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Better: A Surgeon's Notes on Performance (2007)

by Atul Gawande

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1,809616,506 (4.05)65
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 are on the line with every decision. Author Gawande explores how doctors strive to close the gap between best intentions and best performance in the face of obstacles that sometimes seem insurmountable. Gawande's stories take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. He discusses the ethical dilemma of lethal injections, examines the influence of money on modern medicine, and recounts the contentious history of hand washing. And he gives us an inside look at his own life as a practicing surgeon, offering a firsthand account of a field where mistakes are both unavoidable and unthinkable.--From publisher description.… (more)
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Showing 1-5 of 60 (next | show all)
One of my favorite nonfiction writers. Atul Gawande is always worth a read. In "Better", he considers the question of what might make medicine as a whole industry ... better. In terms of cost, effectiveness, reach, and advancement of knowledge. For doctors and patients, and to a lesser extent, society as a whole.

This is an enormous question, of course, and Gawande does manage to address it in a meaningful way by detailing three major case studies and several smaller ones. I found the case study of polio eradication in India the most fascinating. That so few local overseers belonging to UN agencies coordinate such a massive effort for eradication is astounding, especially knowing the challenges of Indian systems intimately like I do.

The other case studies, such as hand washing among doctors and the medical side of childbirth are also memorable. Hand washing especially, I went in with something like a "duh why can't they do it properly" attitude, and Gawande's case study left me with a deep understanding of exactly why not.

There were two slightly frustrating things about this book. One was that Gawande is so scrupulously apolitical that it gets a bit annoying. When he discusses health insurance, for example, it is hard to see how he can possible do it well while steadfastly remaining apolitical, and yeah, his reticence does hurt the chapter. He leaves many options for alternative systems for healthcare provisions unexamined because of it.

The other slightly annoying thing is how Gawande seems to see doctors as demigods, if not actually divine. Often this is an endearing attitude. But sometimes it grates, this high-and-mighty way he has of suggesting throughout that doctors are ever so Special and must be held to godly standards of performance and morality, etc. I am not one to suggest doctors are the same as any other profession like car sales, but Atul Gawande is on a completely new level of reverence for the profession. Like I said, this IS usually endearing. If I had to choose a doctor I'd most certainly choose one who felt the special weight of doctorly responsibility than one who is in it just for the money. But in some chapters, like the one on childbirth, Gawande's reverence leaves him utterly unable to admit the depth of the medical profession's failure in treating women like people, and accepting the fact that sheer greed is what is behind the over medicalization of childbirth throughout the previous venture that continues to this day. Any failures of the medical profession are blamed on lack of knowledge and good intentions. This is annoying.

But regardless, a really good book, great fun to read. ( )
  nandiniseshadri | Jul 12, 2020 |
Dr. Gawande looks at ways medical people have improved the field. ( )
  addunn3 | Jan 27, 2020 |
I had learned about this book when trying to find medical material to read that would give me a better understanding of medical professionals so that I could pray for them. From the first chapter, I was hooked. Moreover, I was elated to find that I had a couple things in common with the author in having Indian ancestry also, and I was born at Brigham and Woman's Hospital! "Better" was truly an eye-opening and fascinating look at the world of medicine, its history, and unavoidable pitfalls. I now have more patience for the great medical professionals my family and I routinely see, and even more respect for what they do! ( )
  nlpolak | Jan 25, 2020 |
A thoughtful insight into what it means to be a doctor. Treating patients as efficiently and effectively as possible is all about trade-offs. This is fraught with danger given the constraints which span cost; equipment; staffing and expertise; weighing survival against quality of life; possibilities of litigation.

There are some specific anecdotes which I recall. The challenges of getting all hospital workers to religiously wash hands. How large-scale polio vaccination is implemented in India. How staunching wounds and relocating soldiers to appropriate facilities yields better outcomes than immediate treatment. The benefits of spreading good practice rather than monopolising it as demonstrated by Cystic Fibrosis clinics. The final section is devoted to adoption of best practices at institutional and individual levels.

A quick read and highly recommended alongside Gawande's Being Mortal: Medicine and What Matters in the End. ( )
  jigarpatel | Dec 5, 2019 |
What’s The Point?

Gawande's second book, Better, delves again into explaining medical issues. Covering improvements in cleaning hands and saving lives on the battlefield, the moral issues around capital punishment, malpractice lawsuits, and improving birth rates in hospitals and overall performance, many topics are presented and fully explained.

How Was It?

An interesting and quick read. The book is mostly exposition, with many references, and personal anecdotes from Gawande. Most of the insights were new to me and as a programmer, I was able to correlate most of the wisdom to my profession. I am still impressed at the self reflectiveness of the book, discussing the medical profession's successes and failures. I feel many writings on the medical community are not nearly as accessible as this book.

Who Should Read It?

Anyone looking to learn about the medical community and understand their observations on performance. Or anyone interested in evaluating their own professions performance standards. ( )
  askedrelic | Aug 31, 2019 |
Showing 1-5 of 60 (next | show all)
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For my parents and sister
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Several years ago, in my final year of medical school, I took care of a patient who has stuck in my mind.
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