Deliver Us From Experts

I was reading through the August 13 & 20 issue of the New Yorker last week, and became highly engrossed in a particularly well-written article. It was an article comparing the kitchen operations of The Cheesecake Factory with the state of the practice of medicine in the US. The prose was brilliant, the analysis incisive. I almost never take note of the article writers, so halfway through the article I wondered “Who is this author?”

I should have known: it was Atul Gawande, once again. Since he writes for the New Yorker only once every few months, I always forget that he is a contributing writer. But halfway through his articles, something about his writing lights up my brain, and I say to myself “This is great writing, who is this author?” It’s a weird feeling.

In this specific article, Atul goes inside the kitchens of The Cheesecake Factory to answer the basic question: “I wondered how they pulled it off.” “The chain serves more than eighty million people per year. I pictured frozen bags of beet salad shipped from Mexico, buckets of precooked pasts and production-line hummus, fish from a box. And yet nothing smacked of mass production. … I asked one of the Cheesecake Factory’s line cooks how much of the food was premade. He told me that everything’s pretty much made from scratch …”

Atul goes on to find that a keystone of the chain’s success is the kitchen manager: “A kitchen manager is stationed at the counter where the food comes off the line, and he rates the food on a scale of one to ten.” The kitchen manager also checks the portion sizes, the plating, and the timing. One would think the line cooks would resent the micromanagement, but: “The managers had all risen through the ranks. This earned them a certain amount of respect.”

Atul also mentions the computerized inventory systems, computerized menu and recipe systems, and so forth. And then he concludes that the entire Cheesecake Factory system: managers, computer systems, inventory control – are precisely tuned to generate world-class results. World-class results are The Cheesecake Factory’s raison d’etre.

Atul then compares this to the dismal state of the practice in medicine. Since ancient times, doctors have “generally been paid for what we do, whatever happens. The consequence is the system we have, with plenty of individual transactions – procedures, tests, specialist consultations – and uncertain attention to how the patient ultimately fares.” In the article, Atul mentions doctors that are veterans, self-styled experts at what they do, but who regularly achieve mediocre results.

And this is why I most like Atul’s writing: his focus on results. As a doctor, he understands that his profession kills people. He can count the number of botched treatments, the damaged lives. He measures the results, and he works to highlight and to fix the problems. He doesn’t approach his profession as an “expert,” with his mind made up – he understands that the results can, and should, teach him his practice.

During the last few weeks, I have seen “experts” writing about many topics: “Oh how awful high-frequency trading is,” or “How awful that hospital systems make such profits,” or “How awful that robots are putting people out of work.” Of course, these so-called experts have not spent years actually working in the professions that they decry, learning about how these industries achieve results. They lack real-life experience with producing world-class results, with entrepreneurship, with capitalism itself.

Lord, deliver us from experts.

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