Rating: 
Summary: Read This Book!
Review: Rarely do I think a book is so important and so good that it should be read by everyone. Atul Gawande has written such a book.America has the best health care in the world and yet our health care system is a mess. High insurance rates and malpractice suits make for a situation where patients often cannot get the help they need and many doctors are afraid of taking risks because of the chance of being sued. With a willingness to realize certain things and make some changes, America could turn it's medical services into a true blessing for all of its citizens. What is the most important realization? That doctors are human beings and even the best of them are going to make mistakes from time to time. This is probably the most important point Gawande makes in his book. It is a sad state of affairs when every single doctor in this nation expects to be the defendant in a major lawsuit at least once in their careers. How many possible brilliant doctors has this single fact driven from the profession? It is one thing when a doctor makes an error through maliciousness but a doctor who makes an honest mistake should not have to fear career destruction. If something could be done about all this litigation, it would likely be easier to drive truly bad doctors from the profession because doctors and hospitals would be more like to start admitting when things go haywire and actually make a concerted effort to try to make things better. Though his insights into what it's like to be a doctor are incredibly valuable, I find his views on the psychology of being a patient interesting as well. His articles on the mystery of pain, the horrors of nausea & blushing (yes, blushing) and the results of a patient who has undergone gastric bypass surgery for obesity are eye-openers. He also has a very good chapter on the ethics of medical decision-making between a patient and doctor. Those people in the camp that all medical decision should be left up to the patient need to understand that, in many cases, the patient simply doesn't want to make that decision. I had read much of the material that is in this book before as Gawande has published in various magazines. But I kept an eye out for this and I am glad to see it all gathered together in a single volume. It has been awhile since I've been so impressed by a book.
Rating:
Summary: A view behind the curtain
Review: 'Complications' offered a fresh and critical look into a profession that is often seen with mystery and reverence. Medicine is frequently seen as a magical endeavor performed by perfect physician/machines who know all the answers but lack the time or humanity to perform miracles on their helpless patients. This book presents a human view of physicians as caring individuals with human flaws, imperfect skills, and limited knowledge who try to heal in a murky world of compromises and uncertainties. He unveils the hidden humility that many doctors secretly conceal behind their superficial confidence. As a paramedic, surgical technician, and medical school applicant, I have seen firsthand many of the situations the Dr. Gawande describes and can testify that he describes the many complex controversies with remarkable clarity and incite. While discussing subjects ranging from flesh eating bacteria to superstitions in medicine, he shows that he has the has the unique combinations of an insider's knowledge, understanding, and access with the outsider's objectiveness, skepticism, and compassion. He presents the unique combination of expert and student, and together with the remarkable clarity of his pros creates a must-read for both patients and providers.
Rating:
Summary: A moment with a surgeon
Review: There is a lot to like in this self-portrait of a physician. OK, now here's a guy who has a long list of life's best ticket punches. He grew up as the privileged son of a double-doctor couple in a verdant, genteel Ohio college town. He went to Stanford, then Oxford, then Harvard. Now, he's in residency, training to be a surgeon, a more prestigious medical specialty than either of his parents had. He is a published author, both in the medical research literature and in the popular press. I know about him because I've read his articles in the New Yorker. But the self-portrait that emerges is one of a humble, compassionate and well-rounded human being who just happens to have a first-class analytical mind and formidable skill with a pen. He admits to having no particular talent as a surgeon, just a dogged determination to master a complex set of skills. He makes mistakes, but he has some lucky breaks, too. He has a national reputation because of his New Yorker articles, but he wanders anonymously through his professional conference, acting like a first-year graduate student, feeling bemused and bewildered and lucky to be there. He finds time in his busy life to visit his patients at home because he wants to know if the surgery he performed on them did any good. Dr. Gawande sounds like the kind of doctor I would like to have. In one beautiful sentence that soars off the page near the end of his book, he states his credo as a physician: to have that one "crystalline" moment in another person's life when his intervention alters its course for the better. I was awed and humbled by that sentence because I know that I can't state my professional goal so succintly or so poetically. Since the sentence was at the very end of the book, Dr. Gawande had deftly preceded it with the weight of evidence necessary for a merely rational person to figure out that the odds were stacked against him. As he says in many ways throughout the book, medical knowledge and clinical skill are always imperfect, so such moments are rare and fleeting. But when I thought about Dr. Gawande's sentence more deeply, I found it disturbing. A generation ago, the ideal doctor was a Dr. Welby-like character, who delivered you and your sister and your mother and knew that all of you had a sweet tooth. Maybe managed care has damaged our health-care system so profoundly that all we get now is one moment with a doctor. If we're extremely lucky, that doctor may be a Harvard-educated surgeon like Dr. Gawande, who is not yet cynical about his job and is having a good day. One of Dr. Gawande's own cases illustrates a big problem with his credo. A woman shows up in a surgeon's office after a mammogram revealed suspicious microcalcifications in her left breast. She was upset because the surgeon recommended a biopsy. This was the fourth time that her breast would be biopsied and it was already disfigured from the previous attempts. And all of those earlier biopsies had come back benign. "I'm not getting another goddamed biopsy," she said. Every time I come in here, you people find these specks and want to operate. Dr. Gawande's response was to try to persuade the patient to change her mind because the abnormal mammogram could be an early symptom of cancer. But rather than discus with her the large body of literature that shows that the history of breast cancer surgery is a history of overtreatment, that there are many biases built into the culture of medicine and surgery that predispose to overtreatment, and that patient pressure has forced doctors to scale back their mutilating therapies, Dr. Gawande offers a cheap rhetorical trick. A good doctor, he says, will let the woman get dressed and invite her into his office, where they will sit side by side in comfortable chairs. He will say: Every time you come in here, we find something. And every time we do a biopsy, it's benign. As Dr. Gawande writes, these sentences show empathy because they convey to the patient that she's been heard. But the only thing the doctor actually did was repeat what she said. So maybe that crystalline moment isn't enough time for a genuine conversation. If Dr. Gawande can't pull it off, with his obvious communication and people skills, then who can?
