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67 of 71 people found the following review helpful
5.0 out of 5 stars Not always right but never in doubt
Surgeons are full of courage. To cut into another human being, slicing through the living, bleeding skin, exposing the interior organs, removing, rearranging or remodeling them, requires outrageous conceit. An elective surgery, performed on a patient who is healthy, who freely requests such injury in pursuit of a greater good, is daring enough. But surgeons are often...
Published on January 3, 2012 by BrianB

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21 of 27 people found the following review helpful
3.0 out of 5 stars Could have been much better to me
First off, I do recommend this book. For entirely too long the world of doctors has been 'behind the curtain'. Dr. Ruggieri should be commended for writing this book. He puts himself out there for all to see, warts and all.

That said, the book was a tad heavy on how he feels day to day and extremely light on medical technology. If he had explained why...
Published on January 15, 2012 by Michael D. Fisher


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67 of 71 people found the following review helpful
5.0 out of 5 stars Not always right but never in doubt, January 3, 2012
By 
BrianB (Northern California) - See all my reviews
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
Surgeons are full of courage. To cut into another human being, slicing through the living, bleeding skin, exposing the interior organs, removing, rearranging or remodeling them, requires outrageous conceit. An elective surgery, performed on a patient who is healthy, who freely requests such injury in pursuit of a greater good, is daring enough. But surgeons are often confronted with a desperate person, one who teeters on the brink of death, desiring only life. Surgery in such circumstances may save them, or it may hasten their departure to the land from which none return. The final arbiter of that hasty decision may be a judge and jury, and the final disposition financial and social ruin for the intrepid doctor. Who would choose such a job in a time of shrinking pay and waxing quality reviews?

Fortunately for all of us, there are plenty of individuals who would. The old axiom that surgeons are born, not made, holds true. Regardless of the rewards or penalties exacted upon their persons, surgeons can be nothing else but surgeons. So they tell us. And Dr. Ruggieri tells us plenty. In Confessions of a Surgeon, we read about his emotions, his late night thoughts, his shortcomings and misgivings, his resentments towards his patients, in short, his all too human traits. He writes about his mistakes, how they affect him, and how they affect his patients. Most patients don't like to think of their surgeon as a human being, but surgeons have all the limitations that the human condition entails. Star Trek Voyager may have the perfectly unflappable android doc, but you and I were born too soon for that. Some readers want the unvarnished truth, and here they will get it. If you prefer your surgeons on a pedestal, don't read this book.

Dr. Ruggieri is not a professional writer, and Confessions is more like a conversation than a polished narrative. There are clichés, repetitions, and meandering paragraphs, but it does not detract from the story. This is highly readable, informative and entertaining. He allows you to walk into surgery with him, belly up to the table, and get your hands bloody. If you really want to know what happens in an operating room, or what a surgeon thinks about while you complain about your belly ache, it is all here in living color.

I am an anesthesiologist, so I spend my days and nights working with surgeons, helping them, accepting their help, joking with them, and fighting with them. I have made a close study of the surgical personality, and Dr. Ruggieri is an outstanding specimen. He writes about the enormous complexities of human physiology, yet he is compelled to fast decisions and faster action. He writes about being humbled by his profession, and in the next paragraph he compares surgeons to gods. That is the mind of a surgeon. When he says humble, he means as humble as a god can be. I'm having some fun here, but considering what they do every day, you have to give them enormous respect. You have to respect his writing too. This book is a winner.
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11 of 11 people found the following review helpful
5.0 out of 5 stars Great insights and worthwhile to get an MD's perspective on the "business" of surgery., January 16, 2012
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Well-written, easy to read book on the surgical profession past and present. Eye-opening insights to the good, bad and ugly aspects of the profession. The doc-writer brings to the fore the intersection of old-school "feel" of a surgeon and today's world of intense, regmented, diagnostic medicine. The author leaves no doubt and confirmed my own belief that a referral to a surgeon will put you on a path to a surgical procedure, with a second opinion only increasing your chances of going under the knife. The author did complain about the economics of the profession changing for the worse, but it wasn't over the top. He justly stated that the old school "business" is not what many surgeons bargained (my inference) and that the current direction of the regulatory framework governing hospitals and surgeons, would result in greater specialization, I.e. a surgeon that only performs surgery on thyroids or the colon. Great insights.
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12 of 13 people found the following review helpful
5.0 out of 5 stars Well-written truths, January 22, 2012
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
Prompted by a review in the WSJ by the author, Dr. Paul Ruggieri, I purchased this book via Amazon.com. It was well worth the effort as the book presents a very honest, concerned surgeon responding to the stresses of challenging and medically fragile patients, exhaustion, threat of lawsuits, and the overwhelming number of regulations hovering over his shoulders in the OR. The WSJ review was printed before the book was available to the public. It generated a number of attacks against Dr. Ruggieri as the short review supported stereotypes of surgeons having temper tantrums, throwing instruments in the OR, and complaining of problems such as keeping the surgical field open in face of layers of fat in a 330 pound patient. These critics should read the whole book before throwing rightous barbs.

