Gawande, Atul, Better: A Surgeon’s Notes on Performance, Henry Holt & Co., New York, 2007. 273 pp.
Several years ago, Dr. Gawande published a best-selling book on his experiences as a young surgeon called Complications: A Surgeon’s Notes on an Imperfect Science. In the intervening years, he’s written a number of elegant essays on medical topics for the New Yorker while maintaining a surgical practice at the Brigham and Women’s Hospital in Boston. In a further embarrassment of talent, he was a MacArthur Fellow in 2006 and now also teaches at Harvard Medical School and the Harvard School for Public Health.
Notably, he’s a rare voice of humility amongst his profession in reflecting on the day-to-day practice of medicine. Not just on the larger issues of “what we don’t know” or “what we can’t do” but on the oft-overlooked issues of “what we do poorly, every day, merely out of habit.” That honesty adds particular strength to his writing. In his latest book, he’s assembled his essay-chapters into three larger themes (diligence, doing right, ingenuity) all tied around his reflections on how he wants to improve his own practice as a doctor.
The results are fascinating. As befits a writer for the New Yorker, Gawande makes good use of anecdote and the background research for each topic covered. He writes well and writes for a general audience. A few months ago I listened to a podcast interview with the author and he mentioned that it’s a real struggle for him to get writing done because of his professional obligations. To some extent, that time limitation is reflected in this book. The subject area, improving individual doctor performance, could cover a lot of ground. Gawande doesn’t pretend to do so exhaustively. Instead, we have a series of vignettes on the limitations and successes of medical practice. For any reader interested in a particular chapter’s topic, the results are excellent. Those interested in the “gaps” between chapters may need to head for the academic literature and something closer to a textbook. More’s the pity.
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