Complications: A Surgeon's Notes on an Imperfect Science

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Summary: An Anecdotal Review of an Imperfect Science
Review: Atul Gawande's work is an achievement that should serve as testament to the power of scientific writing to change one's perception of the medical profession. All too often is it easy to presume that doctors know how to handle every situation they encounter, having been hardened by the years of training and experience that has served them invaluably. Although this is usually true, Gawande describes a "gray" zone, where the lines of science and practical care seemingly blur, that is larger than anyone might've guessed.

Through his numerous reports, Gawande relates anecdotes replete with personal concerns & troubles that enshroud the surgical profession, hopes about its potential to cure even the incurable, along with the inevitable fears and regrets that come from past failures. It is with a tone characteristic of hard-earned wisdom (neither overconfident nor pessimisitc) that Gawande leavens his stories of cases too bizarre (i.e. chronic pain sufferers with no physical signs of pain) or too emotionally-charged (i.e. good doctors suddenly going haywire) for anyone but a doctor to tell with such unwavering constancy. Doing much of the detective work himself, Gawande plays the role of the outside reporter who strangely also has inside access, being a surgical resident himself. Among the issues he tackles is the ongoing debate over teaching institutions vs. surgically-specialized centers (centers in which only one type of operation is performed and every surgeon is an inveterate expert at it), the often unpredictable nature and course of human disease (even in the face of new technological advances and better diagnostic methods), and the looming uncertainty that every doctor feels, but which, against all odds, demands a decision be made so that lives may be saved (or lost). Throughout his work, Gawande portrays the industry not as the cold & composed exterior that many patients are fooled by, but as an intensely more human endeavor prone to errors and uncertainties just like any other. Decision-making is examined in great detail only to reveal that doctors, just like experts in any other profession, can make mistakes, and what's worse is that these mistakes can been avoided or corrected long before they become hazardous. What Gawande strives for in this work is not so much a cauterizing chop-busting aimed at putting all doctors under the gun, but a series of sympathetic peaks into the lives of surgeons and the difficulties they must encounter not just as professionals, but as fellow humans.

Gawande is full of stories, and he tells them with such open-handed honesty and detachment, sometimes even putting his own cases into the objectifying pool of things, that one would be hard-pressed not to rethink how medicine actually operates across the United States. The cases themselves are sometimes amazing, sometimes bewildering, and sometimes out-of-this world, but through it all there is a voice of hope and compassion--one that reaches out in spite of all the bad decisions, malpractice lawsuits, and unceasing ethical debates intrinsic to the surgical field, and that bridges the all-too-common tenuous gap between doctor and patient. Through his anecdotal and research evidence as well his own personal expertise, Gawande builds understanding for the sheer complexity of patient care (e.g. nonstandard equipment for testing, misinformation, conflicting sources of information, inaccessible data due to ethical issues, rapidly evolving technologies with little or no hands-on training, limitations of the medical science itself) for doctors who themselves are human and therefore necessarily fallible to negligence, error, fatigue, irrationality, emotional fits, and even immorality--a cardinal sin for any practicing physician.

It is no wonder this book was a Finalist for the National Book Award as the merit of its insight into the medical field is unparalleled, and the depths to which we, outsiders, are taken into the trenches of clinical warfare are truly hard to grasp, but nonetheless they provide a hard look at some of the most difficult aspects for the surgical profession, and for doctors on the whole. It might be easy to be saddened or appalled to discover the hands we put our lives in are, afterall, only human, but this shouldn't change our hope that whatever their risks, surgeons remain a modern blessing to us today, and that hope should not be lost, for, as Gawande subtlely informs us, modern miracles (or blind luck as you will) are possible. That though medical science still has many limitations barring its potential to cure many millions more, this should not deter us from our belief that disease can be prevented and cured, or that medical science as it is now is not capable of many wonderful and glorious things, because it is and does. What Gawande's work ultimately shows is the need for continued alliance in the search for better medicine by addressing its most baffling and stringent limitations of today, in the hopes that one day those who have unnecessarily suffered in the past or are suffering currently won't have to.

