Complications: A Surgeon's Notes on an Imperfect Science
Complications: A Surgeon's Notes on an Imperfect Science

 
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Gently dismantling the myth of medical infallibility, Dr. Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science is essential reading for anyone involved in medicine--on either end of the stethoscope. Medical professionals make mistakes, learn on the job, and improvise much of their technique and self-confidence. Gawande's tales are humane and passionate reminders that doctors are people, too. His prose is thoughtful and deeply engaging, shifting from sometimes painful stories of suffering patients (including his own child) to intriguing suggestions for improving medicine with the same care he expresses in the surgical theater. Some of his ideas will make health care providers nervous or even angry, but his disarming style, confessional tone, and thoughtful arguments should win over most readers. Complications is a book with heart and an excellent bedside manner, celebrating rather than berating doctors for being merely human. --Rob Lightner

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.

Customer Reviews:

  • best med essays
    Dr. Gawande's book is one of my recent favarites. If you watch ER, Grey's Anatomy, this is a must have!...more info
  • great book for medical and non-medical professionals!
    Excellent book on the imperfections of medicine. Keeps the reader interrested through the entire book - it's almost sad when finished......more info
  • Excellent writing and will challenge your assumptions about medicine
    Gawande is a wonderful, vivid writer and this book was well chosen as a National book Award finalist. He is not afraid to admit some errors he made along the way, including some regretable hubris that harmed some patients but he also writes about the way doctors learn - and the limits and challenges they still face in the imperfect world of medicine, where so much depends on following one's instincts, in spite of so many advances.
    Whether learning about how autopsies first came to be used (for religious reasons) or how a newscaster dealt with a disabling case of blushing or about how and why "Good Doctors go Bad" (and how they are treated), I found this book a rich compendium of useful facts and information.
    It will also help you ask the right questions next time you have to face a medical decision, large or small, guiding you to ask the right questions of your doctor. ...more info
  • Great insight into the medical profession and into people in general
    This is an honest and open look at the medical profession. If you are suspect of doctors or if you look up to them, this audio book will bring you closer to reality....more info
  • Nurses love Dr. Gawande's stories too!
    Being a critical care nurse and emergency room nurse, I've seen lots of medical crisies, and things that should have gone right but went really wrong. I have also had the blessing to see people live, who should have died. Doctors and nurses work very hard to promote life equally for all our patients, but I've learned, it's not in our hands at all. God has the ultimate say.
    Dr. Gawande writes with the most natural prose and interesting flair that I have ever seen. I cannot imagine how he found the time to jot down all his musings while being on duty for days at a spell.
    The man's got some powers of observation, that's for sure. And I learned a lot of valuable information by reading his interesting cases.
    For example, he talks about his struggles to become a talented surgeon,and how equisitially difficult this specialty can be. On page 41 he discusses superspecialization, at a Hospital that did nothing other than surgical repairs of hernias. Apparently, this hospital does this procedure extremely successfully, and their statistics are impressive. Dr. Gawande observes their surgeries, day in and day out and then wonders if doing the same surgery over and over becomes tedious or boring? One of the surgeons answers, "No, I am not bored. Perfection is the excitement."
    Whoa.
    That stopped me in my tracks for sure!
    Another chapter of the book details routine gallbladder surgeries and how a commonly done procedure such as a lap chole can result in a fatality if anatomical variance is not respected in all patients. I never knew about this, and I appreciated the depth of Dr. Gawande's descriptive prose in discussion of lap chole, or open abd choles. Very interesting stuff here!
    Thirdly, I really loved the story about the woman who blushed incessantly and uncontrollably. I always wondered what part of the autonomic nervous system was responsible for blushing and Dr. Gawande mentioned blushing is a sympathomimetic response to stress. A young woman was so disturbed by her own incessant blushing that she was driven to have surgery to cut the nerve that was responsible for it. This was a most interesting case to understand....where does Dr. Gawande hear of such interesting cases?
    Finally, the last big case study was about a healthy young woman who had a case of cellulitis, which turned her leg red. It was more a hunch than scientific certainty, but Dr. G insisted the patient remain in the hospital for a complete work-up. This saved this young woman's life, in ways that the good doctor cannot still explain. It was just a hunch, but the wound culture grew group A Streptococcus eating up the flesh in her leg. The surgeons eventually had to perform an amputation on the woman, but she is alive today, all due to one doctor having a hunch and nothing more than that to go on.
    The book is chock full of more very interesting cases from his workplace and each one holds a valuable lesson.
    Doctors are up against all sorts of challenges; each and every day. They recieve decades of training and yet, this doesn't cover every disease that they will be commanded to recognise, treat and cure. Medicine is not an exact science and not the most beautiful of art, but it is all we have that seperates us from an early grave. There are no algorithms for life; it is by experience and 'feel' that alot of MDs practice and hopefully, they're right each time.
    In the end, Dr G ponders human judgement and how doctors sometimes succeed with it and fail with it.
    Get this book and read it...spend some time savoring the case stories, because this is real life and all doctors and nurses agree that for all that we know with our modern, sophisticated western medicine - we really end up showing that we know very little.
    ...more info
  • great read
    this book was fascinating. interesting cases, a good amount of medical information but not enough to leave you reeling, written with compassion and frankness. it made me really think about my own interactions with doctors. ...more info
  • Not that extreme
    Going into this book I envisioned many extreme surgical cases to overwhelm me. That wasn't the case though. This book only gives cases from one persons viewpoint as examples of the learning process for those in the medical profession. This book is really trying to gain a bigger audience than it deserves by playing up the complications of surgery when it is really more of a learning aid. I enjoyed it but was somewhat let down....more info
  • A good read for medical students
    I read this collection of essays for a medical school class. Gawande is a skilled writer who tells vivid stories. The medicine is neither dummed down nor hyped up for the general public. The only reason I did not give it five stars is that the middle third of the book strays from the theme of Gawande's experiences as a surgical resident to essays about general interest health topics. As a physician in training I am particularly interested in Gawande's stories about his residency and the struggles of being human in a profession where recognition of human weakness in oneself is not always seen as a positive. I encourage every medical student to read his thought provoking essay 'Whose Body Is It Anyway?' (pg 208, paperback edition)...more info
  • A Great Read !!!
    This book has such great detail thta you feel that you are right there and involved. The author is really good at defining medical terminology and, what others might not understand. Very good, if you interested in the medical field....more info
  • Eye-Opening
    This book was very interesting, and it's taken me a week or so after reading it to decide what I think about it and formulate what I want to say in a review.

