Books : Better: A Surgeon's Notes on Performance

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Author name: Atul Gawande

: Better: A Surgeon's Notes on Performance
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Type of bind: Paperback
Dewey Decimal Number: 616
EAN num: 9780312427658
ISBN number: 0312427654
Label: Picador
Manufacturer: Picador
Quantity: 1
Page Count: 288
Printing Date: January 22, 2008
Publishing house: Picador
Release Date: January 22, 2008
Sale Popularity Level: 1789
Studio: Picador



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Product Description:
National Bestseller
 

The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision.

 

Atul Gawande, the New York Times bestselling author of Complications, examines, in riveting accounts of medical failure and triumph, how sucess is achieved in this complex and risk-filled profession. At once unflinching and compassionate, Better is an exhilarating journey, narrated by 'arguably the best nonfiction doctor-writer around' (Salon.com).





Customer Reviews
User popularity level: out of 5 stars

Rated by buyers 5 out of 5 stars - Another Great Look Inside the Medical Profession
I thought Atul Gawande's last book, Complications, was one of the best books written on the medical profession in a long while. In it, Gawande showed a deep respect and sympathy for patients while trying to be clear about what would help the medical establishment do a better job from a doctor's point of view. In this book, he covers some of the same ground but, as his title implies, here he is focused specifically on what it takes to do things better as a doctor. The chapters here are grouped under three big heading which Gawande feels are the categories of improvement: diligence, doing right, and ingenuity. Within that, he tells some fascinating stories.

Under diligence, he describes how simple persistence can improve performance significantly. For example, simple compliance with washing hands before and after each interaction with a patient would reduce unnecessary infections greatly and yet it is one of the poorest areas of performance in many medical establishment. My wife had a baby a couple weeks ago at a well-respected New York City hospital (that shall remain nameless) and, having read this book, I couldn't help but watch the hand washing. Though there was hand-washing going on, my anecdotal results were somewhat disappointing. It's scary. And yet, his stories of the effort to send polio the way of smallpox and the amazing sucess rates of medical teams in Iraq through no more than basic diligence with well-established methods give readers hope.

Under doing right, Gawande tells stories of the continuing debate over what constitutes right and wrong in medicine. What is the proper way to interact with someone who you have to examine naked? When is it fair to sue a doctor and how much is it worth? What should a doctor be paid for their services? Should a doctor participate in executions at prisons, considering the methods we use now are basically medical? When should a doctor continue treatment at all costs or let a patient die? These are questions with no easy answers and Gawande takes a balanced approach.

Under ingenuity, he discusses some simple, clever ideas that have helped improve performance in various areas. His wonderful chapter on childbirth focuses on the Apgar score for newborns. As most know, this is a number ubiquitous now at the birth of a baby. It wasn't even developed by an OB/GYN. It was developed by an anaesthesiologist. It required no new medical techniques. It simply required doctors and nurses to do a directed assessment of a baby at birth. And yet, this simple, ingenious change, dropped child mortality rates significantly as babies previously thought to have no chance were given a chance and hospitals competed to "improve" their Apgar scores. In this section he also has a discusion on how true analysis of doctor and hospital performance is rare but, when used, greatly improves sucess as well as a discusion of the amazing cleverness of doctors in the poorest parts of the world to do procedures with limited equipment. It was incredibly eye-opening.

It is a fact of life that all of us will have to encounter the medical establishment from time to time. It can be incredibly frustrating. Still, it's nice to know that there are doctors like Gawande trying to understand things and make them better. In addition, he is a fine writer who has a wealth of interesting history and personal anecdotes that help make his ideas clear. Everyone should take some time and read his work.


Rated by buyers 5 out of 5 stars - Better: Diligence, Doing Right and Ingenuity
I have to agree with Stephen Laniel that Gawande's Better is such a thought-provoking and insightful book that I couldn't help but keep reading till the end (however, I am such a slow reader, so I wasn't able to finish it in 4 hours. Though I managed to finish reading it on my road trip back to New York City from Maine this weekend. Of course, I was sitting comfortably in the passenger seat.

I do like "The Doctors of the Death Chambers" a lot. I think it was a tough call for the four physicians to make: whether to abide by the medical ethics codes or to "do it right" according to their conscience. Life is full of these ethical dilemmas that none of us can avoid. Normally we simply follow our gut feelings and if we are wrong likely it won't have any fatal or tragic consequence. But the dilemma these physicians encountered was particularly difficult as human lives were involved. They were being criticized by others as unethical and they could even jeopardize their jobs. Although medical professionals should be dedicated to preserve life, is it wrong to make it a less violent and more peaceful passing when the death is inevitable? Observing the rules blindly meant unnecessary and inhumane suffering during the execution, which is not something the medical society (or anyone of us) should encourage.

