Reviews for Better: A Surgeon's Notes on Performance

The average rating for Better: A Surgeon's Notes on Performance based on 2 reviews is 3 stars.

Review # 1 was written on 2012-11-24 00:00:00 Jamie Dunbar I have had a lot of doctors in my life. The best one I ever had was the surgeon who failed. Before I went under, he told me it would take about 2 hours and had an 85% success rate. When I woke up, nearly five hours had passed, I was in far more pain than I had been led to expect, and he was waiting to tell me that I was in the 15%, that he hadn't saved my eye, and that he would be ready to talk to me as soon as I was back on my feet. When he retired several years later, I wrote him a thank you note. Because he did his best, and it wasn't enough, and he knew it, and he told me so honestly and in great detail as many times as I needed to hear it, and he held his office trash can for me to throw up in, and he waived thousands of dollars in bills so he could keep seeing me when I was in law school with the horrible useless insurance, and he cared whether I was having a good life. A surgeon - can you imagine? This book isn't really about that sort of failure, the kind where current technology and understanding isn't enough. It's about designing behavioral triggers to save lives by increasing compliance with hand-washing drills, and it's about the massive manpower efforts necessary to eliminate infectious diseases from the world, and it's about what a patient is owed after a failure of any kind. It struck a huge cord with me, because one of the things that medicine and the practice of law at my level have in common is an expectation of a 0% error rate. Seriously - I am explicitly and implicitly told on a daily basis that anything less than perfection is failure. There are no stupid slip-ups, and there are no impossible situations that no one could solve. Which has nothing to do with reality, of course. Learning to live under these conditions is, uh, let's call it emotionally taxing and leave it at that. Anyone who has ever been through a medical residency is probably nodding right now. So I thought this book - I got there! - was great. Not just for the case studies of Polio outbreaks and third-world surgery, though they're pretty interesting. But because this book is thinking specifically about that. About the difference between an expectation of infallible perfection, and the seldom-acknowledged reality that our brains are imperfect and even the very best of us sometimes aren't good enough. "When someone has come to you for your expertise, and your expertise has failed, what do you have left? You have only your character to fall back upon, and sometimes it's only your pride that comes through." Succinctly put, and so very true. Ask me about something I fucked up this past summer sometime, and how the surgeon who failed was on my mind in the aftermath, when all I had left to do was take it the best I could. Anyway, rambling. I was intellectually engaged here on multiple levels, the way you are when you're always thinking and reacting, even when it isn't always good. Insert a whole rebuttal essay here on Gawande's ablism in the section on improved rates of survival for devastating combat injuries and all his musing on whether life with this and that disability is actually "worth living," whatever the fuck that is supposed to mean. Scrub that, I know exactly what that's supposed to mean, and I think it's crap. Also, the business of the disabled person in question, not an able-bodied columnist for The New Yorker. /snide. And insert a whole other essay on the execution section, and how Gawande and I have differing opinions on the death penalty - he is for it and I am not - but how fascinating it was that when presented with the ethical dilemma of doctor participation in executions, he concluded that if executions cannot be conducted safely without doctors they shouldn't happen, and I concluded doctors should be permitted to compromise their oaths. Engaged, like I said.

Review # 2 was written on 2007-05-20 00:00:00 Joseph Streeval 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.