    The book was split up into three sections. The first section, "Fallibility," made me not want to be a doctor anymore, because it was so brutally honest about what can go wrong and what does go wrong in hospitals and medical schools.

    The second section was called "Mystery," and I found this section VERY interesting. There were individual chapters in this section about different issues in medicine - where pain originates from, nausea, gastric bypass surgery, and Sudden Infant Death Syndrome. I didn't know very much about any of these topics, so Dr. Gawande's thoughts on them were very much appreciated.

    The third section was called "Uncertainty," and it kind of tied up all loose ends. It discussed possible solutions to problems in the world of medicine, but made it clear that in this field it's almost impossible to be 100% certain of anything.

    All three sections of the book had numerous narratives of patients Dr. Gawande has encountered, and I enjoyed reading these case-studies. The book was a little slow going at time...I stopped reading it for about a month when I got too busy, and just picked it up again over the holidays. Overall, I enjoyed it, and I recommend it to anyone who is looking into medicine as a profession, because it will open your eyes!...more info
  • A peak inside
    I always appreciate a well written book that lets me into the inner circle of a group I will never know. "Reading Lolita in Tehran" served in much the same way....discussion between Muslim women in Iran behind closed doors. An American man will never hear those discussions. "Complications" is similar. I know physicians have their own argot...the secret language if you will, of their profession. They will never allow non-physicians to hear them speak/think candidly...to be allowed into their clubhouse without the degree. Gawande let me lurk...be a bit of a fly on the wall and I appreciate that. I rated this book four stars instead of five because he still hides out a bit behind his pride of profession. Wanting to show us without really letting us in. Hubris is too hard a word, but it's close.
    I've recommended this book....this one and Gawande's other, "Better" to physician friends. I haven't heard back, so I can't say how they will be received, but I suspect he'll get a five from a member of the fraternity."
    ...more info
  • Required reading...
    This book, House of God by Samuel Shem, and Hospital Survival: Lessons Learned in Medical Training by Grant Cooper should all be required reading for ANY medical student or resident. Too scary, real, and entertaning....these books teach, inspire, and warn....all in their own way. ...more info
  • Reality
    I highly recommend this book to any medical student, pre-med or even resident, especially the first year who struggles with the many life altering decisions one makes in the OR. Not only will medical professionals relate to this book, but lay people - future patients - will have an understanding of the importance of learning about their diseases. Fallibility exists in all humans, even physicians, but Dr. Gawande presents a great light to the world of medicine that leaves the reader with both a foundation of medicine's past and a hope for the medical future....more info
  • Interesting insight into the world of being an intern and a doctor
    The first part of the book is the typical medical error conversation - the system needs changes, but, instead, the last doctor to touch a patient is always ultimately responsible. The last two sections of the book are full of interesting patient stories and antecdotes, leaving the reader with a sense of "why do I pay so much for services that are not consistent and not scientifically proven?" Gawande does an excellent job pointing out some of the uncertaintaties of medicine and some of the major health disparities and inequalities - the poor are usually the ones that are used as training tools for interns and residents, and receive subpar-care compared to the well-insured.

