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Dr. George Bartley

A Day at the Races

Dear Readers,

As a life-long Northerner before leaving Minnesota in 2002, it has been fun to experience life on the other side of the Mason-Dixon Line. Recently, a friend informed me that it was time for the next lesson in my "Southern education:" a visit to Daytona to experience America's most popular spectator sport — NASCAR. While I did expect to be awed by the crowds, the speed, and the noise, I did not expect to observe so much that was relevant to medicine.

The most obvious similarity is the fundamental need for teamwork and precision. Prior to the race, each car undergoes a detailed inspection to ensure that multiple standardization criteria, some to the millimeter, have been met. Since the vehicles, therefore, are not significantly different from each other, the result rests on the skill of the driver and the team. It's much the same in medicine, where treatments are becoming increasingly defined and standardized. However, two doctors can have the same training, pass the same examinations, and use the same equipment, but have remarkably different results. Subtle, subjective human factors are unlikely to be "standardized away" any time soon.

Although the driver, like the physician or surgeon, is the most visible person, the support team is at least equally important to success. Particularly impressive is the extraordinary synchrony of the seven-member pit crews, who can change the tires and refuel a vehicle in a dozen or so seconds. It is said that races are won or lost in the pits, and the same is true of medicine. A surgeon may perform a perfect operation, but if medications are not administered timely, dressings are not changed as they should, or subtle signs of problems are overlooked by the allied-health team, the ultimate outcome is in jeopardy. Health care can learn from this example.

I was especially intrigued by the role of the spotter, who observes the race from the very top of the grandstand. One of the spotter's jobs is to look for accidents or other trouble far, far ahead of his or her driver, because a car traveling at 200 miles per hour requires a lot of distance to slow down. Too much of contemporary health care is focused on treating diseases after they've gotten out of hand rather than preventing them from becoming 10-car pileups. We must do better at anticipating and avoiding problems.

Teamwork requires exceptional communication, which need not be wordy to be effective. The broadcast frequency for each driver's team is published beforehand so that spectators can monitor the interchanges between the driver, the pit crew, and the spotter. Some drivers were relatively talkative but most were laconic. It reminded me of how an efficient and experienced surgical team can perform a complex operation in near silence (in contrast to the "doctor shows" on TV where operating rooms often are depicted as a three-ring circus). Yet, there is much room for improvement in communication in health care, particularly the "hand-offs" between the dozens of persons who may be involved in the care of a hospitalized patient.

There's a lot more that is applicable, even inspiring: the sustained concentration of the drivers; the focus on safety; the attention to the customer. If it can happen on the track, we should be able to make it happen in medicine. That's what I learned from my day at the races.

George B. Bartley, M.D.
Chief Executive Officer