More Heart Than Science: Industrialized health care has suppressed the human interaction that forms the ineffable "art" of medicine--while failing to achieve true efficiency.

• Author: Brownlee, Shannon
• Position: Why We Revolt: A Patient Revolution for Careful and Kind Care - Book review

Why We Revolt: A Patient Revolution for Careful and Kind Care

by Victor Montori

The Patient Revolution, 176 pp.

In 2012, the noted Harvard surgeon and New Yorker staff writer Atul Gawande wrote an article that drove many doctors and nurses crazy. In the article, titled "Big Med," Gawande argued that health care could learn a lot about efficiency from another industrialized service sector: Big Food. Specifically, the Cheesecake Factory, a chain of nearly 200 restaurants with a menu that is more than 400 items long, all made from scratch in each restaurant. Cheesecake Factory kitchens are model Henry Ford-style production lines. Food comes in the back door; gets prepped, cooked, and plated; and winds up in front of eight million diners a year, each dish identical to the one prepared at every other location and none costing the diner much more than $20. Managers use algorithms to predict the amount of food they need each night, and they operate their restaurants with less than 2.5 percent waste. "In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality," Gawande observed. "Unlike the Cheesecake Factory, we haven't figured out how."

Indeed, health care, unlike the Cheesecake Factory, is massively, monstrously, colossally wasteful. Hospitals routinely throw out unconscionable amounts of expensive supplies that have never been taken out of their packaging. Home Depot tracks a box of nails more effectively than many hospitals track supplies, labor, and even patients. A few years ago a friend's intensely suicidal wife went missing from a secure ward at a Washington, D.C., hospital. He found her several hours later at home.

A now-famous article published in the Journal of the American Medical Association about six months before Gawande's story created categories of waste in health care and provided a dollar estimate for each. Those categories included fraud, of course, but also things like unnecessary treatment, excessive overhead, and "pricing failure," which is a euphemism for profiteering by drug companies, pharmacy benefit managers, medical device manufacturers, insurers, and hospitals. Estimates for how much this waste costs the U.S. each year range from 20 percent to nearly half of total spending. That's $600 billion to $1.5 trillion.

So why are comparisons to industrialized food--or to the commercial airline industry, another business model sometimes held up for health care to emulate--so deeply offensive to many frontline doctors and nurses, even those who understand the need to make health care safer and less wasteful? Having read Victor Montori's elegant collection of essays, Why We Revolt, I think I know the answer.

Montori is an endocrinologist, meaning that most of his patients are people with diabetes, a disease that usually cannot be cured but often can be managed to avoid its devastating effects. Born and trained in Peru, Montori came to the Mayo Clinic for his residency and has spent the bulk of his career there. His experiences treating poor patients in Peruvian hospitals, and providing rudimentary care to...