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Book Review: A reminder that we can all improve

Posted By David Han On March 24, 2010 @ 5:09 am In Book Review | Comments Disabled

For those of us who wish to find cures for incurable diseases, who aspire to help others in ways most cannot, who desire to dedicate their lives for the wellbeing of others, Atul Gawande’s book Better: A Surgeon’s Notes On Performance offers a glimpse of the profession of doctors, underneath the social prestige and inside the operating room.

Written with piercing reality describing the imperfect science of medicine, Better achieves a level of journalistic authenticity that struck me from the first page.

Gawande, currently a general surgeon at the Brigham and Women’s Hospital in Boston, organizes the book as a series of his own experiences.

Recounting the days of his residency to more recent accounts as a general surgeon, Gawande examines what he believes to be the core aspects of success in medicine: diligence, doing right, and ingenuity.

The book begins with Gawande at the final year of his medical school.

A senior resident gives him the responsibility to look after a relatively healthy patient incase of the off chance of a fever. Gawande fulfills his duties, checking her for symptoms of fever, and finds she is well except for occasional complaints of mild insomnia.

Finding no symptoms of fever and nothing remarkably out of the ordinary, Gawande gradually begins to relax, checking her less often during the day.

Gawande learns later that, although he had been delegated the task, the senior resident had been checking on her twice as many times as he had. The senior resident, apprehensive of the patient’s complaints, checked this patient only to find her with a fever of 102 degrees. The nearly graduated med student had no idea of the incident.

Gawande had not failed in what he was assigned to do, but he nonetheless learned that treating a patient and truly caring for one were different. What was required was diligence, the strive to make less and less mistakes, which, in a profession where the slightest distraction could lead to failure, could make all the difference.

Gawande explores the ethics of medicine in the second main focus of his book, “doing right. Here, he touches upon the issue of malpractice suits, even when the doctor is not at fault.

Despite the litigations of the profession and being at a crossroads between what doctors believe is the best for the patient and what the patient believes is best, Gawande considers that doctors have the responsibility to make their best decision given the circumstance regardless of the possible consequences.

Gawande also touches upon the practices of others, of the importance of doing what is right, even when it is not popular.

Much to people’s surprise, it may save someone’s life.

In the final chapters of the book, Gawande tackles the quality ingenuity in the practice of medicine and how it allows the profession to move forward. It’s the creativity to recognize diseases and removing them before they spread. The challenge is difficult, but possible nonetheless Gawande argues through his account of observing the less preferable sanitary conditions in India.

Throughout the book, Gawande takes a humbling stance on the issues of medical practice. Gawande is unafraid to acknowledge the limitations of science in the field of medicine, which to some come as a shock since they may believe medicine to be an exact science.

Where most of the general public would expect perfection, Gawande instead reveals the inexactness. His sincerity for the science is moving, a quality that pierces through the pages of his writing.

The thought that our doctors and physicians make mistakes does leave us feeling uneasy, but these imperfections are the reason why doctors perform their best each day. What science seems to lack, human nature provides, according to Gawande.

He describes how the little things, like washing hands after seeing each patient or checking on a healthy patient for the simplest of reasons, are what save lives and drastically improve performance, not the high-tech gear or scientific advancements.

Gawande notes how since the medical profession involves lives on the line, doctors must not only think rationally, but also morally, inevitably involving ethics in their decisions. It’s an obvious thought, but I feel it often goes overlooked.

Especially today, with increased competition in the race for success, students may be focusing so much on the scientific aspect of medicine that they are forgetting the moral side to it.

Gawande is not saying that the scientific aspect of medicine is worthless, but that it is not enough.

When everything in science tells you that the patient is healthy, but something about the patient concerns you, would it not be the doctor’s responsibility to do something about it, perhaps notifying other physicians or the patient? When science says one answer but your conscious screams another, what do you do?

Doctors commonly face such dilemma. Gawande believes medical practice is not just scientific, but at times irrational, at times human.

Gawande’s book also indirectly brings up a point about today’s health care debate.

In what some historians believe has become less about providing health care to America’s people and more about party politics, Gawande reminds us of the importance of the doctor-patient relationship in medical practice.

He stresses the importance of trust between the patient and doctor relationship. The doctor can know everything about the subject, but, like was said before, there is a difference between simply treating a patient and truly caring for one.

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URL to article: http://www.denebolaonline.net/2010/03/24/book-review-a-reminder-that-we-can-all-improve/

URLs in this post:

[1] Plain Doctoring: The Future of Health Care An Interview with John D. Stoeckle, MD (MGH): http://www.denebolaonline.net/2010/02/10/plain-doctoring-the-future-of-health-care-an-interview-with-john-d-stoeckle-md-mgh/

[2] Book Review: Alex Tolkin, Class of 2009: http://www.denebolaonline.net/2007/12/19/book-review-alex-tolkin-class-of-2009/

[3] South teen Camille Brugnara breaks free from depression: http://www.denebolaonline.net/2011/04/15/south-teen-camille-brugnara-breaks-free-from-depression/

[4] Book Review: Sally Rosen, Science Department: http://www.denebolaonline.net/2007/12/19/book-review-sally-rosen-science-department/

[5] MSF; perks of globalization: http://www.denebolaonline.net/2010/11/02/msf-perks-of-globalization/

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