Better: A Surgeon's Notes on Performance

by Atul Gawande

Book Overview

NATIONAL BESTSELLER

The New York Times bestselling author of Being Mortal and Complications examines, in riveting accounts of medical failure and triumph, how success is achieved in a complex and risk-filled profession

The struggle to perform well is universal: each one of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important...

• Format: Paperback
• Language: English
• ISBN: 0312427654
• ISBN13: 9780312427658
• Release Date: January 2008
• Publisher: Metropolitan Books
• Length: 288 Pages
• Weight: 0.90 lbs.
• Dimensions: 0.8" x 5.4" x 8.2"

Customer Reviews

What makes a Surgeon Superior

This author has a nice easy style and is easy to read. He thoughtfully explores what characteristics make a surgeon beyond average. They are very similar to characteristics that make some folks easier to like than others.

An excellent book about how to get better at anything

This book will be a great read for you if you're interested in the practice of medicine and how it could be done better. You'll love it if you simply enjoy lucid writing about the practice of medicine. But this book also offers you great lessons if you want to understand how science and performance management come together as they should in business or any other field of endeavor. That's because the author sets out to answer a question that is as important for people in business as it is for people in medicine. What does it take to be good at something when it is so easy not to be? Gawande ways that most people, especially physicians, think that success in medicine comes from canny diagnosis, technical prowess and the ability to empathize. They think that progress in medicine comes from scientific breakthroughs and sophisticated equipment and procedures. The reality, though, is quote different. Improved performance, according to Gawande, comes from Diligence Doing Right Ingenuity Again and again Gawande demonstrates how concentrating on patients and on performance leads to improvement for both individuals and for medical practice in general. He does this with a mix of historical examples, patient stories, statistics and stories from his own life and practice. He divides the book into three sections corresponding to his three necessities for improvement. In the section on Diligence the chapters are on washing hands, dealing with polio in India, and dealing with casualties from the Iraq war. The chapter on military medicine and the concentration on process improvement is worth the price of the book if you're in business. One of the most powerful lessons of this book is that process improvements can lead to dramatic improvements in performance. The section on Doing Right deals with ethical issues that physicians face. The chapters are on medical malpractice, whether and how physicians should be involved in executions, when a physician should fight to keep a patient alive, and the problems and dilemmas of how the business side of medicine affects how medicine is practiced. The central messages of this section are that "Choices must be made. No choice will always be right. There are ways to make our choices better." How to learn about making better choices is the subject of the third and final section of the book. In Ingenuity or "thinking anew," Gawande covers measuring the comparative effectiveness of physicians and medical centers, relative and absolute measures of performance, the practice of obstetrics as a model of change, and how physicians in less developed countries get by without the technology and facilities that are characteristic of US medicine. This section is about how to do better. You can sum it up this way: there is a bell curve in almost all human activities with huge variations in performance between the best and those in the middle of the pack. Measuring results is the way to get results that matter. This book i

An insider's perspective which can help you be a more informed patient

I'm always on the side of self-education when it comes to medical topics, especially in light of the current health care system and its looming problems. Gawande's skill is in writing movingly ab out all sorts of medical issues, including both failures and successes, in a way that illuminates the complexities of practicing medicine in today's world of HMOs, soaring premiums and more. Some of his essays may appeal more to you than others but I urge you to read the entire book, as well as to get his other one, Complications. I've read medical memoirs that put me to sleep and have been baffled by how someone could take life and death situations and turn them into dry writing. This isn't the case here and you'll come away from the book with a stronger understanding of all the factors (and possible solutions) that make up the world of medicine, medical ethics and patient care today.

Though-provoking and a terrific read

This is a non-fiction book so compellingly written it begs to be read in one sitting like a novel. And luckily it's short enough for the reader to do just that and come away with useful insights. Readers seem to get different things from this book. Some are most interested in the chapters on medical ethics. What I found most interesting was what I took as the main theme: that the practice of medicine is complex; that through attention to detail in can be systematically improved in non-obvious, pragmatic ways that are far from the big-money, high-profile research our attention is usually drawn to; and that this improvement can come from dedicated individuals and groups all over the world. Even better, some of the lessons here can carry over to other disciplines. My job has no relation to medicine but I found this book to provoke lots of ideas for my own work. Thanks, Dr. Gawande. A previous reviewer felt that the author's work was becoming "conceited." I have to disagree; I found it refreshingly self-effacing. Unlike some books written by surgeons, this one isn't focused on the tribulations or poetry of the practice of medicine. Rather, it's focused on how practitioners with no more than average skills could help make medicine serve humanity better.