    A very easy and quick read. ...more info
  • Almost a new age medical classic
    I am a great fan of Dr Gawande.
    Since the first time I read his essay in the New England journal of medicine, I have expected more from him.I have read most of his pieces from the New yorker.
    I think he is amazingly talented and that he will only turn out more and better books.
    As a layman, I would give this a 5 stars: for once Dr Gawande has been able to describe in a medical person's perspective that would register with a layman.without the glamour and jazz.
    Our fears,doubts and tribulations.
    For medical personnel: this would be a 3 stars: not because it is subpar, but because he tends to simplify this a little more than I would like him too. He lost me through 3/5 ths of the book when he hit the Bariatric surgery part. I had to struggle to get back in again.
    I would have liked him to tackle the other part of patient care that we, being PC, tend to avoid: difficult patients, people who live of the system, a lazy and inefficient system which chews residents and fellows and makes a mockery of ideal medicine.Of a profit driven insurance system and a medicare/ medicaid system which promotes mediocrity.
    But maybe that is another book.
    a must read for pre meds and parents of pre meds....more info
  • Eye Opening And Insightful
    This is about medicine in the way Apocolypse Now is about the war in Vietnam: don't be fooled by the setting. OK, maybe that's going too far, because the book IS about medicine, but there really is a larger, fascinating examination here of human limitations, and how nothing is black-and-white, depsite our fervent otherwise wishes. Dr Gawande writes with the saavy of a spy novelist- it is virtually impossible to put this down in mid chapter without discovering the outcome of the various cases he uses to illustrate his points! ...more info
  • What a Novelty!
    As the title of the book, Complications: a Surgeon's Notes on an Imperfect Science suggests, the book is about Dr. Gawande's experiences working as a surgical resident. The book talks about the mishaps that happened to patients due to doctors' bad decisions and lack of experience and also the miracles and eccentric cases that nobody can explain. The events are thoroughly researched and written in detail, while refraining from the use of jargon, so that people with no knowledge of technical, surgical terms are able to understand it. The patients and their conditions described in the book are truthful and are easily related to. This book will open its reader's eyes and provide them with cruel insights of the medical world. This is an interesting read; I highly recommend it to everybody....more info
  • A wonderful book: thoughtful, insightful, and clearly written
    I cannot recommend this book too highly for anyone interested in medical practice as a clinician, future clinician, present or future patient, or friend or loved one of a patient. In other words, just about everyone. I am using it in my Medical Ethics (philosophy) course because each of the essays raises important bioethical questions. We are also using it for an educational session in the Pediatric Ethics Committee of a major teaching hospital.

    My only regret in assigning Gawande's essays in a university course is that all of the other readings, even the best written, may seem a bit dull by comparison. Gawande is a master story-teller, and most of the essays tell compelling stories. More than anything I've read, they give the reader a feel for the drama of medical decision-making. But they do more than that because Gawande uses each narrative as a springboard for raising larger issues and, in many cases, offering insightful and compassionate suggestions for how to address them.

    Gawande's essays are, in spite of the ultra-serious subject, a joy to read. They are models of clarity and among the best-written essays I've ever read (and I've been teaching over 30 years).

    Gawande presents the medical profession realistically without sugar-coating. Medical errors and plain negligence are not ignored. But in the end one gains a realistic appreciation of the medical profession, of the frequent need to make life-and-death choices without the comfort of definite evidence, and of the extent and limits of patient autonomy. ...more info
  • good book
    this is a good book from a physician's perspective on medicine and surgery. i gave it to a friend that's in med school and he has thoroughly enjoyed it....more info
  • Great writing and some good old-fashioned follow-up reporting
    MacArthur Fellow. General Surgeon. Staff writer for The New Yorker. Assistant Professor at Harvard Medical School and Harvard School of Public Health. Husband. Father of three.

    That's nothing short of amazing. What's more amazing still is the quality of the writing - it's insightful, fast-paced, educational, and chock full of applicable research and the results of some good old-fashioned follow-up reporting by Dr. Gawande. Gawande is quick and gracious to spread praise to his editor, Henry Finder. Indeed, the pieces seem supremely edited. I'm struck by how focused and well-crafted they are. Results like this aren't from happenstance. Gawande talks of Finder's "patience and persistence and optimism to pull me through seven complete rewrites of the first article I submitted to The New Yorker." That effort is borne in spades on these pages.

