Better: A Surgeon's Notes on Performance

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.

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

Atul Gawande is a fantastic writer and this book is no exception. This is a quick read that sheds a bit of light on to the ways the field of medicine has progressed. I really enjoyed Complications more, but I recommend this book as well.

This book is a collection of previously published and some original essays. The core idea that connects these essays is the idea of better performance in medical practice. To explain this idea, author focuses upon the social and organization aspect, not on technical medical tools and techniques. The book focuses on processes and people to describe various ways of overcoming seemingly un-breakable barriers doctors face when doing their job. From the resource constrained polio eradication project to ethically difficult choices execution assisting doctors faces to plethora of mal-practice suites to compliance issues facing simple practitioner behaviors, it explores problems and quandaries doctors face in their "normal" day to day activities. The suite of essays is full of anecdotes, thought lines and candid self-reflections. These are well written and engaging essays.

On the cover of "Better" by Atul Gawande, the thoughtful Malcolm Gladwell exclaims, "Better is a masterpiece...". To be sure "Better" gets high marks for exploring territory that the medical profession might sooner forget, even Gawande admits to his discomfort level but to suggest that the bell curve tells us "...something unforgettable about the world outside" is to know very little about the world outside. However, I don't want this to be about Gladwell. Gawande is a good writer. He captures the medical world, a world alien to most of us, through the eyes of a surgeon in a way that makes those who heal, those we trust and respect more than any others in society, almost human. They are just like us. As the father of a daughter who was brought into this world with a mere 23.3 weeks gestation and a zero Apgar score, who just turned 10 years old this month, I considered these healers and decided they were superhuman. They were sheltered from a world of stress, financial worry, problems with relationships, and the like. I knew I was kidding myself but I chose to believe. I knew the doctors and nurses caring for my daughter in the NICU for 87 days were on top of their game. Gawande pierces the veil and I applaud the effort to capture his thoughts. To take the time from his busy schedule to think and to consider the meaning in what he does, to improve, to get better. He has a simplistic five-step method; Ask an unscripted question, don't complain, count something, write something, and change. Simple enough, and the beauty of his formula is that it will work, and it can be applied to all aspects of life - so do as Gawande asked, heath professional or not, improve what you are and what you do. However the real message, the journey Gawande takes us on to reach his formula, is the better part of "Better". And since we all get sick and need the medical profession, we should all stand in the shoes of a medical professional. Gawande let's us stand in those shoes, if just for a brief moment, to glimpse a world where life and death decisions hang in the balance. Followed shortly by a life and death decision in the next examination room. Most of us will never know this kind of life. So here is my formula, first go wash your hands. Second go read this book. It will not change your life, but it will change your perspective on your next visit to the doctor's office and how you perceive the hidden world of medicine.