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Better by Atul Gawande

Better (2007)

by Atul Gawande

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I found this book surprisingly enjoyable. I don't read much nonfiction, but I took a chance on this after noticing the author's increasing profile (most notably on NPR) and seeing in his bio that he works at Brigham and Women's Hospital, which is in my neighborhood (and is also where my wife works).

I thought at first I was getting into a collection of feature-length pieces on assorted aspects of medicine, and that is overall what comprises the book. Gawande is very good at explaining the basics about any of the topics he tackles (the importance of hand washing to stem the spread of infection in hospitals, innovations in battlefield medicine in our most recent military conflicts, the complicated ethics of having doctors attend executions, the ways in which doctors in India improvise with limited supplies and inadequate staffing), and he is a good storyteller besides, injecting every story with personal details and human stories to bring his subject to life. The book would have been quite good if it had been merely a collection, because these qualities appear throughout.

Yet I appreciated also the fact that the pieces were tied together both structurally and thematically. No matter the topic, Gawande underscores the way in which doctors strive to improve their practices and performances on an ongoing basis. While it is not difficult to see where any single chapter here could easily have been published without reference to the others, they have been reworked to form a more cohesive whole, and the theme works well both to tie them together and strengthen their effect. He caps off the book with a brief article that relays the five suggestions he makes to doctors to help them avoid the tendency toward routine practices and to seek out new ways for them all to continue to get "better." Often, I fault nonfiction books for tacking on similar "now what?" chapters, but this one felt like more than a rehash of the salient points and a few vague suggestions. It had the feel of being applicable for anyone who hope to do more than scrape by in his life and work. Yes, it smacks of some popular self-improvement books, but in the context of all the courageous, innovative, and humbling stories that have gone before it, the suggestions have unusual resonance. ( )
  phredfrancis | Feb 8, 2014 |
well constructed, well written, diverse in view point and subject; liked his advice at the end; liked how he tried to use different essays to illustrate a single (three-part) theme
  FKarr | Apr 4, 2013 |

It's precisely because of our enormous success that people are bound to wonder what went wrong when we fail. (106)

This book was terrifyingly informative. From a polio vaccination campaign in India, to modern childbirth, to treatment for cystic fibrosis, to medical malpractice, it was fascinating, visceral, and horrifying by turns and sometimes all at once; the author's scientific, commonsense approach seems unique in the world of medicine. One of the main takeaway points is that no matter how good technology gets, human error and inconsistency tend to be the real culprits in the majority of situations. One major example of this is doctors neglecting to wash their hands between patients, and thus spreading infections throughout hospitals. Better ought to be required reading for all doctors, nurses, and patients. ( )
  JennyArch | Apr 3, 2013 |
The first chapter of this book was on the effect that hand-washing has on infection rates of MRSA and VRE in hospitals. It was fascinating! I never thought I would find twenty pages on hand-washing so engrossing - I have high hopes for this book!

The book got better and better. Proper review will be forthcoming, definitely. But when? ( )
  Petra.Xs | Apr 2, 2013 |
In his second collection, Gawande ranges further afield than he did in Complications: A Surgeon's Notes on an Imperfect Science. There, many of the essays dealt with surgical training and socialization. Here, while still grounded in hospital practices (such as handwashing, or the lack of it), Gawande recounts the history of Ignac Semmelweis, whose handwashing crusade against puerperal fever was thwarted by his lack of both empirical studies and interpersonal skills. Other chapters of note include on on polio vaccination in India and the restructuring of battlefield triage. Throughout, Gawande promotes the concept of "positive deviance" as a way to break out of presuppositions and mindless practices.

I enjoyed Better at least as much as Complications. Gawande manages to speak conversationally but not callously about some pretty horrific stuff. However, at times the material seemed either oversimplified or not updated. For example, contemporary concerns about handwashing gel, polio outbreaks in Europe, and the shocking conditions at Walter Reed are simply missing. While some of these essays appeared first in The New Yorker and The New England Journal of Medicine, the publication date for the book is 2007, and Gawande should have updated some of these pieces, or appended an epilogue.
( )
1 vote OshoOsho | Mar 30, 2013 |
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Amazon.com Product Description (ISBN 0312427654, Paperback)

National Bestseller

The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision.


Atul Gawande, the New York Times bestselling author of Complications, examines, in riveting accounts of medical failure and triumph, how success is achieved in this complex and risk-filled profession. At once unflinching and compassionate, Better is an exhilarating journey, narrated by "arguably the best nonfiction doctor-writer around" (Salon.com).

(retrieved from Amazon Mon, 30 Sep 2013 13:32:04 -0400)

(see all 4 descriptions)

Explores the efforts of physicians to close the gap between best intentions and best performance in the face of insurmountable obstacles, discussing such topics as the ethical considerations of lethal injections, malpractice, and surgical errors.

» see all 4 descriptions

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