    I enjoyed every piece. What stands out is how much more there is to doctoring than just the practicing of medicine and how well Gawande gets to the essence of those 'other' aspects. ...more info
  • Articulate and Thought-Provoking
    Doctor Gawande gives a scintillating account of how our medical system can harm us. None of us thinks that we will be the victim, but this book gives us, with alarming clarity, how we are mistaken if we believe that our medical system is infallible. While I have always believed, and still believe, that most doctors do their best to do right by their patients, this book shows how easy it is, in the system that we have for delivery of our healthcare, for us to be hurt by negligence, inattention, or lack of caring. Doctor Gawande has been a participant in the system that he describes, with great attention to detail. His prose is riveting, his descriptions are pointed, and his compassion for his patients is evident in this much-needed disclosure of the truth of errors in our medical system. Anyone who wonders what he might risk by submitting to surgery or medical care should read this book. ...more info
  • Thoughtful and Engaging.
    An extraordinarily thoughtful work. The first few chapters are gripping, troubling, and somewhat inspiring all at once, though the high expectations that the first chunk of the book establishes aren't entirely met come the last page....more info
  • A Glimpse Behind The Curtain
    The medical profession, for much of its lifetime, has been shrouded in mystery. For many, the words and judgements of a doctor seem infallible, which is why there is often such incredulity associated with mistakes. It's only been in the past few decades that this has changed and people are learning that doctors are humans too. In Atul Gawunde's book, we get a behind the scenes look at his life as a resident in Internal Medicine and some of the truths that people must accept take place when they enter a hospital. What amazes me most about Gawunde's writing is his use of anecdotes to perpetuate his arguments and ideas. His experiences have been so rich and varied that he is able to draw upon so many fascinating cases to highlight some of the great and some of the not so great aspects of medicine and of learning to be a physician. Anyone who would like to be a doctor - and especially those who want to go into any surgical field - will benefit from this open and honest account of what it truly means to be a doctor. I was thoroughly engaged and even scared to learn about what often goes on in the mind of the person wielding the scalpel blade....more info
  • Brilliantly written reflections of what it is to work in medicine
    This book was required for a friend's ethics class and she could not stop talking about it! I had to read it, too, thanks to her. We are nursing students, about to embark on our clinical rotations, and have both been strongly affected by this real and wonderfully written book. Dr. Gawande really has captured everything for the reader, who is left profoundly more knowledgable about a challenging and difficult, but rewarding, profession. He is amazing!...more info
  • awesome
    there is nothing bad to say about this book. It was rivetting from the start and held me to the end. Definitely give this a read, because there is so much useful information....more info
  • Great book
    It's a great book. What more can I say? Read it if you are going into medicine. It is a great example of fine writing produced by a physican on the topic of medicine. ...more info
  • doctor diagnoses doctors
    Gawande's essays provide a long-overdue look at what it's really like to be a surgeon and the uncertainties and quirky personalities behind doctors' professional masks. It would appear that more recent books that take readers behind the scenes of modern medicine and explore the persons behind the mask owe a great deal to Gawande's pioneering work. He had the courage to explore and expose these issues when he was at a relatively early and therefore very vulnerable stage of his career. Would a female surgeon who tackled these subjects - and perhaps addressed the sexism in her medical speciality -- have been as well-received as Gawande says he was? Interesting question. Most of the topics are interesting - why good surgeons go bad, nausea, flesh eating bacteria. Although the essays at the beginning and end of the book are quite fascinating, the ones in the middle are uneven - both in terms of the quality of the subject matter and the quality of his writing. He's also somewhat formulaic in how he puts each essay together. But his candor, his evident commitment to his patients, his endless curiosity, and the way he follows up with patients about whom he clearly cares very deeply make this a wonderful read - and give laypersons reason to hope that if the need arises, we may have the good fortune to encounter such a caring and honest surgeon in real life. Well done and well worth reading. ...more info
  • excellent!
    I use this book in my course "U.S. Health Care Policy & Politics" and the students love it. It's a great primer on the residency experience, the unpredictability of medical care, and a variety of topical issues: medical education, obesity, medical malpractice, physician monitoring, pain management, medical conferences, etc. I highly recommend this book to anyone interested in medicine and health care policy. The writing is superb....more info
  • Easy to read
    Needless to say, this is a very interesting book. What surprised me is that it is so easy to read. It doesn't have many big words or difficult medical terms. I really enjoyed the book. I especially recommend this to anyone interested in doctor's life or practice of medicine (from a non-technical and more general view)....more info
  • A glimpse of a surgeon's pressure
    A down to earth consice portrait of the problems and pressures facing surgeon's and surgical assistants. A good read. The reality of training - the variety of problems interestingly exposed. An excellent book....more info
  • Science Giveth - And Science Taketh Away
    These are words my general pathology prof tells his class every quarter. And indeed, that is what happens in real life, sometimes in a matter of seconds.

    Anyway, before purchasing this book, I wanted to know what happens behind the scenes - the office politics everyone has to deal, 17-hour shifts as an intern, how docs deal with making life & death mistakes, regrets made in the OR, unusual diseases, difficult patients, prima donnas, and so forth.

    I was not disappointed. Dr. Gawande has a way with words that makes this book a great read, even for people like myself - someone who is not a great reader. My mind could make pictures from his words as if I were watching a very special movie. He paints a face on the mysterious surgeon that every reader can relate with. The surgeon becomes a real person that deals with conflict every day. The surgeon is human and must sometimes act fast. Not everything goes by the book and sometimes he finds his own judgment is literally, dead wrong.

    I may read this book again soon - after I read Dr. Gawande's new book.

    ...more info
  • Spot on
    I received this book as a gift from my residency director at the conclusion of my Emergency Medicine residency. Residency is a difficult time of self-doubt, self-effacacy and self-discovery. I found Dr. Gawande's insight and frank discussion quite refreshing. It reminded me of the humanity in this very human endeavor. I encourage all my patients, present and future to read this book and realize that the physician is human, fallable and trying to do the right thing. Dr. Gawande shows how it is the "Art of Medicine" rather than the "Science of Medicine." Must-read reading for both physicians and patients alike....more info
  • Great book on surgery
    Atul Gawande gratefully takes the reader to the back of the OR, a place open for a few, yet intriguing for many. Dr. Gawande is extremely frank and poignant, as he describes actual cases from his own surgical practice. He admits that cutting someone open for the first time is hell, praises surgery which gives chance to obese people, wonders about doctor's intuition, and remains human in every case.

