV you’d expect for someone running a healthcare joint venture between Amazon, Berkshire Hathaway and JPMorgan. That’s exactly why he was chosen. Jane Lewis reports.

When Amazon, Berkshire Hathaway and JPMorgan Chase announced a healthcare joint venture for their US employees earlier this year to tackle soaring costs, it wiped billions from the market value of health insurers. The trio offered scant detail, says the Financial Times. Yet the mighty combo of an e-commerce giant, Buffett’s investment conglomerate, and America’s largest bank by asset value was seen as a huge threat to one of America’s biggest industries.

Starting a healthcare revolution

The appointment of Dr Atul Gawande to lead the “ABC coalition” was in some ways a relief for healthcare’s vested interests, however. Gawande is that rare thing: a surgeon-journalist. He teaches at Harvard Medical School and writes for The New Yorker. He has gained “national recognition” as a best-selling author chronicling the state of America’s “broken” medical system. But he has never run a major business.

For an industry running scared about a big disruption, that seems like a stay of execution. Gawande’s arrival suggests the new entity “may be focused more on experimenting with technology and data” than on “the more radical step of launching a managed-care provider that would directly compete with the biggest US healthcare players”.

Industry insiders have been quick to highlight Gawande’s lack of experience, says Forbes. They don’t seem to understand that “Jeff Bezos, Warren Buffett and Jamie Dimon did not hire a big-thinking industry outsider to set up a conventional insurance system or haggle with doctors and hospitals over prices”. Gawande was selected to “change how healthcare is structured, paid for and provided”. His job is “to make traditional health plans obsolete, and to create a bold new future for American healthcare”.

It would be hard to find anyone better qualified, says The Independent. Born in New York in 1965 to immigrant Indian doctors, Gawande initially “toyed with a political career”, taking a degree in biology and political science at Stanford, followed by a Rhodes scholarship at Oxford, where he read politics, philosophy and economics. Returning to the US, he went to Harvard to study medicine in 1990, but then ditched the course to become head of health and social policy to Bill Clinton, later following him to the White House as a senior adviser.

From politics to medicine

To the relief of Gawande’s parents, he eventually completed his medical studies and began practising: “I didn’t like the idea of my future being dependent on politics”. Yet it is for his writing that he is most admired. Encouraged by his friend Malcolm Gladwell, Gawande “quickly garnered acclaim and awards for his elegant essays on public health and medicine”, says the FT.

Four subsequent books have expanded his reach. His third, The Checklist Manifesto, became “a manual for medical reform”. Hospitals following his basic advice “found their death rates nearly halved”. It was a 2009 article questioning the extraordinarily high costs of the US medical system that first attracted the attention of Warren Buffett and his business partner Charlie Munger, says Bloomberg. “Munger thought the article so socially useful that he mailed Gawande a $20,000 cheque.”

“A tall, gangly figure”, Gawande is “softly spoken, modest, contained”, says The Independent. He has a ferocious work ethic, getting his writing done in the 45 minutes between surgical cases. There will be little time for that now he is writing a blueprint for mass reform, says Forbes. “The good news for healthcare’s incumbents is that the change process will likely take five to ten years… The bad news is that the clock just started ticking.”