Better: A Surgeon's Notes on Performance | Atul Gawande

Better: A Surgeon's Notes on Performance | Atul Gawande | Better: A Surgeon's Notes on Performance

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Better: A Surgeon'...

	Better: A Surgeon's Notes on Performance Atul Gawande Picador, 2008 - 288 pages average customer review:based on 79 reviews view larger image
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highly recommended

a captivating peek into medicine

Better is an entertaining compilation of writings about different facets of medicine, I picked up this book and finished it during one travel day.

Atul Gawande, a surgeon at Brigham's Hospital in Boston, weaves individual patient's stories with his thoughts about larger issues facing society. The stories remind us that medicine, given all of its dimensions, may be the most "human" of all endeavors.

I am not related to any doctors, I don't have any friends in the medical field, and I see my own doctor as infrequently as possible. Meanwhile, 15% of our economy is based on medicine and health care. This book was a peek into that world for me, showing how engulfing it is, occupied by deeply dedicated professionals who are barraged by emotional, intellectual and physical challenges as part of their commitment to others' health.

Gawande maps out his book in the Introduction. He says that there are three core requirements for success in medicine, around which he organizes his book: diligence, doing right and ingenuity.

In the section on diligence Gawande talks about the effort to encourage doctors and nurses to wash their hands to stop the spread of superbugs, the diligence of doctors on the battlefield in Iraq (many soldiers' lives are saved that would have been lost before,) and lastly, the effort to rid polio from the earth, how complicated and human that effort is in its problems and issues.

In the chapters on doing right Gawande talks about doctors' pay, medical lawsuits, doctors who assist in prisoner executions (when they have sworn to "do no harm") and how to know when to "pull the plug" on a dying patient (hint: you can't know.)

In the chapters on ingenuity Gawande talks about how medical centers can implement systems which improve survival. He describes in detail how a couple medical centers (and, arguably, due to the influence of a couple people in particular) are responsible for the life expectancy of cystic fybrosis patients now being up to age 45+, when in the 1960's the average patient could expect to live to age 3.

For me, reading this book was like meeting a captivating guest at a dinner party who offered me a glance into a deep, engaging, world. I came away thankful for the author and others in medicine for their commitment to a tough field in which they make meaningful differences in people's lives and well-being (and, therefore, happiness.) I know that people in medicine are as human as everyone else, and that there are people in medicine who abuse power, are greedy, etc, just as in every other field. But I think, for the most part, people enter and stay in medicine for noble reasons. This book is about those people, whom I can only admire and appreciate.

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Better: A Surgeon's Notes on Performance

Sorry, unable to comment. This book was purchased for distribution to my Hospital Board of Directors. Thank you

Thought provoking

This is an easy read, but asks some profound questions about the status of medical practice in the U.S. today. Definitely worth reading.

"Becoming a positive deviant"

In any human endeavor, variations of performance create a bell curve and most participants are average or below average. Dr. Atul Gawande explores the challenge of practicing medicine and striving to be a "positive deviant" on that curve. Better: A Surgeon's Notes on Performance explores the pursuit of perfection in several areas of medical practice. Athletes, he writes, teach us a lot about "the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line." (p. 4)

Several chapters of this book appeared first as articles in periodicals. Though the book follows a fascinating theme, do not expect it to be as well-integrated as Complications: A Surgeon's Notes on an Imperfect Science. The overall message is the dialectic between strict adherence to practices known to work (hand-washing) and an inspired ingenuity. How to achieve both?

There is much interesting material here: the WHO campaign to eliminate polio, the history of Cesarian sections in obstetrics, the ethics of assisting in the death chamber, the story behind longer life span for cystic fibrosis patients. These and other chapters are tied together by the quest for improvement of outcomes.

The afterword encapsulates Dr. Gawande's advice to medical students on making a difference in people's lives, and it alone is worth the price of the book. "It often seems safest to do what everyone else is doing ..." he writes in closing. "But a doctor must not let that happen--nor should anyone who takes on risk and responsibility in society."

Altogether this is an informative and thought-provoking book with lessons that go beyond the specifics of medical practice.

Linda Bulger, 2008

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