    As always, Atul Gawande is not just writing about medicine; this book reaches far beyond the realm of the operating room. He touches on the most complicated ethical questions of medicine and society as a whole. Gawande speaks of mistakes and our imperfect judgment; tackling the questions of good doctors gone bad along with malpractice claims and punishments. He makes the case for autopsy as a means of learning. He admits that medical students must practice on cadavers or animals in order to cut people open; all ethical questions are answered by means of vivid examples.

    For instance, in the 1980s the death rate from a particular surgery would be about 10%. When the new surgical treatment of heart pathology arose, surgeons started trying the novice. At that training period, the rate of children death from this particular intervention increased to 25% of cases. Sounds horrible? Yes, but after surgeons learned, the rate fell down to just a couple percent. Was it worth it? Sure, granted the number of lives saved in the long run. Never, granted now many kids died just due to surgeons' learning. Would any doctor let anyone practice on his own kid? Never. At the same time, learning is a necessary part of medical progress.

    Those questions dominate the book; Gawande ponders at the patient's right to choose, reminds us that doctors are human and prone to mistakes, reveals mysteries of complications, which are usually open only during the M&M - Mortality and Morbidity Conference behind the closed door. Gawande is not afraid to open the doors. Moreover, he is confident that openness is the only way to reduce the complications.

    I almost wanted to say the book is too idealistic, except it's written by a person whose profession is to think realistically. Great book!...more info
  • Goes Beyond Medicine
    The theme of many of the essays that Atul Gwande presents in this book transcend medicine and apply to other occupations as well.

    If you are a person who looks insightfully at the big picture behind your occupation--then you will appreciate how carefully Atul Gwande crafts each essay around a theme.

    I challenge those in the field of software development to pick up this book and see if you make the same conclusions as Atul does in your own field....more info
  • pointed and accurate
    This book is both precise and poignant. It gives clear examples from real cases about how the medical system has been, and will be, unable to avoid the personal errors of even its most talented members. While doctors are a conscientious and industrious profession as a whole, there are mistakes that are both avoidable and predictable in a system reliant for perfection upon the unattainable perfection of its human beings. Acknowledging that the practice of medicine is a fundamentally human endeavor, filled with doctors having both good and bad days, the author reveals, in personal account, the horrors of inexperienced surgeons, overworked residents, over-ambitious egocentrics, and just plain old human mistakes. He acknowledges that 3,500 avoidable deaths occur each year from anesthesia misphaps alone, and as many as 100,000 avoidable deaths in hospitals per year. While doctor Gawande recognizes the huge statistics of injured patients caused by either inattentive individuals or an inattentive system, his one shortcoming is his failure to acknowledge that the justice system is valuable to those who are inalterably and devastatingly harmed by the system. He states that such mishaps are not reason to take the offenders "to court," yet he does not explain how the admittedly injured victim is to live his life without the assistance of the justice system. The book is well-written, often woven with explicit accuracy of detail, containing thought-provoking admissions of a surgeon, and a valuable tool for understanding our system of healthcare. Michael Townes Watson, author of America's Tunnel Vision--How Insurance Companies' Propaganda Is Corrupting Medicine and Law....more info
  • About More Than Surgery
    This book is only ostensibly about surgery, and it achieves brilliance on many levels. Often it is the engineers, the lawyers, the doctors, who are the best writers. These types of people tend to care for the important details, and, when they choose to be writers, get these details down on the page. Atul Gawande, a surgeon from Boston, is the archetype for this rule. His prose is crisp, clean, and efficient. Needless to say, from a technical point of view, he also knows his stuff.

    Gawande structures his essays so that they create suspense. For example, in many essays he does not go right out and say what happens to a patient. He first frames a dire situation, then takes the reader on a tour of the problems, fallacies, and circumstances, and finally, only after the reader knows all the isses, Gawande constructs a climax. In other essays we read about his honesty in describing how difficult it is to master certain medical procedures. In the final part of the book (the last four essays) we learn about human decision making fallacies, and how they apply to human doctors making split-second decisions. These insights are typically wrapped around a heart-stopping narrative involving patients on the verge of death -- or, in the final essay, on the verge of losing a leg.

    COMPLICATIONS asks a lot from its reader. We think about philosophical issues facing Gawande's patients; we learn about decision making and psychology; we learn about the human drama of life -- what it means to live and die; we learn about the pressures 20th century professionals are under to perform well in an ever less empathetic world (see the essay "When Good Doctors Go Bad"). Gawande really brings it. ...more info
  • A doctor who can see beyond the details
    Too many scientific authors get bogged down in technicalities and details. However Dr. Gawande is able to describe things from a more practical and relevant perspective . He succeeds in explaining the '"So what does it mean to me?" question all patients have. ...more info
  • The hurricane and the ice cube
    People often take medical care for granted, but anyone who lives through an injury or illness (their own or a loved one's) experiences the complex set of issues discussed in Atul Gawande's fascinating book.

    "Complications" is presented in three sections, abstractly named Infallibility, Mystery, and Uncertainty.

    INFALLIBILITY

    We've all read other books about medical education and training, but Gawande states the realities chillingly: "Like the tennis player and the oboist and the guy who fixes hard drives, we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon."