Rating:
Summary: Lovely
Review: Beautifully written book lacking in the self-congratulatory tone of so many medical memoirs. Perhaps most appealing is the doubt and uncertainty that surrounds some of the practioners and practices, serving to remind patients of the fragility of life and the limitations of medicine.

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Summary: Inspiring and entertaining
Review: I picked up this book and the local [store] not expecting a collection of cleverly written short essays that not only entertain but inform and inspire. I am a current pre-med student who was looking for a book that could perhaps share with me the experience of what it's like to be a doctor. Gawande was exactly what I had been searching for.
His articulate brilliance, along with sometimes gory details, gives the reader a behind-the-scenes look at the life of a surgeon that's easy to read, almost like fiction. Gawande shares with the reader the emotions, dilemmas, and distractions running through a surgeon's head. He recaps his encounters with numerous patients and shares with you the pain, suffering, grief, and relief that comes with them. I recommend this book to anyone looking for a little insight into the medical world. It's light, entertaining, refreshing, and so hard to put down.

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Summary: Good Read, Bigger Ego
Review: Atul Gawande is obviously a thoughtful and accomplished physician and writer and I enjoyed the way in which he unfolded many of the vignettes about various patients and the practice of medicine.

I was troubled, however, by the strong ego present throughout each story. Dr. Gawande often places himself at center stage during the telling of the story...even placing himself ahead of others when listing who was involved in the story, e.g., "I, another resident and an attending...." I found this practice to be disruptive. Additionally, several times I found myself wondering if Dr. Gawande wasn't telling a story in a certain way in order to elicit the response "Thank God he was there to save him/her!"

I also felt that Dr. Gawande should have expressed more gratitude for the privilege of being able to have direct access into patients' most intimate concerns and complications...and then have the opportunity to write (and reap benefit from!) the suffering (and sometimes healing) of his patients. I became concerned that Dr. Gawande viewed each subsequent patient with an eye toward his or her potential to develop into his next New Yorker piece.

"Complications" was worth the read if you can overcome the strong "ego" emanating from the pages.

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Summary: A great book
Review: Like the reviewers below, I read this book in a hurry and found it fascinating. For me, one of the crucial threads of this book concerns the psychological sophistication and maturity that doctors need in dealing with patients. How does a doctor speak to a patient in the subtly persuasive way that gets the him to make the correct decision about his treatment - especially now that it is no longer considered ethical for the doctor to take control? How does a doctor tell a patient he has cancer, or tell a family that their father didn't survive the surgery? The little story of how the surgeon got the post-operative patient to get out of bed and walk over to the chair, seemingly trivial, tells volumes about the way a humane doctor can use psychological power to accomplish a medical goal.

All in all, one of many great books about the human side of medicine.

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Summary: Are All Doctors Perfect?
Review: Well, not exactly. All doctors aren't perfect. Atul Gawande's book, "Complications: A Surgeon's Notes on An Imperfect Science" clearly explains why doctors aren't perfect. The fact is that all humans make mistakes, therefore doctors make mistakes. Since I'm intending on going into a medical field, this book makes me realize how much effort you have to put forth in order to receive a medical education. Atul Gawande gives you an opportunity to take a journey through his medical training and it shows the rigours of a surgical residency. Think how scary it would be performing surgery on a patient for the first time? If I were the patient I would be petrified because I wouldn't want the surgeon to make a mistake, risking my life. His incredible experiences with gastric bypass surgery, the case of the pregnant woman, the dead baby mystery, the case of the red leg, and many others kept me completely captivated with this book. The book is written in such a way that you never want to put it down. It's very intense, scary, and breathtaking, since you don't know what's going to happen with his patients. "Complications" is a must read, especially for those heading into a medical field.

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Summary: Morning sickness, chronic pain, obesity and more!
Review: Complications explores the humanity of doctors and society's unrealistic expectations of them in interesting ways. The author's observations on how patients want perfect doctors--but don't want doctors learning/practicing on THEM--were particularly striking. (When my husband needed a bone marrow biopsy, it was done by a UW student who had only done 10 in the past--we were not too happy, but we trusted him, and the young dr. did a good job.)

The book is divided into three sections--the first and third are best, because in them, the author is relating his own experiences. The second section, while very interesting, seemed like a synthesis of others' studies. The discussions of nausea, chronic pain, and appetite are interesting--Gawande makes the latest research accessible to the layman.

