- 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: 673 customer reviews
- Amazon Best Sellers Rank: #3,391 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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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.
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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!