Better: A Surgeon's Notes on Performance

My father was a surgeon, so when my wife checked "Better: A Surgeon's Notes on Performance," by Atul Gawande, out of the library, I decided to open it and see if it was worth a read.

Happily, it was absorbing reading! In spite of the title, it was not a collection of stories of successful heroic surgeries, but a series of essays on widely varying medical topics dealing with decision-making in the absence of complete data, morality, ethics, doctor-patient interaction, etc. Dr. Gawande deals with real-life issues that possibly could confront any member of the healing professions--supervising lethal injections of convicts, for example--in spare, straightforward prose packed with well-researched statistics, extensive interviews with doctors and nurses, and exposure to all sides of the issues. Although I paced myself, reading one chapter a day, I could have finished the book in a few hours, as it was interesting and written in down-to-earth terms.

Perhaps the greatest value of this book is the emphasis on performance measurement--"benchmarking," if you like. Dr. Gawande's research into treatment of diseases like cystic fibrosis, for example, revealed that the most successful treatment centers (1) kept detailed records of treatments, (2) were eager to try any seemingly logical approach, and (3) learned quickly from their successes and failures.

I'm going to recommend this book to all of my physicians--all of whom I regard as exceptional caregivers, but I heartily recommend it to anyone concerned with the state of health care in America.

A follow up to Gawande's earlier "Complications." This is a good, quick read, but it lacks some of the depth that the earlier parts of "Complications" had. Still, a worthwhile book.

This book is well written and passionately effective in its detailing the modern realities of health care from all sides of the "aisle."
The choices that we all make, doctors, insurers, patients, family members are reviewed in an anecdotal way that's clear, concise and well structured.
The author writes very well, the anecdotes themselves are interesting and illuminating and the book is a good read.
It appears to be a collection of essays that were published in The New Yorker?
A good book to read and pass on to others.

Beautifully written and wide ranging investigation and analysis of extraordinary medical care by a leading surgeon. Its message, that real diligence, as well as time and attention to detail and listening to patients, are the keys to improved medical treatment, not newfangled technology. It is a shame that most medical practice ignores these fundamental principles.

I am a huge fan of Dr. Gawunde's work - "Complications" was an incredible piece of writing and an insightful look at the medical profession and residency and his New Yorker contributions (one of which was a chapter for this book) almost always provide new ways or at least valuable commentary on the state of the medical industry. So I had high hopes for this book, which were all dashed. Instead, I finished "Better" wondering what, if anything, I had learned. Instead of giving us a behind the scenes look at medicine, we got a rehashing of medical cliches and nothing really new or nothing people haven't known or gotten from other sources - medicine is like sports and other professions, only mistakes cost people their lives; medical malpractice has its supporters, but has many issues that need to be solved; there is a bell curve showing that some doctors are better than other - is this something we didn't know? Dr. Gawunde's strengths are always his anecdotal evidence and that is about the only thing that carries the book. At the end, he lists 5 suggestions to improve the profession, things like ask your patient an unscripted question, but again, is any of this new? The book has a strange crisis of identity since I wonder who it is being written for. Doctors I know who have read it have had mixed reactions, but the very end, where he tries to give advice, falls flat because the suggestions are too obvious, and it makes him come off as condescending. As if a doctor needed to know some of these things. In many respects, Dr. Gawunde seems to be trying to make himself into the voice of the medical profession, a conscience in print. Unfortunately, his writing does not lend itself to this position. Anecdotes work for pulling back the curtain and showing some of the things residents and doctors go through, but not for sweeping change. That's where statistics and actual studies work. Overall, it's a good book for people thinking about medicine and individuals who know absolutely nothing about medicine, but not much more.