There is much humor, some of it dark,in the book. The information is true and written by a real doctor in the front lines of medicine and not by a non-medical scriptwriter or journalist.

His last chapter, WILL YOUR SURGEON BE THERE?, is a must read and could easily be changed to: WILL YOUR PHYSICIAN BE THERE? Physicians are now starting to retire at younger ages; not as many talented college graduates are applying to medical school; medicine has become a business and not a calling or profession; easier subspecialties with better work hours, more income, pleasant lifestyle, and time to sleep are causing a troublesome shortage of physicians in general surgery and primary care (internal medicine, pediatrics, and primary care.)

Dr. Ruggieri tells the truth in this highly readable and remarkable book. Surgery is a contact sport with life and death outcomes.
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8 of 8 people found the following review helpful
5.0 out of 5 stars Very insightful, February 28, 2012
By 
Patricia (San Diego, CA, United States) - See all my reviews
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
I originally bought this book in the Kindle version but then wanted to give it as a gift to a doctor friend so I bought this hard-cover version for him. The author, a successful surgeon, is remarkably forthright in his descriptions of the life of a surgeon, covering his days in medical school to his early practice and later as a more experienced and respected practitioner. It is his openness about his mistakes that makes the book so interesting. I certainly admire him. He is not happy with the way the practice of medicine is moving today and spends a lot of time refuting it. That part can seem a bit preachy but the book is well worth it.
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21 of 27 people found the following review helpful
3.0 out of 5 stars Could have been much better to me, January 15, 2012
By 
Michael D. Fisher (People's Democratic Republic Of Oregon) - See all my reviews
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First off, I do recommend this book. For entirely too long the world of doctors has been 'behind the curtain'. Dr. Ruggieri should be commended for writing this book. He puts himself out there for all to see, warts and all.

That said, the book was a tad heavy on how he feels day to day and extremely light on medical technology. If he had explained why cutting the wrong thing would cause problems and HOW, I would have enjoyed the book more than I did. No spoilers here - I won't go into detail about what I feel was missing as it is surely subjective. You'll probably find the book more than enlightening.

A good, solid book about modern medicine from the other side of the gown. And I'm really happy to see a doctor admit that we, the patients, have feelings and hopes - most doctors are standoffish and perfunctory. Maybe someday that cold, uninterested doctor will see me to have their computer fixed. I'd love the turnabout.
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4 of 4 people found the following review helpful
3.0 out of 5 stars Repetitive and opinion-heavy, but still interesting, July 29, 2012
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
I've been doing a lot of medicine-related reading over the past month, so I have quite a few other books to compare Ruggieri's to. This was the first I'd read specific to surgery (the others have all been on more specific topics), and it's a medical career path I'm somewhat interested in, so I was excited to get into it. The first 150 or so pages are good - with a lot of experiences and interesting insights mixed together. Additionally, it doesn't fall in to the trap of being interesting but poorly written. Quite a few of the other books I've read recently have suffered from that curse, which is understandable, since the authors are often scientists or doctors and not writers. However, as I read on, I began to notice that Ruggieri repeated himself. Very often. To such a degree that I thought, on multiple occasions, that I'd read the same exact paragraph or entire page previously in the book... in some cases, more than once. I understand referencing things mentioned earlier on, but I feel like I was told the same things two or three times word-for-word as if it hadn't been touched on before. It got very annoying after a while.