An Intriguing Work by a Top-Notch Medical Writer

Atul Gawande is a general surgeon at the Brigham and Women's Hospital in Boston and -- from everything I've heard and read about him recently -- one of the best of the new breed of medical writers who devote their prose to informing the general public about important concerns in the world of medicine. If this new book, "Better: A Surgeon's Notes on Performance," is a representative example of his usual writing talent, I will completely agree with the above assessment. This collection of original and previously published essays is highly readable and very interesting. Normally, I am not all that interested in reading about medical topics unless it impacts me personally. I'm not a great fan of hospitals nor am I enthusiastic about going to a physician. Fortunately, for most of my life I have enjoyed relatively excellent health. My attitude, however, changed five years ago and Gawande's book takes on some genuine relevance for me. How so and why? In a section of his book, entitled "The Mop-Up," Gawande discusses polio and the campaign to wipe it out in Asia wherein he was a momentary observer in the field in 2003. Way back in ancient history, when I was a mere child in the 1940s and America was hit with a polio epidemic, I was diagnosed with polio and almost died. Hence the relevance here for me. But more than that, I am convinced to this day that I was "saved" because of the efforts of a nurse -- I'm sure she was one of Gawande's "positive deviants" which he describes in his book -- who insisted on treating me and others with a controversial treatment (opposed by most of the medical "establishment" at the time) called "The Sister Kenny Method." She never lost a patient, by the way; we all recovered without any significant aftereffects that I know of. Fortunately, from that time in the 1940s I never needed to be hospitalized again. That is, until 2002. Then I had a heart attack and was forced into a hospital for an angioplasty and had to take note of medical matters, including the state of medical care in this country." So, whereas before that latter year I could ignore books of the type that Gawande writes, I now have a profound interest in all things medical. Even more so since my second heart attack and angioplasty in 2006. (I even subscribe to daily updates via e-mail about medical topics!) I am now very concerned about "better" when it comes to medical care and policy. Gawande divides his book into three significant sections: Diligence, Doing Right, and Ingenuity. He says that "Diligence" is "the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles." The section "Doing Right" considers topics such as "how much doctors should be paid, and what we owe patients when we make mistakes." Important as these sections are, the final section, "Ingenuity," is of even greater importance in my opinion. Ingenuity, he says, "demands more than anything a willingness to recognize failure" and "arises from deliber

Difficult problems are ... difficult

First, as a quick proxy of how good it is, and as a way of enticing busy readers, I should note that I finished Atal Gawande's book Better: A Surgeon's Notes On Performance in less than four hours. I can't remember the last time that happened. True, it's a relatively short book, and I had some uninterrupted time on a bus. But mostly it's that Gawande is a straightforward, energetic, thoughtful writer whose essays relentlessly pull you forward. Each discusses one or two ideas in enough depth to make you realize that they're not easy problems -- which is all most people need, and which does a world of good on its own. Every country has its unquestioned assumptions; it's the rare writer who helps us question them and gently remind us that if there were easy solutions, we'd have found them by now. Gawande is good at that. The most moving and thought-provoking of these essays, to me, was "The Doctors of the Death Chamber," in which Gawande interviews four doctors (whom he labels "A," "B," "C" and -- wait for it -- "D," in order to secure their anonymity) who help states carry out the death penalty humanely. The use of "humanely" here is questionable; it's humane in the sense that, if we are to use the death penalty, we must not be needlessly cruel at the time of the criminal's death. But it's inhumane in the larger sense that we are furthering a corrupt system -- we are "tinker[ing] with the machinery of death," to use Justice Blackmun's words. Since a doctor's role is to protect human lives, are anaesthesiologists who help execute people painlessly violating their roles? To put it more succinctly: should a doctor make the best of the machinery of death, or should he take no part in the machine? The American Medical Association has its answer and its role. Democratically elected governments have their own. It's Gawande's job to teach us that easy answers don't exist for complicated problems like this. One reason it's so easy to come up with easy answers for questions like this is that we rarely come face to face with the system we critique. Gawande does the legwork for us. He's at his best, in this regard, when he interviews a medical-malpractice attorney, a doctor, and the family of a dead patient involved in one malpractice case. We're all inclined to boo at the malpractice attorney . . . right up to the moment we feel we've been wronged, when that attorney is the man we want on our side. Gawande knows that this is how we work, so he takes some time to look at a case when doctors failed other doctors: Gawande's friend Bill Franklin found that doctors had failed to treat a tumor on Franklin's son that they should have noticed years before -- that someone had actually singled out on an X-ray for further study. This is the test case where ethics hits the road: when it's your own son, and you're a doctor, and you're well aware of the expenses of medical malpractice, what do you do? After trying other routes, Franklin did what so many others do: he s