- Paperback: 269 pages
- Publisher: Picador; 1st edition (April 1, 2003)
- Language: English
- ISBN-10: 0312421702
- ISBN-13: 978-0312421700
- Product Dimensions: 5.5 x 0.8 x 8.2 inches
- Shipping Weight: 8.8 ounces (View shipping rates and policies)
- Average Customer Review: 684 customer reviews
- Amazon Best Sellers Rank: #6,795 in Books (See Top 100 in Books)
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Complications: A Surgeon's Notes on an Imperfect Science 1st Edition
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Surgeon, MacArthur fellow, and New Yorker staff writer Gawande follows his best-sellers Complications (2002) and Better (2007) with an electrifying manifesto that pairs the most advanced medical science with the humblest of tools: the checklist. Concerned about medical mistakes, an array of which Gawande describes in dramatic passages guaranteed to raise your blood pressure, Gawande investigated the nature of ineptitude and found that the more complex our lives and work become—a raging side effect of technology—the easier it is for us to overlook details and to err, sometimes catastrophically. Hence the well-thought-out to-do list. Overwhelming torrents of details and demands are by no means restricted to medicine. In fact, Gawande discovered the power of the checklist in his research into aviation, and he extends his inquiry to architecture, finance, and legal cases. Back on his turf, Gawande credits nurses with creating the first health checklists and describes his own quest to make and properly use a safe-surgery checklist. With numerous tales from the front and striking anatomies of cognition and distraction, Gawande’s back-to-basics credo is invaluable. --Donna Seaman
“None surpass Gawande in the ability to create a sense of immediacy, in his power to conjure the reality of the ward, the thrill of the moment-by-moment medical or surgical drama. Complications impresses for its truth and authenticity, virtues that it owes to its author being as much forceful writer as uncompromising chronicler.” ―The New York Times Book Review
“No one writes about medicine as a human subject as well as Atul Gawande. His stories about becoming a surgeon are scary, funny, absorbing....Complications is a uniquely soulful book about the science of mending bodies.” ―Adam Gopnik, author of Paris to the Moon
“Gawande is arguably the best nonfiction doctor-writer around....He's prescient and thoughtful...the heir to Lewis Thomas' humble, insightful and brilliantly crafted oeuvre.” ―Salon.com
“Complications is a book about medicine that reads like a thriller. Every subject Atul Gawande touches is probed and dissected and turned inside out with such deftness and feeling and counterintuitive insight that the reader is left breathless.” ―Malcolm Gladwell, author of The Tipping Point
“Gawande is a writer with a scalpel pen and an X-ray eye.... He turns every case--from gunshot wounds to morbid obesity to flesh-eating bacteria--into a thriller in miniature. Diagnosis: riveting.” ―Time
“Gawande's prose, much like the scalpel he wields, is precise, daring, but never reckless....Much like reading George Orwell, the reader emerges entertained, enlightened, transformed and immensely satisfied.” ―Abraham Verghese, author of My Own Country
“Wrenching human tales...Gawande has pushed the medical yarn in a new direction.” ―The Boston Globe
“Atul Gawande is a rare and wonderful storyteller who portrays his profession with bravery and humanity.” ―Ellen Goodman, Pulitzer Prize-winning columnist
“The stories in Complications are gripping medical mysteries that always have something extra. Gawande draws you in with the story but leaves you wiser about science, about health care issues, and even about the human condition.” ―Michael Kinsley
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The theme of this book is reflected in its three parts: Fallibility, Mystery and Uncertainty. Each part talks about a particular aspect of Gawande’s career as a surgeon that deals with the less-certain side of being a doctor. Each concept is accompanied by one or more anecdotal references to his own real-life cases that illustrate his point brilliantly.
And that point is that doctors know a lot - but they don’t know everything. Their education and practical experience can help prepare them with knowledge, but skill comes from years of learned real-world practice. I could really sympathize with him and the stressors he has to deal with. I’ve been guilty as well of feeling my doctor must and should know everything that is right for me to do. The truth is a lot more complicated than that.
This book doesn’t even take into consideration the patient frustrations with healthcare - cost, attention, etc. It really does focus on pulling the screen back and giving you a glimpse into the vast uncertainty that accompanies this sometimes wondrous profession.
This is NOT a book that says, “I’m a surgeon. Here’s all the supercool things I’ve done and this is why I’m awesome and don’t you wish you could get me as your doctor?” This book shows the doctor, warts and all, and makes them much more human.
***What of this book?
1. It is written in three sections.
a. Fallibility (The shortcomings of physicians)
b. Mystery (Mystery Illnesses)
c. Uncertainty (Gray areas and diagnostic uncertainty)
2. I get the distinct impression that the author wrote a series of essays and then chose the best of them as could be fit into this book. It's like he didn't write only as many "songs" as he needed for this "album." He had a whole bunch of them in a vault somewhere and then just pulled some number of them together and then made the concept of the "album" after the fact.
***What can we learn from this book? Much, as it happens. I can give some of the things that popped out at me the most
1. Medicine is an empirical science. A lot of things are learned/ decided on the fly and with more information they might have been decided differently. There are no algorithms or simple answers.
2. There are questions about ways that surgeries can be set up. Do you train one surgeon to do many things, or do you train many surgeons (teams?) to do one thing only. The discussion of the hernia repair team and the way that they improved their efficiency by doing the same thing OVER AND OVER again (p. 35) is food for thought.
3. The training of physicians has to happen on *someone*. And the training for procedures to be done on humans can only be done on humans. And yes, people who are poor and unable to purchase their own insurance are more likely to be guinea pigs. And that's just the reality of things.
4. There are no clear mechanisms to sanction physicians when they are past their prime and start killing patients. This book is about 15 years old, but then (as now), government accountants and colleagues will catch the physician before any ethics/ disciplinary board.
Verdict: Recommended. The fact that this book is still high priced in spite of being 15 years old is its strongest recommendation. The present reviewer is offering one more.
As a young Corpsman with the Marines, I was thrust into medicine, and learned very quickly what did and did not work. "Watch one, do one, teach one" is how we were instructed to learn medical practices. From diagnosing (even though we couldn't "diagnose" as Line Corpsmen...we still did essentially) cellulitis, learning to place sutures, to removing infected toenails, I made mistakes, but generally our medical skills quickly flourished, and we were able to practice outstanding medicine for the grunts.
Atul writes about this, and the decisions he had to make, which affect him to this day. As a surgeon and author, he actually cares about his patients, which is a great thing to have as a medical professional. While he doesn't touch on this very much in his book, his caring about the patients and following up is the mark of a true caregiver. For it is those doctors, medics, corpsmen, nurses, and other medical professionals that actually care and are empathic with their patients, yet know how to distance themselves when needed, that operate the best and can change medicine for the better.
A truly great read, I would recommend this book to anyone interested in the healthcare system, surgery, medicine, and anyone who has ever worked in the medical field!