Better: A Surgeon's Notes on Performance Book

Not nearly as good as his first, in a number of ways.

What made Complications so exhilarating was that we were learning about being a doctor just as Gawande was learning about being a doctor. Literally: he wrote most of those essays while still a resident. The humility this brought to Gawande's essays makes all the difference. We were forced to consider the ethical implications of a healthcare system that has to deploy inexperienced doctors so that they can be trained and become better doctors. Crucially, we did so, or were introduced to this problem, because the author brought us into his very first OR and lets us see his own anxiety at being one of these inexperienced doctors.

Not anymore. Now we have Atul Gawande, investigative reporter extraordinaire. He cruises around the world, looking for interesting stories about medicine, which are told fine, but they are not personal. And, in that increasingly infuriating New Yorker way, the piece becomes as much about the author as the story: "Blah blah blah," he told me in an email; or, "I went to see him in his office. He was wearing a purple shirt, green pants, and a top hat." Which, again, was fine when we really seemed to be looking out from Gawande's wide eyes.

A consequence of this is that the book promotes a very odd and simplistic message. As you can tell from the title, it's about Doing Better, but the three divisions--the three ways we are told we can do better--are Diligence, Doing Right, and Ingenuity. True enough--but do I need an MD to tell me this? More unfortunately, potentially revelatory stories about, say, containing a polio outbreak in Africa become bookended and framed as stories about Diligence. Maybe, but that the docs are Diligent is the least interesting thing you can say about that story.

This sort of oversimplification worried me from the introduction. It sounded like Malcolm Gladwell's doing, I thought, and I don't like Gladwell, whose M.O. is to oversimplify things and categorize them into Big Themes, often to the point of getting them wrong (see his piece on Enron). And lo! in the acknowledgments, Gawande says he has become best friends with Gladwell. Another great topic ruined by the frizzy-haired Canadian.