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Atul Gawande

Complications: A Surgeon's Notes on an Imperfect Science Paperback – April 1, 2003

by Atul Gawande (Author)

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[Complications: A Surgeon's Notes on an Imperfect Science] [By: Atul Gawande] [January, 2008]
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In gripping accounts of true cases, surgeon Atul Gawande explores the power and the limits of medicine, offering an unflinching view from the scalpel's edge. Complications lays bare a science not in its idealized form but as it actually is―uncertain, perplexing, and profoundly human.

Complications is a 2002 National Book Award Finalist for Nonfiction.

Print length

269 pages
Language

English
Publisher

Picador
Publication date

April 1, 2003
Dimensions

5.5 x 0.72 x 8.25 inches
ISBN-10

0312421702
ISBN-13

978-0312421700
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Editorial Reviews

From Booklist

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

Review

“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

Product details

Publisher ‏ : ‎ Picador; 1st edition (April 1, 2003)
Language ‏ : ‎ English
Paperback ‏ : ‎ 269 pages
ISBN-10 ‏ : ‎ 0312421702
ISBN-13 ‏ : ‎ 978-0312421700
Item Weight ‏ : ‎ 8.8 ounces
Dimensions ‏ : ‎ 5.5 x 0.72 x 8.25 inches

Best Sellers Rank: #12,821 in Books (See Top 100 in Books)
- #8 in General Surgery
- #58 in Medical Reference (Books)
- #210 in Diseases & Physical Ailments Health

Customer Reviews:
2,493 ratings

About the author

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Atul Gawande

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Atul Gawande is the author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker since 1998, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by Foreign Policy and TIME. In his work as a public health researcher, he is Director of Ariadne Labs a joint center for health system innovation. And he is also co-founder and chairman of Lifebox, a global not-for-profit implementing systems and technologies to reduce surgical deaths globally. He and his wife have three children and live in Newton, Massachusetts.

You can find more at http://www.atulgawande.com.

Customer reviews

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2 star		1%
1 star		1%

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Top reviews from the United States

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John M. Vizcarra

Surgeons are people, too.

Reviewed in the United States on March 9, 2017

Verified Purchase

I was referred to this book by a friend of mine who knew I liked the books of Malcolm Gladwell. I first read it near about when it came out, around 2002, and just got around to re-reading it. I had only remembered two of the stories from the book, so it was very similar to reading it again for the first time.

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.

61 people found this helpful

Helpful

Chris R.

A great read! Unable to be put down until completed!

Reviewed in the United States on May 20, 2014

Verified Purchase

As a former Navy Corpsman (Medic) attached to the USMC infantry, I have always had an interest in medicine, and science in general, and this book was a great insight into the medical and surgery field.

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!

23 people found this helpful

Helpful

Anne Burnik

Medical Honesty

Reviewed in the United States on October 9, 2015

Verified Purchase

The author writes from the viewpoint of a resident and young surgeon covering such topics as When Doctors Make Mistakes, When Good Doctors Go Bad, Pain, Nausea, Obesity and the Ethics involved in end-of-life decisions. His excellent writing makes the hospital setting and the O.R. come very much alive. Doctors are portrayed as human beings with a high fallibility factor and surgeons are portrayed with very high confidence levels. Yet the doubts, the anxiety and the frustrations of the medical profession are also expressed very eloquently. His insight into the medical world is almost profound and his empathy with the patient is palpable. Gawande has written other medical books for the popular market that have gotten good reviews. I hope to read them soon.

18 people found this helpful

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Amazon Customer

A fast paced eye opening read that you can't put down!

Reviewed in the United States on June 6, 2017

Verified Purchase

I found this book to be very entertaining, well written, and disturbing at times. It certainly made me aware of how fragile life truly is and that we should take advantage of every minute of good health that we are given in this life. It also makes me realize that doctors are just like you and I, they might have more education, but when it comes to the nonordinary, they are just like the lesser educated in that they must make their best educated guess. We all put our pants on the same way but physicians through shear hard work get to live briefly in their patients world, and make profound decisions that will effect the outcome of their patient's lives forever. What a purposeful joyful burden they share with their patients. What a great payoff for all their hard work and studying: To change for the better and sometimes save lives every time you go to work!

5 people found this helpful

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Top reviews from other countries

Brian R. Martin

Daily dilemmas of a junior surgeon

Reviewed in the United Kingdom on December 18, 2014

Verified Purchase

This volume was originally published in 2002, when the author was a junior doctor undergoing surgical training in an America hospital. It was the first of a subsequent series of books that, together with giving the 2014 BBC Reith Lectures, have established him as a household name. It consists of a series of essays based on cases he worked on. They vary very widely, but all are linked by highlighting important question about the role of the doctor in medical treatment and the doctor-patient relationship, particularly in a hospital setting where decisions often have to be taken quickly against a background of imprecise information or knowledge.