My other problem with the book is that in its last third, it shifts from mainly presenting real cases and unique insight to becoming heavily opinion and dialogue based. Up until this point, I fully considered this a four star book, but the last eighty or so pages were a real challenge to push through. There is a lot of talk about lawsuits - which I felt were adequately talked about throughout the book previously (this was, again, a case of specific repetition, for a while). However, what really got me was his complaining about the challenges of being a surgeon and the strict regulations being placed upon them. Ruggieri honestly, at quite a few points, sounded like a grumpy old man who had no good reason to disagree with the changes being made to surgery. In at least three sections of this book, he harps on how the 80 hour a week limit surgeons now must adhere to is a bad thing. Interesting arguments are given for why surgeons should instead be pushed to their limits during their training like they used to be. He notes that data shows that less mistakes are made under 80 hour limits... And then he writes that data off and simply says that surgeons just won't be as good without insane training because that's what he did. This was ironic, because he earlier complained that his mentors were extremely set in their ways and adamant that future surgical students be subjected to the same training as them. To further add to the contradiction, there's an entire section of the book where he talks about how tired and worn out he is and how he won't be able to keep up with the long hours as he gets older.

So, my takeaway from that argument was that: less than 80 hour work weeks are bad because they decrease experience, even though they reduce mistakes, but longer than 80 hour work weeks are bad because they wear you out and make you want to retire early. I honestly was not sure what he wanted readers to think about all of that.

Although other similar, contradictory arguments appeared in the latter third of the book, I'm not saying that I regret reading it. It WAS informative and interesting for someone going into medicine and trying to learn about the pros and cons of surgery. But I DO wish that the book had been more refined. In its current state, with all of the fat trimmed off, I'm sure that the book would be significantly shorter - probably only coming in at around 150-200 pages.
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8 of 10 people found the following review helpful
3.0 out of 5 stars A CASE STUDY IN ARROGANCE AND SELF-PITY, June 2, 2012
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
Although I really enjoyed some of the stories in this book, the author is just way to happy with himself and quick to find fault with everything in the world that he does not like or agree with. While reading it, I constantly reminded myself that the AVERAGE general surgeon has an income of over $300,000 per year. I'm not saying they dont earn it - they sure as hell do, they worked their butts off for over a decade in school and training and deserve every penny. But I can only stand so much complaining from millionaires. The vast majority of the book consists of the author talking about how awesome he is, how great surgeons are, and how his patients are LUCKY to have the chance to pay him a ton of money to cut them open. Then he proceeds to complain about pretty much everything under the sun - fat patients, nurses, administration and rules, lawyers, non-surgeon doctors, blah blah blah yadda yadda yadda. He seems not to realize that his choice of profession is just that - A CHOICE!!! If you dont like it, walk away, buddy! Stop your whining - the unemployment rate is around 10% - whining from the 1% is not flying these days.

Other irritating parts of the book include his attitude towards surgeons working superlong hours and operating while EXTREMELY fatigued. Even as he admits that tired surgeons make more catastrophic mistakes resulting in loss of life, he insists that its all OK because it taught HIM how to deal with adversity. It provided HIM with valuable experience and HE learned a lot! Well great!! Patients might be hurt, or die, but as long as he furthers his career and knowledge, thats all that matters. Its very distasteful.

The author left me with the overall impression that he thinks he's infallible and should not have to answer to anyone. How dare a malpractice attorney hold him accountable for his mistakes? Theyre lucky to just be near his majestic aura!

