Better (2007)

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

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. ( )

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? ( )

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.
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This is an excellent insight into the intricacies of "performance" in medicine/surgery, but also provides good thoughts on being "better" in any industry or line of work.Included are thoughts on malpractice, disease eradication, etc... a worthwhile read to better understand the world and each of our roles within it. ( )