www.amazon.com/gp/product/0312421702
com Gently dismantling the myth of medical infallibility, Dr. Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science is essential reading for anyone involved in medicine--on either end of the stethoscope. Medical professionals make mistakes, learn on the job, and improvise much of their technique and self-confidence. Gawande's tales are humane and passionate reminders that doctors are people, too. His prose is thoughtful and deeply engaging, shifting from sometimes painful stories of suffering patients (including his own child) to intriguing suggestions for improving medicine with the same care he expresses in the surgical theater. Some of his ideas will make health care providers nervous or even angry, but his disarming style, confessional tone, and thoughtful arguments should win over most readers. Complications is a book with heart and an excellent bedside manner, celebrating rather than berating doctors for being merely human. From Publishers Weekly Medicine reveals itself as a fascinatingly complex and "fundamentally human endeavor" in this distinguished debut essay collection by a surgical resident and staff writer for the New Yorker. Gawande, a former Rhodes scholar and Harvard Medical School graduate, illuminates "the moments in which medicine actually happens," and describes his profession as an "enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line." Gawande's background in philosophy and ethics is evident throughout these pieces, which range from edgy accounts of medical traumas to sobering analyses of doctors' anxieties and burnout. With humor, sensitivity and critical intelligence, he explores the pros and cons of new technologies, including a controversial factory model for routine surgeries that delivers superior success rates while dramatically cutting costs. He also describes treatment of such challenging conditions as morbid obesity, chronic pain and necrotizing fasciitis the often-fatal condition caused by dreaded "flesh-eating bacteria" and probes the agonizing process by which physicians balance knowledge and intuition to make seemingly impossible decisions. What draws practitioners to this challenging profession, he concludes, is the promise of "the alterable moment the fragile but crystalline opportunity for one's know-how, ability or just gut instinct to change the course of another's life for the better." These exquisitely crafted essays, in which medical subjects segue into explorations of much larger themes, place Gawande among the best in the field.
His writing style is similar to that of Malcolm Gladwell, Jerome Groopman, and other <i>New Yorker</i> authors of the David Remnick era - intelligent and clear. Gawande is a surgical resident, so he is experienced enough to have insight into the medical profession and practices of surgeons, but still new enough in the field to bring a keen critical mind and the clarity of a relative outsider's perspective. Also, his compassion is one of his distinct qualities and shines through in the writing. If you are a regular New Yorker reader, you probably have already read all of these essays. The brilliant essay about why doctors make mistakes is included, as well as memorable essays about when good doctors go bad, and how the practice of autopsy goes in and out of fashion. The only one that was new to me was the one about a surgeons' convention, which was entertaining but not crucial reading. It is nice to have them all in once place, but unless you are a completist or a rabid Gawande fan, I'd recommend getting it from the library or waiting for the paperback.
Gawande's essays are thoughtful and very well written, and it blows my mind that he was able to be such a prolific writer while doing a residency (let alone a surgical residency). I read these essays one at a time originally when they appeared in the New Yorker during my pre-med and med school days, and I enjoyed rereading them recently, now that I'm a resident myself. It is always refreshing to see honesty when it comes to the imperfections of the medical profession. His stories about dealing with his own children's medical problems are very compelling, struggling with when to relinquish control to other doctors and when to step in and advocate. I also currently find myself much more interested in the cognitive science of decision making, having to make potentially life-altering decisions in a split second, balancing multiple confounding variables along with personal styles, experiences and instincts. Another topic given well deserved scrutiny is the phenomenon of physician burnout and how the profession deals with, and often fails to deal with, "good doctors gone bad." Gawande comes across as the type of person I wouldn't expect to enjoy working with the typical surgeon colleagues. In fact, I would love to see him address this topic in his future writings. It would take a writer of his skill to explore the stereotypical personalities and cultures of the different specialties. No one wants to over-generalize, but medical students from various schools will have very similar descriptions of the types of OB residents versus psychiatrists versus pediatricians versus orthopedists that they worked with. The broad, simplified version of this is along the lines seen on the TV show Scrubs, with surgeons being the jocks and internists being the geeks. It's an interesting question, what perpetuates these sub-cultures, whether it is the type of person drawn to a specialty or whether people pick their careers based on who they want their colleagues to be. In the end, even with all the discussions of mistakes, burnout, and imperfections, I found this book to be affirming about the medical profession. Affirming both as a physician and as a sometimes patient or family member of a patient. Medicine doesn't always work like it should, and doctors should not be placed on pedestals. There are real problems in the system, but there are also plenty of very dedicated, hard-working, medical professionals doing their best to overcome those problems, working to provide the best care possible to their patients, to make the best decisions possible given the limitations of our knowledge. In times of crisis, you just have to take a deep breath and then put your faith in the system.
The reader is drawn in smoothly along a thread of entertaining medical vignettes. These anecdotes serve as the framework for a set of well reasoned essays that explore the inner life of the surgeon. Gawande's primary purpose is to convey the various challenges, surprises, and contradictions that he has encountered as a surgical resident. His scrupulous honesty in describing the motivations, limitations, exhilarations, foibles, and challenges of the surgical profession is refreshing. Firstly, Gawande does not deal in this book with the issue of tort reform and malpractice insurance. Perhaps this will become a more significant issue for him as he moves into independent practice. Secondly, thoughout the book I kept wondering why he did not apply decision analysis to his difficult medical decisions. When in the last chapter Gewande describes an unsuccessful attempt to apply decision analysis, it is clear that the analysis methods had not been correctly taught to him. Maybe these are issues that he can address in a future book - a book which I look forward to reading.
This book revealed several rather significant misconceptions I previously held concerning surgeons and surgical practice and exposed them as myths using real-world examples and statistical evidence. My primary conclusion after reading this book is that caveat emptor (buyer beware) holds as true in the arena of surgical medicine as it does at the mall or supermarket. I would strongly encourage anyone who is considering undergoing a surgical procedure or who may be in the unenviable position of having to make a surgical decision on behalf of a loved one or relative to read this book in advance. I gave up caffeine, or more specifically I gave up caffeinated sodas. This resulted in me getting a lot more sleep than I am...
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