Better: A Surgeon's Notes on Performance by Atul Gawande
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Book Reviews of Better: A Surgeon's Notes on Performance
Book Review: Very good read
Summary: 5 Stars
The medical system is filled with compromise, problems and lack of understanding. Variants of care vary drastically from place to place without a complete understanding of how or why. Questions of ethics, morals and codes doctors must abide by with little oversight. Understanding the medical system is a tedious and seemingly hopeless task. One must often wonder, what holds this system together?
Dr. Atul Gawande has taken a selection of real life stories of great and inspiring acts in the field of medicine. His portrayal of these stories is even inspiring to those who have no interest in medicine. His description of a hospital team that's primary job is preventing infection. There struggle to get people to simply keep their hands clean was daunting. However it proved when you involve everyone in the solution you can more effectively fix the problem. His description of FST (Field Surgical Teams) in Iraq was eye opening. Little attention by the press was given to this handful of surgeons who saved countless soldiers and civilians lives. One of their greatest accomplishments being the tedious collection of information, which ultimately helped shape war time trauma care. The depiction of the Adgars scale and how its creation dramatically increased newborn mortality rates. It was created by an unlikely Anesthesiologist, the second female in the country given this title. I could go on, however I will save the book for your reading.
Overall the book beat my expectations, so I would recommend reading it. It will inspire you to seek to do "Better". You will feel as though however small your achievements it's the collective efforts of us all that overcome all odds.
Book Review: As good as Gawande's first book.
Summary: 5 Stars
Better" is as good as Gawande's first book. Gawande is interested in the improvement of medical practice, and he combines personal experiences and observations with a study of best practices by others. He is obviously comfortable in interviewing both patients and doctors, as well as being brilliant and an entertaining writer.
As it happens, only because his daughter urged him, he got a second opinion on her psoriasis, and it was cleared up with a common antibiotic. I am sure Gawande had researched her problem, so this illustrates the point he makes later that there is a need for more informal write-ups of things which seem to work. My daughter had a similar experience with a different problem. I was surprised to learn that he expects 2% of his surgeries to go wrong: either there will be life threatening bleeding, or collateral damage like harm to a critical nerve, or a wrong diagnosis.
I enjoyed some chapters more than others, but I have no confidence my rankings will correspond to those of other readers. Anyway, I liked most the chapters on the problems in implementing better hand washing; how treatment of Iraq war wounds was dramatically improved; medical malpractice; medical care in India; and, my favorite, the chapter on the bell curve as illustrated by treatment for cystic fibrosis. I think Gawande really has something in suggesting that the U.S. handle inadvertent harm by doctors as it does harm from vaccines. However, like with unemployment insurance, doctors and hospitals should have to pay more into the fund if their history has been bad.
Book Review: A Straightforward and Thought-Provoking Work
Summary: 5 Stars
Atul Gawande's second book is the 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 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.
Book Review: Better Health Care for All
Summary: 5 Stars
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.
Book Review: How we can all do better
Summary: 5 Stars
Readers of the New Yorker magazine may be familiar with Atul Gawande's regular essays on the state of American healthcare. In this, his second book, he delves into the question of why some surgeons consistently achieve better results than others, and how the example of those positive deviants can be used to raise standards everywhere.
This collection of essays encompasses subjects as diverse as the failure to maintaining hygiene in hospitals, the ethics of doctors and nurses participating in the execution of the death penalty, medical malpractice lawsuits, how much should doctors be paid, and how doctors in India improvise to overcome a scarcity of resources. This is no dry tome; Dr Gawande illustrates his themes from his own experience, that of his family and of his colleagues, and is not afraid to let the humanity shine through. His accessible style makes this both an easy book to read and a thought-provoking one.
The lessons contained in the book go beyond medicine, and can be applied to most, if not all, professions. One of Dr Gawande's prescriptions in his concluding chapter is that we should write when we can, so that not only can our knowledge and insights benefit others, but the simple act of writing itself will clarify our own thoughts. It certainly inspired me to write this review.