Complications: A Surgeon's Notes on an Imperfect Science | Atul Gawande

Complications: A Surgeon's Notes on an Imperfect Science | Atul Gawande | Great book on surgery

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Complications: A S...

	Complications: A Surgeon's Notes on an Imperfect Science Atul Gawande Metropolitan Books, 2002 - 288 pages average customer review:based on 148 reviews view larger image
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highly recommended

A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is -- complicated, perplexing, and profoundly human.

Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won't go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.

At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.

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Humble Human makes a Great Doctor!

An amazing thriller...

Dr.Atul's superb portrayal of finest qualities of a doctor, yet the limitations of an individual, their weekness,strengths, system flaws etc with vivid examples of real life cases makes "Complications" the best medical book I'v ever read.It's not the content of the book alone that deserves appreciation, it's also the flow of words that blend with the topic.

Certainly the pinnacle of the book is the story of Joseph Lazaroff, Atul's Anguish depicting the finest of human character and also the professionalism of a doctor, also his questions behind the ethics of "absolute insane rights of patient's expression". I felt a pain in the heart for that "unknown soul" ( a gist of that chapter is below)

Chapter : Whose body is it Anyway :
...I turned the ventilator off, and the suddenly the room was quiet .His breathing slowed ...Joseph Lazaroff had died.But Knowing how much Lazaroff had dreaded dying the way he died....

Chapter : Education of a Knife:
I said to the patient that there were "slight risks" involved.And the disasters weighed on my mind: the woman who had died from massive bleeding, the man who had to have a chest opened, the man who had a cardiac arrests.I said nothing of such things when I asked my patient's permission to do this

Chapter : When Doctors Make Mistakes:
At 2 A.M on a crisp friday in winter a few years agao, I was in sterile gown , pulling a teenage knifing victim's abdomen open, when my pager sounded "code trauma, three minutes"

Chapter : When Good doctor's Go bad:
Before the license of Dr.Goodman was taken away, he was a highly respected and sought after surgeon...he could do some of the best, most brilliant work around....In one case , he put the wrong-size screw into a patient's ankle,another case when he refused to do hip replacement. For the last several years, he was the defendent of a stream of malpractice suits.

Chapter : The Man Who Cannot stop Eating :
...He had to let his legs apart to let his abdomen sag between them. He cannot lie down and breath properly because of excess fat in the tongue and upper airway. He had to sleep in the recliner and every thirty minutes or so , he would wake up asphyxating, He could no longer stand up to urinate, he had to shower after moving his bowels to get clean

A Must Read book...Afterall, someday you might be an example in his future books!

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Great book on surgery

Atul Gawande gratefully takes the reader to the back of the OR, a place open for a few, yet intriguing for many. Dr. Gawande is extremely frank and poignant, as he describes actual cases from his own surgical practice. He admits that cutting someone open for the first time is hell, praises surgery which gives chance to obese people, wonders about doctor's intuition, and remains human in every case.

As always, Atul Gawande is not just writing about medicine; this book reaches far beyond the realm of the operating room. He touches on the most complicated ethical questions of medicine and society as a whole. Gawande speaks of mistakes and our imperfect judgment; tackling the questions of good doctors gone bad along with malpractice claims and punishments. He makes the case for autopsy as a means of learning. He admits that medical students must practice on cadavers or animals in order to cut people open; all ethical questions are answered by means of vivid examples.

For instance, in the 1980s the death rate from a particular surgery would be about 10%. When the new surgical treatment of heart pathology arose, surgeons started trying the novice. At that training period, the rate of children death from this particular intervention increased to 25% of cases. Sounds horrible? Yes, but after surgeons learned, the rate fell down to just a couple percent. Was it worth it? Sure, granted the number of lives saved in the long run. Never, granted now many kids died just due to surgeons' learning. Would any doctor let anyone practice on his own kid? Never. At the same time, learning is a necessary part of medical progress.

Those questions dominate the book; Gawande ponders at the patient's right to choose, reminds us that doctors are human and prone to mistakes, reveals mysteries of complications, which are usually open only during the M&M - Mortality and Morbidity Conference behind the closed door. Gawande is not afraid to open the doors. Moreover, he is confident that openness is the only way to reduce the complications.

I almost wanted to say the book is too idealistic, except it's written by a person whose profession is to think realistically. Great book!

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Interesting insight into the world of being an intern and a doctor

The first part of the book is the typical medical error conversation - the system needs changes, but, instead, the last doctor to touch a patient is always ultimately responsible. The last two sections of the book are full of interesting patient stories and antecdotes, leaving the reader with a sense of "why do I pay so much for services that are not consistent and not scientifically proven?" Gawande does an excellent job pointing out some of the uncertaintaties of medicine and some of the major health disparities and inequalities - the poor are usually the ones that are used as training tools for interns and residents, and receive subpar-care compared to the well-insured.

A very easy and quick read.

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