    From the inexperience of the intern to the ubiquitous medical error to the burned-out doctor gone careless, medical care is saddled with the variability of all human endeavors. In the second chapter of this section Gawande outlines two examples of reducing that variability -- what he calls "the quest for machinelike perfection in the delivery of care."

    A Swedish study, led by an expert in artificial intelligence, fed EKGs and the multitude of factors involved in their interpretation into a computer and trained it to do 20 percent better than a cardiologist in determining whether a patient had had a heart attack.

    The second example involves a medical center outside Toronto -- the Shouldice Hospital -- where hernia repair is the only operation performed. Due to "routinization and repetition," variations are ironed out of the process and near perfection is attained.

    A particularly interesting chapter details how patient safety was deliberately engineered into the delivery of anesthesia, dropping the death rate to 20 percent of what it had been in only a decade.

    MYSTERY

    The second section of "Complications" explores several conditions that are particularly fraught with intangibles: chronic pain, nausea and vomiting, blushing, and obesity. These conditions and their possible treatments (gastric stapling and bypass, in the case of obesity) are explored with humility and respect.

    UNCERTAINTY

    The several issues covered in the final section highlight the frequent difficulty of knowing the best thing to do. Gawande explores the modern concept of patient autonomy in decision-making, a welcome turnaround from the paternalism of earlier times. These chapters detail cases where the best decision is by no means clear, even with a second and third opinion. Decision theory, he points out, is a good predictor in the aggregate, but of little use in the individual case.

    Gawande's essays (some of which were previously published) are loosely linked in theme, but together they give a fascinating look at the realities of medical care and decision making. Though some treatments and statistics may have changed in the six years since "Complications" was published, the underlying realities are enduring.

    The most telling metaphor in Gawande's book is that of the hurricane and the ice cube: science, he says, can give a good statistical prediction of what a hurricane will do. But it can state with 100% certainty that an ice cube thrown into a fire will melt. Medicine, he shows us, is more the hurricane than the ice cube.

    Linda Bulger, 2008...more info
  • take it with a grain of salt
    This book has gotten rave reviews but I was not so impressed. Dr. Gawande describes his training in a large academic medical center where every test, scan and specialist is available at the snap of ones fingers. Mobs of specialists descend on complicated patients like swarms of locust. Dr. Gawande describes one anxiety filled period time when he has to wait a full 20 minutes for one such specialist to appear. This is not how most medicine is practiced. I think Dr. Gawande should do a shift in a rural emergency room to learn what real uncertainty is all about. ...more info
  • an inner journey
    Atul Gawande's book "Complications" is a rewarding read on many levels. The reader is drawn in smoothly along a thread of entertaining medical vignettes. These anecdotes serve as the framework for a set of well reasoned essays that explore the inner life of the surgeon. Gawande's primary purpose is to convey the various challenges, surprises, and contradictions that he has encountered as a surgical resident. His scrupulous honesty in describing the motivations, limitations, exhilarations, foibles, and challenges of the surgical profession is refreshing.

    I was disappointed by two omissions. Firstly, Gawande does not deal in this book with the issue of tort reform and malpractice insurance. Perhaps this will become a more significant issue for him as he moves into independent practice. Secondly, thoughout the book I kept wondering why he did not apply decision analysis to his difficult medical decisions. When in the last chapter Gewande describes an unsuccessful attempt to apply decision analysis, it is clear that the analysis methods had not been correctly taught to him. Maybe these are issues that he can address in a future book - a book which I look forward to reading....more info
  • Read America
    In his book "Complications" Dr. Atul Gawande journeys past the blue curtains, automatic doors, and those signs that say "Staff Only" in order to demystify the current practice of modern medicine. This book examines the human side of medicine that we wish did not exist, but at times, can not do without. His humble rhetoric combines with his clear surgical expertise and the result is a wonderful book both wildly informative and thoroughly entertaining....more info
  • Gawande is an asset to both the layman and the entrenched physician
    Atul Gawande has a keen eye for the fallibilities and eccentricities of medicine. While inherently clinical and precise, his prose is accessible and engrossing. This book should be on the must read lists of anyone who goes to a physician, and to physicians in practice. I laud Gawande for showing that medicine is far from a perfect science and is often more art than science. Medicine is often a guessing game based upon probabilities unclear studies. We treat our doctors with such a severe double standards. We expect doctors to be able to cure all of our health problems no matter the cost and yet we fail to take care of ourselves. We expect them to never make a mistake and yet often we are unable control our own diets, exercise every once in a while, or to follow medical orders properly. Gawande's ultimate purpose coupled with his gift of story telling, is to educate us all that doctors are not perfect, nor do they always have the right answer, in fact they often guess. Most of all doctors are just like you and me, do you ever make mistakes at your job? Do you think doctors are somehow exempt from this? Unfortunately the magnitude of their mistakes are often grave. Doctors cannot be perfect, but they must always try to be, what more can we ask. ...more info
  • Vignettes On The Scalpel's Edge
    Being in the medical field, I found myself pretty engrossed in Atul Gawande's COMPLICATIONS. But even if you're not in medicine, there's no reason you shouldn't pick up the book. Focusing on both sides of the scalpel (those that get cut as well as those that do the cutting), the vignettes sketched out here are hit upon with compassion, thoughtfulness, and razor-sharp telling ("We have taken [medicine] to be both more perfect than it is and less extraordinary than it can be.")

