Observations BMJ Confidential

John Wennberg: Tenacious, optimistic, sceptical

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.f7669 (Published 08 January 2014) Cite this as: BMJ 2014;348:f7669

In the latest in its series asking the movers and shakers of the medical world about work, life, and less serious matters, the BMJ spoke to the creator of the Dartmouth Atlas of Health Care

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Biography

John Wennberg is a US epidemiologist who first put unwarranted variation on the medical map. He showed what is now a commonplace but was then a surprise: that medical care varies greatly from place to place in cost, quality, and outcomes. Where you live determines how well, or badly, you are treated and how much it will cost: geography is destiny. He founded the Dartmouth Atlas of Health Care (www.dartmouthatlas.org) to document these variations, thereby helping to transform the understanding of medical practice in the United States. One solution, he says, is for patients to be far more involved in decisions about their care. Another is to limit overall use of healthcare through budgeting or constraints on capacity.

What was your earliest ambition?

To become a mountaineer, ski bum, forester, pastor, philosopher, linguist of the Germanic languages, and sociologist. None of these worked out, so I went to medical school.

Who has been your biggest inspiration?

Kerr White, viewed by many as the father of health services research, who taught me to be sceptical and to use the tools of epidemiology to understand the healthcare system. At the time I learnt from him he was professor at Johns Hopkins School of Hygiene and chairman of its Department of Health Care Organization, which he founded.

What was the worst mistake in your career?

My early assumption, picked up in medical school and as a resident, that healthcare delivery was based on sound science.

What was your best career move?

My first job! As director of a well funded regional planning programme at the University of Vermont I worked with Alan Gittelsohn (who had taught me statistics at Johns Hopkins) to develop our method for small area analysis. This uncovered the remarkable differences in healthcare delivery among Vermont communities—and led directly to my career long interest in understanding variation in medical practice.

Bevan or Lansley? Who’s been the best and the worst health secretary in your lifetime?

Bevan changed history, and for the better. The effects of Andrew Lansley’s policies have yet to be assessed, but I hope the pursuit of “competition” doesn’t end up with an NHS that looks more and more like US care.

Who is the person you would most like to thank and why?

Egmont Norregard Wennberg (my dad). He was kind and generous, taught the importance of family, and helped my wife, Corky, become a successful artist.

To whom would you most like to apologise?

That can’t be explained in three sentences or less.

If you were given £1m what would you spend it on?

Micro-grants to fund innovation in healthcare delivery in developing countries that do not assume that the pathway to better health is more Western-style medicine.

Where are or were you happiest?

With my family, especially when we are in our cabin in western Wyoming.

What single unheralded change has made the most difference in your field in your lifetime?

The relentless increase in the proportion of gross domestic product invested in healthcare has reached the point where the study of practice variations and the influence of physicians and medical capacity on demand for healthcare is an international priority.

Do you believe in doctor assisted suicide?

The real question is whether doctor assisted suicide will play a significant role in helping patients achieve the care they want at the end of life. In Oregon, where enabling patients’ preference for end of life care has been widely discussed, the answer appears to be yes, but elsewhere the debate over end of life care seems to be stuck on the assumption that more is better.

What book should every doctor read?

My Tracking Medicine,* of course.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

Ode to Joy (in Schiller’s German, please).

What is your guiltiest pleasure?

Showing doctors at Harvard, Yale, and the University of California how much their utilisation rates varied.

If you could be invisible for a day, what would you do?

Be on the Hubble telescope and see the evidence for the Big Bang.

Clarkson or Clark? Would you rather watch Top Gear or Civilisation?

Easy question: I have never watched Top Gear but really liked the Civilisation series.

What is your most treasured possession?

If I can count my family as a possession, then the answer is easy.

What personal ambition do you still have?

Among the wide variation in medical practice, to learn which rate is right.

Summarise your personality in three words

Tenacious, optimistic, sceptical.

Where does alcohol fit into your life?

Nicely at the right time of day and with the right company.

What is your pet hate?

Waiting for an obvious answer to an uninteresting question.

What would be on the menu for your last supper?

Not sure I would have an appetite for a last supper.

Do you have any regrets about becoming a doctor?

None whatsoever. After the pain of getting there, the door opened to many interesting things.

If you weren’t a doctor what would you be doing instead?

Who knows? I took many false starts before becoming a medical care epidemiologist. It would be fun to spin the wheel of chance one more time and see what happens.

Notes

Cite this as: BMJ 2014;348:f7669

Footnotes

  • *Tracking Medicine: A Researcher’s Quest to Understand Health Care (ISBN-13 978-0199731787)

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