Rating:
Summary: Surgery as you've never seen it before
Review: This book reveals surgeons as human beings who learn and practice surgery, with the emphasis on the words human beings. Dr. Gawande exposes the myth of doctor perfection and replaces it with a compassionate look at the humanity of surgeons. Of course this comes at the price of a loss of confidence in surgeons or at least a heightened sense of concern when someone you know goes into the hospital. Do surgeons make mistakes? They learn and practice on people and as part of that process they make mistakes. So should you use only experienced surgeons? What if they are not up to date on a newer and safer technique? They still have to learn and practice them. Where will our next generation of experienced surgeons come from if no one would use the less experienced ones?
These are tough questions that must be answered. It is easy to say that surgeons need to practice on people and should be encouraged to while under the supervision of a more experienced surgeon, but what if it is your child being operated on? Gawande even shares his experiences as he had to deal with this situation. A thought-provoking and revealing book it will educate and entertain. For people who want to see the human side of the surgeon's profession it is a recommended read.
Rating:
Summary: Confident With Him As My Surgeon
Review: "Complications", by Dr. Atul Gawande is a very gutsy and honest discussion about medicine in general, and surgeons in particular. The book is also unique, for unlike others of its type it is written by a surgeon that is starting his career, and not looking back upon it. I would imagine that the book caused some consternation amongst his peers. The book does nothing to minimize the skills and accomplishments of the men and women who can reach in to the body and do some pretty spectacular work. The book does portray them as human beings that come with all the normal traits that any of us do. The pressure they must deal with is that when they make a mistake, it can irreparably harm or cause the death of the patient they are trying to help. The vast majority of careers that people practice does not involve decisions that can cause the outcomes I mention above. And few occupations require of their practitioners near perfection, that if not delivered has a major legal industry prepared to hammer them with lawsuits. Incompetent or negligent doctors should be punished and removed from practice, but what about a human error, or a doctor that makes every single decision that is correct and appropriate for the patient he or she sees, and misses the 1 in 250,000 cases where doing everything correctly can cause a patient to die. The final chapter of this book deals with exactly those type of odds. Whether those odds are beaten often depends on the instincts of the physician. And these intuitive feelings they may or may not act upon are certainly helped by experience, but younger doctors without the years that familiarity brings can often make a decision largely because they are so new. Dr. Gawande makes clear that all the sophisticated technology available does not replace the one on one interaction with the patient. If we ever need a surgeon we want a person we perceive as experienced, a person we are literally willing to risk our health and our lives with. The problem is that virtually no one wants to be part of a new surgeon learning his craft even with very experienced surgeons standing right at the table, watching and even directing the path the surgery takes. Dr. Gawande also shares his feelings when his children are ill and the contradictions he deals with as a parent, even as he is often on the other side with people judging him and his youth. The statistics say that a surgeon will make a given mistake once every 200 times he or she performs a surgery that is described in the book, and that is also fairly common. If the mistake is made the results range from terrible to potentially terminal. The author does a great job of sharing what it feels like to be told that you will make the mistake, that doing the task 99.5% of the time without error can still cost a life. A person who decides to become a general surgeon will study and practice until their mid 30's before they are able to operate on their own. That type of commitment is rare, and recent articles have said that less men and women are willing to devote that much of their lives before beginning their chosen career. We want these people to be perfect when it is either we, or someone we care about that is to be operated on. They are not perfect, although those that are excellent can statistically come very near perfection. I would trust Dr. Gawande for he is a man that is clearly skilled, but is also acutely aware of how fine a line he walks every moment of his day.
Rating:
Summary: A remarkable "autopsy" of the physician personna.