    Gawande holds back nothing in his narrative. One chapter will discuss the evolution of a surgeon and how perilous and dangerous it can be ("Everyone wants a surgeon with experience, but how does a new surgeon become the veteran?"), while the next will look at how effective specialized medicine is (a hospital that does ONLY hernia operations and how incredibly successful those surgeons are).

    The most frightening portion of the book -- for me -- was the discussion on dangerous doctors (chapter 5: When Good Doctors Go Bad). When MD's get older and can't function as well, or get burned out, or simply can't keep up with new medical technology, there's no system in place to remove them. The AMA, local affiliate groups, none have the sole power to remove a doctor until it is often too late for the patients (Gawande's examples are horrifying, showing us an orthopedist who had more law suits pending against him than patients in his practice, and still he practiced and operated).

    The big flaw with this "novel" is that it isn't novel at all. It is a compilation of short stories without a core. Whipping back and forth between medical superstitions in one chapter to the study of subjective pain the next, there's no rhyme or reason to the placement of chapters within the book. This isn't all bad, though, just something the reader should be aware of before digging in.

    Regardless, it is an eye-opener to those in the medical profession and those who are patients within it. Gawande is as sharp with his pen as he is with his scalpel. And he spares no one; from the physicians within his own cadre, to the misconceptions patients hold for their care givers.

    Complications should be required reading by all physicians, past, present and, especially, future simply because it is brutally honest and keeps its perspective tightly woven toward patient care....more info
  • Written with candor
    A very interesting account of what really happens in the medical community hidden from the average patient. The author writes an easy to follow, captivating book covering medical explanations, struggles of the physician and the fears and insecurities they deal with under a veil of confidence. The author treats the physician and the patient with compassion and respect, and poses some very pointed questions concerning medical practices and procedures. It will certainly cause a person to reconsider any unnecessary surgery!...more info
  • Humble Human makes a Great Doctor!
    An amazing thriller...

    Dr.Atul's superb portrayal of finest qualities of a doctor, yet the limitations of an individual, their weekness,strengths, system flaws etc with vivid examples of real life cases makes "Complications" the best medical book I'v ever read.It's not the content of the book alone that deserves appreciation, it's also the flow of words that blend with the topic.

    Certainly the pinnacle of the book is the story of Joseph Lazaroff, Atul's Anguish depicting the finest of human character and also the professionalism of a doctor, also his questions behind the ethics of "absolute insane rights of patient's expression". I felt a pain in the heart for that "unknown soul" ( a gist of that chapter is below)

    Chapter : Whose body is it Anyway :
    ...I turned the ventilator off, and the suddenly the room was quiet .His breathing slowed ...Joseph Lazaroff had died.But Knowing how much Lazaroff had dreaded dying the way he died....

    Chapter : Education of a Knife:
    I said to the patient that there were "slight risks" involved.And the disasters weighed on my mind: the woman who had died from massive bleeding, the man who had to have a chest opened, the man who had a cardiac arrests.I said nothing of such things when I asked my patient's permission to do this

    Chapter : When Doctors Make Mistakes:
    At 2 A.M on a crisp friday in winter a few years agao, I was in sterile gown , pulling a teenage knifing victim's abdomen open, when my pager sounded "code trauma, three minutes"

    Chapter : When Good doctor's Go bad:
    Before the license of Dr.Goodman was taken away, he was a highly respected and sought after surgeon...he could do some of the best, most brilliant work around....In one case , he put the wrong-size screw into a patient's ankle,another case when he refused to do hip replacement. For the last several years, he was the defendent of a stream of malpractice suits.

    Chapter : The Man Who Cannot stop Eating :
    ...He had to let his legs apart to let his abdomen sag between them. He cannot lie down and breath properly because of excess fat in the tongue and upper airway. He had to sleep in the recliner and every thirty minutes or so , he would wake up asphyxating, He could no longer stand up to urinate, he had to shower after moving his bowels to get clean

    A Must Read book...Afterall, someday you might be an example in his future books!


    ...more info
  • A raw examination of life
    Dr. Gawande, explores the surgical psyche both from a doctor's and a patient's perspective. This is what makes this book interesting.

    He takes the reader into the mental state that often has an explanation for us, but sometimes does not. Cases in point being inexplainable deterioration in a doctor's performance or a hunch the prevents amputations. He exposes the fragility of our bodies and life.

    The book illustrates medicine as the best way to monitor, examine and rectify any problems, but does not promise miracles.

    I've barely visited any hospitals, but his vivid description of the aura and mental states of patient and doctors, brings to life what could have just been a set of journal entries.