A perfect example of this, although extreme, is the final case he discusses of an otherwise healthy young woman who presents with an inflamed red leg. Is this a severe case of cellulitis (probability approaching 100%) or is the leg infected with the bacteria necrotizing fasciitis (probability vanishingly small, but with potentially devastating consequences)? The author honestly admits that hunches, gut feelings and other unscientific considerations inevitably play a role in decisions about what actions to take, however much he wishes that they didn't. He is just as frank about other aspects of medical practice, such as the need for surgeons to hone their technique on real patients, with the inevitable consequences that the less advantaged in society become the `guinea pigs' and some operations will not be done well. But when his own child becomes dangerously ill he honestly confesses that he does not want an operation to be done by an inexperienced junior surgeon, as would any parent wanting the best for their child. How do we resolve this dilemma?

There are many other dilemmas of medical practice discussed in the book, such as: how should poorly performing surgeons be disciplined in a way that does not make the profession in general too conservative and hence hinder surgical progress; to what extent is a surgeon entitled to `steer' a patient into a course of action that they, the doctor, thinks is the right choice, even though the risks may be high; and should a doctor attempt to prolong life, even when the treatment will not prevent the inevitable outcome and may even produce more suffering?

This well-written book brings home to the reader not just the technical difficulties of being a surgeon, but also the ethical responsibilities it entails and the stark problems that surgeons have to face daily. It can usefully be read by both medical students and professionals, as well as by anyone who is liable to be a patient at some time, and that means all of us.

21 people found this helpful

Damaskcat

Complications

Reviewed in the United Kingdom on September 11, 2013

Verified Purchase

This fascinating book provides insights into the world of medicine. It is about the author's triumphs and failures and about his mistakes and his almost miraculous intuitions. I enjoy his writing style and he must be an interesting person to know in real life. There are strange and puzzling cases and even more strange and puzzling people - both as patients and in the medical profession. The author talks about marvellous recoveries and tragedies and about cases where medicine intervenes too much rather than letting the human body work things out for itself.

I think the one thing which comes over to me from all the medical books I read is that however much medical science advances there is just so much about the human body which remains undiscovered. Doctors are never going to get it right all the time however well trained they are and however much experience they have. I was interested to see how much of an inexact science diagnosis is and the autopsy figures quoted by the author show that the cause of death may turn out to be incorrect as many as a third of cases. The figures haven't changed in the US since the 1930s in spite of the huge increase in modern technology and ways of seeing inside the human body.

It is all too easy to assume that modern medicine has all the answers and this book will swiftly disabuse the reader of this idea. I found the chapter about patients being given all the risks and options fascinating. Do we want doctors to make decisions for us or do we want to be given enough information to make our own decisions? What should a doctor do if he/she believes a patient is making the wrong decision? This author's books are a must read for anyone who has had any dealing with modern medicine if only because it helps to remind us all that doctors are people too

14 people found this helpful

Barbara Macdonald

Surgical practice

Reviewed in the United Kingdom on October 13, 2015

Verified Purchase

Complications is a book for everyone and anyone; in theory we know many of the points Gawande raises - but in reality we don't know what it means to be a surgeon or medical practitioner. There has always been such mystique about the practice of medicine, even for those who practice it, that it's inevitable that few people know let alone understand of the doubts and responsibilities associated with this profession. And how many of us want to be operated on by a trainee? We all want the best surgeon. Yet how can the trainee student doctors ever learn to be surgeons and physicians if they are never given any responsibilities other than with those who have no money to pay for procedures? How many ssurgeons can excel at every possible type of surgery? How can they keep up with all the changes and advances in medicine and surgery? It's just not possible.
Thought provoking and highly recommended.

2 people found this helpful

Anthony

A fantastic book

Reviewed in the United Kingdom on April 30, 2012

Verified Purchase

You must read this book if you have any interest in Surgery or medicine! I have learnt so much from reading this. Atul's style manages to grip you so that you cannot put the book down. I did not realise that this is actually a collection of stories he wrote at different times and has been put together in a book. So some of the stories do not seem to follow on very well from the previous chapters. However this book has taught me to question Doctors and to ask them for second opinions. Doctors are not infallable and they do not know all the answers. A lot depends on how much time the Doctor has to diagnose you and on his/her "hunch" being right! In a way medicine becomes more of an art than a science at times! Hard to understand unless you read the book. Buy this book. You will not regret it!

One person found this helpful

Dynevor

A fascinating insight into the science or is it the art of surgery?

Reviewed in the United Kingdom on November 16, 2020

Verified Purchase

This is an honest account of the issues facing doctors and especially surgeons on a daily basis. The account of the specialist hospital in Canada devoted to just one operation shows demonstrates the adage that Practice makes Perfect - another example from Malcolm Gladwell's The Outliers...

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