Review: I read this book while convalescing from surgery,therefore with recent 'experience" from both sides of the blade. I was amazed at the impressive insight and expressiveness of this surgical resident who only starting his medical career. His descriptions of various controversial medical themes and dilemas evoked many of my own experiences,emotions and my own impressions of how it is that we solve our daily medical mysteries that rarely conform to the textbooks. I've recommended this book to my son who is contemplating a career in medicine, I think he'll understand better what he might be getting himself into. I am anxious to follow any subsequent writings of this writer to see what I think will be an interesting evolution as he becomes first an attending physician and then deals with many more challenging experiences that will leave him even more perplexed,doubting,dispirited,uncertain but at the same time elated by his many clinical triumphs.
Rating:
Summary: Tremendous Medical Writing
Review: We're inundated with medical information every day. Much of it is hype, or half-digested research work proposing cures for every known disease or ailment, "and all you have to do is ...." Gawande is a brilliant writer, but his main gig is as a resident surgeon. He explores many medical issues and ethical dilemmas in this book, illustrated throughout with real-life examples and case studies. You are certain to learn something from reading his collected essays, even if he sometimes raises more doubts in your mind about medical practice than you might care to enjoy. All of these essays have appeared elsewhere, but that doesn't detract from their power as a carefully sequenced collection. Highly recommended.
Rating:
Summary: Don't let the blood stop you
Review: Yes, this is a book by a surgeon, and there are certain, um, "graphic" descriptions in this book. But it's well worth your while to read them, even if they make you feel goosy, in order to learn from this incredibly talented writer, surgeon, and ethicist. Some ethical questions:
- Should a doctor act on hunches?
- What if the action might be risky?
- Should a teaching hospital let a junior doctor operate on YOU?
- Will the hospital even tell you if this happens? A big one:
- Is it ever right to ignore a patient's plea to "Please don't put me on a machine"? You may think you know the answer to the last one, but after you read his description of an actual patient who said this, you'll be much less sure. And what about when a doctor is sure of his diagnosis - is the doctor right? How often? Well, it happens that there _is_ a way to find out, and it was commonly used 50 years ago. We just don't like to use it much, anymore. It's called an autopsy. But in the few cases where it is still used, there are surprises. What an incredibly informative book. Read it. Get past the blood, you'll be glad you did. You'll see your doctor, and medicine, and your own body, in a whole new light.
Rating: 
Summary: promising
Review: Atul Gawande, who is currently finishing a medical residency in Boston, has some pretty big shoes to fill. As a surgeon writing essays about his profession for the general public, he follows in the footsteps of Richard Selzer, who has been writing wonderfully about the complexities and oddities of surgery for several decades. And writing in the pages of The New Yorker, he follows in the tradition of the great Berton Roueche, whose "Narratives of Medical Detection" are among the best pieces ever to appear in the magazine. Perhaps wisely, Dr. Gawande neither tries to be as lyrical as Dr. Selzer nor to plumb the mysteries and the adventure of medical investigation as did Roueche. Instead he offers us an entree to the world of the physician in training and tries to be scrupulously fair in his treatment of the various and often competing concerns of doctors, patients, ethicists, insurers, etc. He's generous in sharing his own experiences and discussing his mistakes and the essays are often interesting, but they are somehow antiseptic and less engaging than they might be if he took firmer positions on the issues or at least revealed more of his own opinions and prejudices. Dr. Gawande writes that : Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however-close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes -- is how messy, uncertain, and also surprising medicine turns out to be. He's at his best when he's leading the reader through the mess. From doctors with psychological problems to the vagaries of diagnosis to the strange, but surely coincidental, occurrences of a Friday the 13th with a full moon, he shows us that for all the advances in medicine in recent years, there is still much we don't understand and a stubborn persistence of quite alarming human error. He's less good in essays like the one on the decline of autopsies (which happens to be on-line) when he strives so hard to take a blanced and empathetic approach that he borders on abandoning medical judgment. The book is definitely worth reading and I'll be keeping an eye out for his essays. I suspect, and hope, that his best work lies in front of him and that as he gains experience and confidence he'll be willing to give his writing a little harder edge. Hopefully he can do that without losing his welcome humility, rare enough in doctors in general but almost unheard of in a surgeon.
Rating:
Summary: An utterly fascinating view
Review: There are other writing doctors around, but there's nobody like Atul Gawande. I'd first got to know his voice, his distinctive approach -- immense vivid medical detail combined with an almost philosophical interest in the systemic or ethical dimensions of the problems he explores--in the pages of The New Yorker. But there's a lot here that never appeared in that magazine, and, besides, the whole really is greater than the sum of its part. His arguments -- about the fallibility of medicine, about judgment under conditions of uncertainty, etc. -- run through the chapters like sinews. "Complications" is a genuine page turner, but you come away not only entertained, but enlightened, too. I've recommended it to a lot of my friends, and nobody's been disappointed yet.
| 
