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Comments on Atul Gawande’s 2014 Reith Lectures: The Idea of Well-Being (Part 4)

I have been blogging about the 2014 Reith Lectures currently being given by Atul Gawande. This is the final part, Part 4, and is related to Gawande’s fourth talk entitled Part 3, which responds to the third lecture’The Problem of Hubris’ is here. Part 2, which responds to the second lecture ‘The Century of the System,’ is here. Part 1, which responds to the first lecture ‘Why Doctors Fail,' is here


In his final Reith lecture, recorded at the India International Centre in Delhi, Gawande addressed The Idea of Wellbeing. Gawande starts the lecture with some family history. His parents were both from India and his family’s fortunes have changed significantly in just three generations. This is used to illustrate the changing nature of public health in ‘advancing economies’ like India. Previous issues concerning malnutrition and diarrhea are increasingly giving way to Western illnesses like diabetes and hypertension. The message is that the major challenges to population health are changing from the acute to the chronic and the responses require a shift in perspective from health to wellbeing or, one might say, being well. Solutions, if indeed there are any, are less about infrastructure, like the provision of clean water, and more about social structures, our individual and collective behaviors, the way we eat, exercise and lead our lives.  

Comments on Atul Gawande’s 2014 Reith Lectures: The Problem of Hubris (Part 3)

I have been blogging about the 2014 Reith Lectures currently being given by Atul Gawande. This is Part 3, and is related to Gawande’s third talk entitled ’The Problem of Hubris.’ Part 2, which responds to the second lecture ‘The Century of the System,’ is here. Part 1, which responds to the first lecture ‘Why Doctors Fail,' is here


In this weeks lecture Gawande again spent a lot of time recounting an illustrative case. This time it was about a family friend who had a recurrent cancer that ultimately proved untreatable. The purpose of the story is, first, to show the difficulty doctors have when dealing with patients whose conditions are terminal, second, to consider how healthcare professionals can help these patients to live well whilst dying and, third, to examine the connection between these two phenomena. 

The difficulties medical professionals have when dealing with death and dying seems to provide the inspiration for the lecture's title - The Problem of Hubris. However, it seems a little ungenerous to think that individual doctors are reluctant to talk to patients about death and dying because they have an 'over-weaning confidence' in their ability to treat patients. After all the empirical evidence clearly augers against such presumptions. Rather, much like the rest of us, I think healthcare professionals find talking about death and dying difficulty and emotionally challenging. It is easier for them to retreat into their socially sanctioned roles and provide the patient with medical facts and information. 

Comments on Atul Gawande’s 2014 Reith Lectures: The Future of Medicine (Part 2)

I have been blogging about the 2014 Reith Lectures currently being given by Atul Gawande. This is Part 2, and is related to Gawande’s second talk entitled ‘The Century of the System.’ Part 1, which responds to the first lecture ‘Why Doctors Fail,' is here


Gawande devoted much of this lecture to recounting the case history of a three-year-old child who plunged through the ice into a pond, spent thirty minutes under water and ultimately survived with no apparent negative consequences. The tale is, I think, designed to illustrate the value of a systemic approach to medical practice. The young girl’s life was saved as a result of a lot of different interventions happening at the right time and in the right order over the course of at least 2 days. As one of the commentators following the lecture pointed out, this is a highly unusual occurrence. Certainly people who drown in warmer conditions will die. Thus, in this case, the circumstances of the injury are an important part of medicines ability to save the lives of people like this young girl.

Comments on Atul Gawande’s 2014 Reith Lectures: The Future of Medicine (Part 1).

Atul Gawande is one of those sickeningly accomplished individuals who succeeds at everything they do. His day job is surgery but he is world renowned for his work on healthcare and healthcare systems. I have found his previous writing stimulating but have not yet read his latest work Being Mortal. He is giving this year’s Reith Lectures and I am going to try and write something on each one. 

This is Part 1, and is related to Gawande’s first talk ‘Why Do Doctor’s Fail?


Offering an enlightening mix of the personal and the professional the first of Gawande’s Reith Lectures addresses the question ‘Why do Doctors Fail?’ Whilst much of his career, particularly the Checklist Manifesto, has been concerned with the avoidance of preventable error and ensuring the practice of medicine meets the highest standards possible this lecture engages with a broader set of concerns. 

To this end he makes use of a perspective set out by MacIntrye and Gorowitz in a 1976 article ‘Towards a Theory of Medical Fallibility.’ The articles subtitle - Distinguishing Culpability from Necessary Error - makes clear their view. There are medical errors for which medical professionals are responsible but there are others that are unavoidable: there can be no error-free medical practice.