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: Even "Better" than Complications
Summary: 5 Stars
Insightful, well-written, and goes beyond the limited scope of "Complications" to include medicine outside the walls of U.S. hospitals.Book Review: Erratic, Fascinating, and Fun
Summary: 4 Stars
Atul Gawande is one of the rising stars, maybe THE rising star, amongst those publishing on the subject of American health care. After an undergraduate degree at Stanford, a stint as a Rhodes Scholar, and graduating from Harvard Medical School, he has gone on to become one of the best medical and public health writers in the U.S. Few people know more about the ins and outs of health care issues in America, and his dual associate professorships (Both the school of public health and the medical school at Harvard) keep him up to date. And...the guy can write. A long time contributor to The New Yorker and Salon, few do better at putting complex concepts into understandable language.
Better: A Surgeon's Notes on Performance, is a book that reads as what it is: a collection of essays that have been published elsewhere, and were often published for reasons other than figuring out how to deliver better health care. That said, Atul Gawande's voice is refreshing, and in this wide-ranging book he clearly outlines some of the most important challenges confronting 21st century medicine, including both quality and cost.
Gawande is convincing that measures for improving healthcare quality and affordability require stepping away from traditional viewpoints. His examples of how MRSA infection rates (endemic in American hospitals) were reduced to ZERO in one hospital, and dramatically reduced in several other hospitals, are engaging and fascinating. Similarly, his essay that traces the increase of lifespan in cystic fibrosis patients from less than a decade forty years ago to over sixty years in good pulmonary centers, is no less than amazing.
Gawande is less powerful when he wanders into medical ethics, expressing his desire that health care workers, especially doctors and nurses, be banned from having anything to do with state mandated executions. I'm not sure what this has to do with improving healthcare, and I find it just plain odd in other ways. Demanding that doctors adhere, under threat of law, to a government prescribed code of ethics is, well, kind of kooky. I know that I, as a family physician, don't want the government, be it Bush era, or Obama era, telling me what I can and can't do with my medical license, other than that I must comply with the law of the land in the way I use it. As an Oregon physician that lives in a state that allows both medical marijuana use and physician assisted suicide, I'm personally acquainted with what happens when government mandates regarding physician's code of ethics whipsaw between two administrations as different as those that had John Ashcroft and Eric Holder as attorney generals.
All in all, a fun and stimulating read. This book is provocative, informative, and intriguing. It will change your point of view, and solidly ground you in some of the issues that currently confront American medical care. Written in an easily accessible style, experience in the medical field is NOT necessary to fully enjoy this book. It is written for all comers, and almost all comers will truly enjoy it.
Book Review: Better is Good
Summary: 4 Stars
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.Book Review: Positive deviance
Summary: 4 Stars
Atul Gawande's collection of essays reflect on medicine in an amazingly even-handed way, considering the author is a surgeon. Rather than a defense of medical care, the author explores several controversial issues affecting health care and manages to not only see the various aspects of each issue, but to examine them in such a way the reader's mind is opened.
Divided into 3 main sections, each a virtue that contributes to the development of modern medicine: diligence, doing right, and ingenuity.
I was grabbed immediately by the first chapter regarding hand washing. Yes, hand washing! As an obsessive hand washer myself, I found the statistics regarding health care professionals and hand washing to be astonishing! And in the face of overwhelming evidence favoring hand washing, its pretty amazing that everyone is not donning exam gloves for everyday tasks. On the contrary, the cavalier attitude demonstrated by doctors and nurses towards hand washing would make a great psychology study. But luckily for us, there are people out there that not only appreciate the value of frequent washing, but took the extra step to figure out how to make it happen.
I must apologize for not making this sound more interesting, because it truly is.
While I found every chapter fascinating, I was particularly intrigued by the study of cystic fibrosis centers, and the description of medical care in India. In each chapter, we meet people who use their knowledge and skills to BE better.
I especially appreciate Gawande's advice on becoming better, a 5 step program for improvement, or how to be a positive deviant. 1. Ask an unscripted question. 2. Don't complain. 3. Count something. 4. Write something. 5. Change.
When are our efforts enough? Why do we always have to be better? Because we have not eradicated disease. We have not eliminated mistakes. We have not erased social inequities. Read about the people who are dedicating their lives to making things better. It will make you want to be better as well.
Highly recommended to health care professionals and patients alike.
Book Review: "Becoming a positive deviant"
Summary: 4 Stars
In any human endeavor, variations of performance create a bell curve and most participants are average or below average. Dr. Atul Gawande explores the challenge of practicing medicine and striving to be a "positive deviant" on that curve. Better: A Surgeon's Notes on Performance explores the pursuit of perfection in several areas of medical practice. Athletes, he writes, teach us a lot about "the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line." (p. 4)
Several chapters of this book appeared first as articles in periodicals. Though the book follows a fascinating theme, do not expect it to be as well-integrated as Complications: A Surgeon's Notes on an Imperfect Science. The overall message is the dialectic between strict adherence to practices known to work (hand-washing) and an inspired ingenuity. How to achieve both?
There is much interesting material here: the WHO campaign to eliminate polio, the history of Cesarian sections in obstetrics, the ethics of assisting in the death chamber, the story behind longer life span for cystic fibrosis patients. These and other chapters are tied together by the quest for improvement of outcomes.
The afterword encapsulates Dr. Gawande's advice to medical students on making a difference in people's lives, and it alone is worth the price of the book. "It often seems safest to do what everyone else is doing ..." he writes in closing. "But a doctor must not let that happen--nor should anyone who takes on risk and responsibility in society."
Altogether this is an informative and thought-provoking book with lessons that go beyond the specifics of medical practice.
Linda Bulger, 2008