Each chapter is stand-alone; the book itself has some chapters that were originally published in magazines. This makes Complications an excellent book to read on a plane or at a patient's bedside--you can leave it for days, then pick up where you left off.

As the wife of a cancer survivor, I found this book refreshingly honest--it made me even more grateful to the doctors whom God used to save my husband's life. I truly believe that it is worth searching the country to find a doctor with whom you fit--a doctor like Gawande.

Rating:
Summary: Complications
Review: Complications is a great book. I like the way Gawande points out that just because your going to the hospital it doesn't make it safe even if yor going for a simple procedure. Things can go wrong thats why its an imperfect science. Another brilliant thing about Gawande's book is he holds nothing back and touches on several topics and people he knows. Complications has also tounched me because I'm a athlete and Gawande makes it clear that if I would need surgery I could have a first year doctor practicing on me and I wouldn't even know.

Before reading Gawande's book I use to think going to doctor was a safe thing because they're smart people and get paid the big dollars but I now realize that Surgeons are humans and all humans make mistakes. Complications also showed me that Being a surgeon is like any other profession you learn from your mistakes the only difference is these mistakes are life or death. Gawande's book also thought me several thing that go on in the surgeon's world like the M & M meetings were the doctors come forward and tell their mistakes they have made throughout the week.
So overall Complications is an excellent read and I will remember this book for a lifetime.

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Summary: Outstandingly True
Review: Nothing captures what it's like to be a doctor like the way Atul Gawande's Complications does. As a doctor in his internship year, ready to start off his residency soon, I also though that the medical field follows a certain path. You show interest in medicine, then you get into medical school, and then you follow your dream specialty and be the doctor that you want to be. Not true!

During my short tenure of true practice in different hispitals and fields, I have yet to bridge the gap between what it's like to be a medical student and what it's like to be a junior doctor. When we were students we were taught how to follow things in a scientific manner and carruy out what it's thought to be the right medicine. What you experience during your graduate years is something else. There are real patients that you take care of, with real problems and who want real answers. You don't just deal with diseases as you were used to, but with human beings. You meet different mentalities, different backgrounds and most importantly different human problems. Notthing could get you to know what doctors experience in everyday life and how they deal with things that they do. Atul Gawande, however, sheds some light one some of the different aspects of what it's like to be a doctor. He dissects the myth that doctors know everything and seem omniscient. He makes the doctor be what he always was, a human being. With all his fallibilities and imperfections.

Gawande divides the book into three parts, with different essays showcasing the different major topics. As a surgeon, he has the hardest task of breaking the ice on the most enduring, self absorbed specialty. Surgeons may give out the feel that they are god, but they're by far very different that what they are according to this book. I bought the book for my chairman during my tenure in surgery as part of my internship year. He came up to me the next day after reading several chapters, saying that if he were a writer, he woul be writing about exactly the same things as what Gawande is writing.

Gawande's style of prose is easy to read and thought provoking. His simple English is a pleasure for everyone, the doctor and the layman. His few uses of medical terms is followed by an explanation of what they mean. Thus, the book is a pleasureful read from beginning to end. His chapters are not dragging and he follows them at the end with a bibliography of the scientific papers he quoted in his essay. Most of these essays were previously published in The New Yorker and Slate magazine, but they still are anice to read in this collected edition.

Complications is a nice piece of prose that closes the gap between doctors and their humanity. Now I feel more comfortable when I'm in the ward and there are things that I may not know and patients I can't deal with easily. This justification of being only human is not taught to us, but has always been a part of what we are.

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Summary: Endlessly Fascinating Accounts from a Surgeon
Review: I was totally taken aback by how incredibly involving and fascinating this book was. Dr. Gawande writes of the grand successes and the human imperfections of the science of medicine, and shows us how both doctors and patients are involved in the quest for improving health and saving lives. Would you consider a chapter discussing nausea and vomiting to be of interest? Dr. Gawande makes even this unappealing topic unbelievably informative and riveting. Indeed, every page is a revelation. Five stars is a poor rating for such an invaluable source of awe-inspiring essays. Required reading for everyone.