"The bell curve" is my favorite. I was particularly impressed by Dr. Warwick's ingenuity. Not only does he constantly push the quality of care he delivers to a higher level and strive for perfection, he also pushes his patient to do better and try harder. During the course of treatment, patients do play a key role in getting the desirable outcome. I couldn't help but keep thinking about a disappointing dialogue I had with my primary care physician when I told her I had been experiencing knee pain lately - mostly after running for over 40 minutes (funny it's as if my knee has a timer). She simply gave me a cold response, "You just have to stop running." I thought to myself that running is what gives me "bliss," so how can I just give up without even "trying" to fix the problem? If I were lucky enough to have Dr. Warwick as my physician, he would have asked the questions to lead to a more proper diagnosis and offered a workable treatment plan that allows me to run a half-marathon, if not a full marathon. Even if I wouldn't get better, at least we wouldn't give up.

Definitely don't miss the Afterword. The suggestions for becoming a positive deviant are not limited to physicians only. They can be applied more broadly to every single individual. Everyone is given the opportunity to be a positive deviant in whatever aspect of life we desire (be it our professional endeavor, our interpersonal relationship, or our social responsibility, etc...). If you do miss the Afterword, here is the essence: As Atul suggested, "Find something new to try, something to change. Count how often you succeed and how often you fail. Write about it. Ask people what they think. See if you can keep the conversation going.

I enjoyed this book so much that I finished his other book titled "Complications" upon returning to NYC and continue to read through the articles posted on Dr. Gawande's website at http://www.gawande.com.

Coincidentally I recently came across an article titled "Where in the body is that sponge?" in the July 2008 issue of Health IT News (Yes, I am a geek in Health IT) which is related to Dr. Gawande's recent published findings in the Annals of Surgery about a computer-assisted method of counting surgical sponges (see http://www.gawande.com/documents/2008AnnSurg--BeyondCountingeditorial.pdf).



Rated by buyers 5 out of 5 stars - His writing skills are superb
I love his books because of his writing skills. Introduction with a story, then interlace it with evidence (usually historical), mix it with commentary, and end it with a conclusion to the story. Every chapter is like a reader's digest story or a very exciting magazine clipping...his writing is addictive. I went to his website www.gawande.com for more of his works. My husband, who is also a intern, provides little details about his work besides the "long hours" and "doctors are underpaid at $7 an hour, laugh," but I could never understand WHY until I read this book. A lot of outlying issues such as insurance, business practices, wartime physicians, and more are described in this book. It makes being a doctor seem like a journey through life itself. What a profession!


Rated by buyers 5 out of 5 stars - Gawande is as good with the pen as with the scalpel
Better is a very good window on medical practice. There are a lot of books on this subject - and not many have the same cutting edge as this one. All the chapters are good, but the one about the bell curve is outstanding: why some places are much better than others when all should be about the same, using the same medical information that is avaiable for all.


Rated by buyers 5 out of 5 stars - A Straightforward and Thought-Provoking Work
Atul Gawande's second book is the very first work I've read that falls under that bookstore subcategory of "Medical Literature." It's one of those books that can stimulate an interest for a subject in an initially less-than-curious reader. Firstly, Dr. Gawande's prose is very straightforward and approachable; his descriptions are nontechnical without sacrificing detail. Many chapters address issues to which the average person often has knee-jerk reactions to, such as medical malpractice. There are also quite enlightening passages: I for one have always been curious about how the current system for compensation for medical services came about.

Perhaps the strongest feature of Dr. Gawande's writing is the presentation of multiple perspectives, complete with interviews, example cases, and history. The author does not try to hammer his views across, but presents issues that the average reader might not have ever thought too deeply about. By providing a complete framework of an issue, the reader is then able to consider the subject from multiple angles.

The book is a fast read, a credit to the author's writing ability. The material really does keep you thinking long after you've put down the book, and I think that's why it deserves a 5th star in spite of the apparent short length. After all, there are so many books longer in length that, while enjoyable, do not lead to long moments of introspection during quiet times. "Better" is a book that very first makes you think, and when you aren't satisfied with what you know so far, makes you go out to learn more on your own.

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