Our April Read: The Heroism of Incremental Care
Jeff Spross joins me to discuss Atul Gawande's reporting
As the weather warms and vaccinations roll out, we’ll be reading Atul Gawande’s “The Heroism of Incremental Care.” I love his essays on medicine (and I strongly recommend his book on end of life care, Being Mortal).
The reason I’ve picked this essay is because it’s helped shape my thinking on what a real safety net looks like, in medicine and elsewhere. During the covid pandemic, we’ve neglected “boring” interventions like mass-producing and distributing better masks and tests.
In his essay, Gawande discusses how his limited sense of what it meant to be a doctor shaped his speciality:
I knew there was a place for prevention and maintenance and incremental progress against difficult problems. But this seemed like the real work of saving lives. Surgery was a definitive intervention at a critical moment in a person’s life, with a clear, calculable, frequently transformative outcome.
Fields like primary-care medicine seemed, by comparison, squishy and uncertain. How often could you really achieve victories by inveigling patients to take their medicines when less than half really do; to lose weight when only a small fraction can keep it off; to quit smoking; to deal with their alcohol problem; to show up for their annual physical, which doesn’t seem to make that much difference anyway? I wanted to know I was doing work that would matter. I decided to go into surgery.
Joining me for this month’s discussion is Jeff Spross.
Jeff was the economics and business correspondent for The Week, an economics and climate reporter for ThinkProgress, and has written for The American Prospect and the policy journal Democracy. Back when I lived in D.C., I got to go to great in-person magazine article discussions with Jeff and others.
I’m looking forward to hearing his thoughts on the article and how we can build up institutions that take slow, boring work seriously. I’d love to incorporate your questions—please add your comments below.
Ex libris,
Leah
For Jeff (Leah too if she wants), we live in a busy world. What is the best way we can start doing, maybe for a few hours a week, slow/boring work in our communities?
> "Success, therefore, is not about the episodic, momentary victories, though they do play a role. It is about the longer view of incremental steps that produce sustained progress. That, such clinicians argue, is what making a difference really looks like. In fact, it is what making a difference looks like in a range of endeavors." (quote from article)
I think that, from childhood, I was implicitly taught to imagine that all time should be "chiros time" ...that "chronos time" was shoved to the side as "unimportant"...
...Never in those words, of course, but once introduced to the concepts.. I realized that the list of heroes and exploits and success stories that I'd accumulated was "all over" the more "chiros" aspect; not the long, slow (sometimes dull) build-up... that leads to having the character needed to endure a trial, or that cements the depth of relationships needed for a family (or org) to wade through a crisis together.