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: fascinating exploration of past and present improvements in medicine from behavioral innovation rather than scientific discovery
Summary: 4 Stars
Gawanda is a surgeon and a skilled writer. This collection of essays explores the ways in which changes in medical behavior and organization (as opposed to new scientific discoveries) can lead to drastic improvements in health and survival. He explores a broad array of applications, from interminable efforts to eliminate polio in India and elsewhere to impressive innovations in front-line war medicine in Iraq to ways that hospitals have tried to get doctors to ... wash their hands. Even though many of the essays were previously published (in the New Yorker), Gawanda has updated them and integrated them into the broader theme of the book.
Some of the essays stray from that theme, such as the one discussing medical malpractice, but each one is engaging. Gawanda is excellent at writing for a lay audience: I have no medical training and found the book completely accessible.
One of the principal messages, introduced early and revisited often, is that of "positive deviance": the idea that wonderful changes come from identifying (and learning from) individuals who deviate from norms and achieve impressive results. In his conclusion, Gawanda gives some ideas for becoming a positive deviant in medicine and in life. One is to "count something," building on the book's examples in which measurement systems led to drastic improvements in performance: one example is the Apgar score for newborns; another is the publication of cystic fibrosis treatment performance across hospitals around the country. Gawanda goes on to give a compelling example of how his own measurement helped him understand how to reduce sponges getting left inside patients.
The audiobook published by Sound Library consists of 6 CDs (about 7 hours and 30 minutes). It has good, engaging narration by John Bedford Lloyd.
Book Review: Awesome
Summary: 5 Stars
I really enjoyed this book and found it both interesting and helpful as I look for quality in my work and in my life.Book Review: Exposes Medicines Own Diseases
Summary: 5 Stars
What can medicine do to improve the quality of patient care around the world? That is, at its heart, the question that author Atul Gawande throws at readers and practitioners alike. "We can do better," he tells us, and thus begat the title: BETTER.
Having thoroughly enjoyed Complications, I decided to check out Dr. Gawande's other writings and was pleasantly surprised to find this collection of stories. Although both Complications and Better are short story compilations, Complications lacked cohesiveness whereas Better had no such problems.
Leading us down simple and often shocking paths, Gawande gives us complicated facts but in laymen's terms. The simplest would be his chapter on hand washing, and how effective it can be for preventing the spread of infection, especially such newly dangerous things as MRSA, an antibiotic resistant bacterial strain that is killing hospital patients far too often. The ease with which its spread is preventable is as simple as a hand cleanser, yet getting doctors (and other medical staff) to do this is nearly impossible. "We can do better."
The beleaguered medical malpractice insurance requirements that plague every doctors pocketbook is hit hard upon, including a look at why it is necessary and why the system is headed for deep trouble. "We can do better."
Probably the most telling chapters were directed at Dr. Gawande's return to India (his national homeland). Polio is on the run and is nearly extinct as a disease. Yet in small Indian provinces, occasional "hot spots" flare up and a band of less than 10 medical men and women must vaccinate over 4 million children in less than two weeks. And they do it. Gawande tells us if this is possible, can't the U.S. do better at fighting infection? The other striking aspect is how India's doctors often work with substandard supplies (or minimal) on dangerous cases. Or perform a surgery they've never done before or are ill equipped to handle. But handle it they do. One such case involved a boy with hydrocephalus ("water on the brain" caused by a build up of cerebral spinal fluid). No physicians at the hospital Gawande visited had ever done a shunt, the procedure necessary to relieve the pressure. But they eventually do a makeshift surgery that saves the boys life "using about as few supplies as I'd use for a suture repair." Quite an eye-opener. "We can do better."
The chapters on CF (cystic fibrosis) are exceptionally well rendered as we learn that doing better at one thing can have huge benefits. When physicians focus all of their talents on cystic fibrosis, the result was astounding. Life expectancy for CF patients jumped from 17 years of age to over 40. And now it looks like they may very well be able to live into the 70s. It isn't some new super-drug that's extending these peoples lives, but looking at the disease process in terms of better treatment strategies; living proof that doing "Better" can help medicine achieve miraculous results.
Atul Gawande is to be commended for writing a book that flays open the medical system and exposes the diseases beneath; diseases that we can do better at.
Book Review: better...should have been Better
Summary: 3 Stars
Disappointing outing for this usually wonderful author.Granted he does not try to hide from the blemishes of the surgical world but the book at times went on and on and became boring.
I do believe that he is a brave man to write the types of books and articles
that he does write, as the medical profession is a closed society.I understand his need to try to make medicine better but is this the way to do it? we'll never really know.
Book Review: Highly Accessible Essays on Medical Care Today
Summary: 5 Stars
Atul Gawande's talent for bringing complex issues before the general public lies in his excellent writing ability, apparent in his earlier work, "Complications." He explores the issues of current medicine in penetrating essays that can be grouped into three categories: Diligence, Doing Right, and Ingenuity. Doctors in the United States today are facing a litigious public that demands perfection from mere mortals. Gawande presents a balanced picture from the view of patients and their families as well as from doctors' perspectives. The economy of his writing permits the reader to zero in on the issues quickly. I must say, right from the outset of this collection, that the essay on hand washing has made me leery about any doctor's touch. Today's headlines about incurable bacterial infections now reaching into our school systems bear out the relevance of Gawande's concerns.
I see no sense in rehashing all the essays here. As a reader, you should know that these essays are highly relevant to all of us and underscore what we don't know about our healthcare. When we enter a facility for treatment, for instance, do we know where that facility stands in relation to positive outcomes for the condition we need treated? If not, why not? I did especially like the essay about medicine in India, as I frequently visit there on business. I think Gawande's thoughts about achieving better results through diligent adherence to what we already know works is good advice for many areas in life, not just medicine.
This collection is well worth anyone's time. It's thoughtful, well written, and relevant to all of us.