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Better: A Surgeon's Notes on Performance Hardcover – April 3, 2007
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Under diligence, he describes how simple persistence can improve performance significantly. For example, simple compliance with washing hands before and after each interaction with a patient would reduce unnecessary infections greatly and yet it is one of the poorest areas of performance in many medical establishment. My wife had a baby a couple weeks ago at a well-respected New York City hospital (that shall remain nameless) and, having read this book, I couldn't help but watch the hand washing. Though there was hand-washing going on, my anecdotal results were somewhat disappointing. It's scary. And yet, his stories of the effort to send polio the way of smallpox and the amazing success rates of medical teams in Iraq through no more than basic diligence with well-established methods give readers hope.
Under doing right, Gawande tells stories of the continuing debate over what constitutes right and wrong in medicine. What is the proper way to interact with someone who you have to examine naked? When is it fair to sue a doctor and how much is it worth? What should a doctor be paid for their services? Should a doctor participate in executions at prisons, considering the methods we use now are basically medical? When should a doctor continue treatment at all costs or let a patient die? These are questions with no easy answers and Gawande takes a balanced approach.
Under ingenuity, he discusses some simple, clever ideas that have helped improve performance in various areas. His wonderful chapter on childbirth focuses on the Apgar score for newborns. As most know, this is a number ubiquitous now at the birth of a baby. It wasn't even developed by an OB/GYN. It was developed by an anaesthesiologist. It required no new medical techniques. It simply required doctors and nurses to do a directed assessment of a baby at birth. And yet, this simple, ingenious change, dropped child mortality rates significantly as babies previously thought to have no chance were given a chance and hospitals competed to "improve" their Apgar scores. In this section he also has a discussion on how true analysis of doctor and hospital performance is rare but, when used, greatly improves success as well as a discussion of the amazing cleverness of doctors in the poorest parts of the world to do procedures with limited equipment. It was incredibly eye-opening.
It is a fact of life that all of us will have to encounter the medical establishment from time to time. It can be incredibly frustrating. Still, it's nice to know that there are doctors like Gawande trying to understand things and make them better. In addition, he is a fine writer who has a wealth of interesting history and personal anecdotes that help make his ideas clear. Everyone should take some time and read his work.
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.