Im a big fan of medical memoirs, but I cant put this one anywhere near the top of my 'best' list - go with Dr. Michael Collins' books to read much better writing, more interesting stories, and experience what seems to be a much better human being.
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4 of 4 people found the following review helpful
5.0 out of 5 stars captivating insider account, February 5, 2012
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mikemac9 "mikemac9" (Los Angeles, CA USA) - See all my reviews
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This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
Reading this book feels like having a long chat with a friend from childhood with whom you still feel comfortable sharing everything. Many books about medicine focus on just the cases, some are oriented towards the training, but this book covers this and more. Readers get a sense not just of the training and practice of surgery, but what a surgeon thinks as well as a sobering admission that the world of surgery is subject to the same human frailties as anything else. Not every operation is a technical success, sometimes things go wrong due to the inexact nature of the field and sometimes due to error.

Dr. Ruggieri covers a broad swath in this book. One thing you'll learn is that a critical factor, a factor that unfortunately you as a patient can only tease out indirectly, is the ability of your surgeon to recover from the inevitable surprises and complications during a surgery. Fixing problems is huge. Furthermore not all surgeons are cut from the same cloth, but even though hospitals collect statistics on complication rates the patients are never allowed to see this. Dr. Ruggieri also talks about the changes in training in the time since he went thru, the impact of lawsuits on how doctors view their profession and treat patients, the grueling hours, and much more.

In summary if you want to get an understanding of what is on the mind of surgeons today, a sense of what they do, and implicitly some advice on how to pick a good surgeon should you need one, this is a book worth reading.
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8 of 10 people found the following review helpful
2.0 out of 5 stars Here's the deal..., July 14, 2012
This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
...I liked the book because I enjoy books on medical professions, and life in the OR in particular. Having said that, I was very distracted by the heavy repetition in this book, as many other reviewers have mentioned. The voice of the author often seems smug to me, and it is clear that he thinks very highly of himself. I did, however, enjoy his passion for making medicine transparent, and therefore more accessible to patients.

What I cannot get over is his etiquette and behavior in the OR. He seems to be completely accepting of his tendency to blow up, throw things, and generally act unprofessionally during surgery. Much of the book seemed to be him making excuses for his lack of self control.

Overall, I would say that this book could have been much more concise. Also, if you work in an OR, it is likely that this book will irritate you. If you do not work in an OR, or in anywhere in medicine, and do not mind heavy repetition, then go for it.

If you truly want an accurate representation of modern medicine, I highly recommend *any* book by Dr. Atul Gawande. His books are insightful, wonderfully written, and much more thought provoking.

Edit: Also, whoever is recommending this book to pre-med and medical students should stop. This book is not (or, at least, should not be) representative of life in the OR. Seriously...read anything by Dr. Gawande, or this great book: The Surgeons Life and Death in a Top Heart Center
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6 of 7 people found the following review helpful
5.0 out of 5 stars A Must-Read for Young Professionals, October 7, 2012
This review is from: Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors (Paperback)
"Confessions of a Surgeon" is one of the most honest, straight-from-the-heart works of nonfiction that I have read in quite some time. Dr. Ruggieri reveals his personal revelations, insights, and emotions in such a way that I found myself drawn to every page of his account. I wanted to know more after each chapter I finished, swallowing up the book in less than forty-eight hours. As a young professional in pursuit of a medical career myself, "Confessions" gave me such a truthful, personal insight into the real world of medicine and surgery that I have yet to find anywhere else. Others seem to feel the exact same way. On a recent trip to Zambia, I met a young American doctor completing his Emergency Medicine residency in Malawi. He happened to be reading Dr. Ruggieri's book. More recently, I was sitting in a Harvard University lecture hall waiting for my evening Pre-Med Chemistry class to begin and sure enough, a student sitting in the row behind me was reading "Confessions." I highly recommend this book to anyone who is thinking of pursuing a career in medicine and/or has already begun his or her journey into medical school. It is so beneficial to have a piece of literature that reveals the truth behind those closed doors and what truly lay ahead of us in our medical pursuit.

"Confessions of a Surgeon" was fuel to the fire for me. After reading this book, I cannot wait to personally get behind those O.R. doors, regardless of the good, the bad, and the ugly. My only hope is that I will have a mentor as passionate, caring, professional and respectable as Dr. Paul Ruggieri. I'll keep my fingers crossed.
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Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors
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