    Not recommended for the squeamish (or people about to go into the operating ward)....more info
  • Great choice for a medical school book review
    I believe this book touches on many thoughts that medical students carry with them in the early years of their training. The book keeps you engaged in the stories and cases, Dr. Gawande does a good job at keeping chapters connected within their separate parts (there are 3). My only criticism is that there are a few chapters within part 2 that do not seem relevant to the spirit and quality of the other chapters. To me it felt like he inserted a few chapters as "fillers". Overall I would recommend this book to medical students because he is a good story teller and does well at touching on feelings and apprehensions that I have thought about as I go through medical school. We used this book for class discussion, and it created several good discussions. ...more info
  • Should be required reading!
    I really applaud Dr. Gawande for taking so much mystery out of health care. I've always felt that it was important to be a partner in my own health treatment, and I guess I would've considered myself an "educated consumer." But this book made me realize just how much I DIDN'T know about doctors, surgery, and so many other aspects of medical care. The way it's written, this book is an easy read... easy to pick up and read in bite-sized pieces. But, on a much deeper level, it gives you a much greater understanding of how doctors are trained, how they think, and how they're just as human (and fallible) as everyone else. On one hand, this book is a scary "wake-up call" for patients. On the other, it's an incredibly empowering and educational tool. Anyone who receives medical care should be required to read this book!...more info
  • I've been slashed
    I find this book which has gotten such rave reviews disappointing. Dr. Gawande addresses a number of issues which are pertinent to surgical practice. However,I found the book to be superficial and lacking of "heart".

    I will elicudate. Dr. Gawande states frequently that surgeons slash their way into a patient.I suspect that this is for dramatic effect.There are other examples of this such as the description of an autopsy.He tones it down later.He treads lightly on the fact that doctors don't want to own their mistakes which is why there is no improvement in medical care over 20 years ago despite huge advances in both technology and costs.

    The only Surgeon I have ever known who "slashed" his way into a patient ended up losing his privileges...thank God but it took many years and a yeoman's effort and those who spoke up were alienated and shunned. It was not as simple as is portrayed in this book.I do laud him for bringing up the "good doctors going bad" issue. It is a huge problem and bad doctors are often covered for years and years while patients are repetitively injured. It is also very harmful to the doctor who is creating the problem. The cost of this problem to patients, hospitals and society is staggering.

    I looked up the reference that computers were better than doctors at diagnosis. It is not about medical diagnosis, it was about psychologists' diagnosis. The second article was from 1954...A bit dated. before the computer era.

    I laud him for the courage in mentioning his screwed up tracheostomy attempt. There are numerous methods for both intubation and percutanous guided tracheostomy techniques that have been available for 20 years. I have to wonder why he was unaware of these. The technique that he describes for subclavian vein cathethers is also not as safe as other methods which use a small guage finding needle. I have to wonder why 20-30 years after these problems were identified that this young doctor was not being instructed in these techniques.

    His chapter on bariatric surgery is notable for his mentioning of the commercialization of medicine an increasingly dangerous trend is appropriate. At this point bariatric surgery has been shown to be helpful for a large number of patients, but without question medicine has been commercialized.

    His section on uncertainty is the best part of this book. He saved the best for last.

    Nonetheless, I find his "laissez-faire" attitude to these problems even more worrisome.I find little actual feeling that he cared about his patients in this book. This is not surprising as it pervades medicine today.

    I haven't found this book to be a thriller.It lacks depth of character. If he had connected with us and his patients emotionally I believe that it would have been a much more powerful work.

    Sharply contrasting the content of this book is Dr. Gawande's newest book BETTER. Better: A Surgeon's Notes on Performance .
    For readers of this book, reading BETTER is mandatory. It supplies much needed perspective and demonstrates the immense growth Dr. Gawande has gone through both in his professional development and literary ability....more info
  • A modern day Lewis Thomas
    Complications: A Surgeon's Notes on an Imperfect Science, by Atul Gawande, caught me off guard. I had been reading The Best American Science Writing, 2006, and I was encouraged to drop that one and pick up a copy of Complications. In this I failed, since I was attempting to get others to drop their reading of Complications and to instead read The Best American Science Writing (full of intriguing articles on a broad range of topics). So, I started reading Complications. Then I noticed that not only had Dr. Gawande written articles in the past volumes of The Best American Science Writing (at least for 2004 and 2005), but he had been the editor of this volume in 2006!

    I guess I should be paying closer attention to these things. The style of his writing is reflected in the choices he made as an editor for The Best American Science Writing, 2006.

    Gawande's format reminds me of the writings of Lewis Thomas (Lives of a Cell: Notes of a Biology Watcher): focused on the interface of biology, medicine, and human behavior. Whereas Thomas' writings do sound "old" today, Gawande, obviously, discusses the cutting edge concerns and issues affecting medicine.

    He begins by stating that "Western medicine is dominated by a single imperative - the quest for machinelike perfection in the delivery of care" (p. 37). He then outlines numerous examples from his own experiences where he agonizes over his decisions (perhaps "agonizes" is too strong a word... no, it isn't).

    People (the clients of providers of medical services) want the best. Doctors sometimes give it to them. Mixed in this menu of selections is patient consent, professional decision-making, mental illness, the search in humans for patterns, physical versus mental conundrums, detective processes, compassion, error evaluation, and the cutting edge of modern medicine.

    In all probability, most readers of Complications will, at some time in their life (and death), have to deal with issues raised by Gawande. When you do, ask your physician if they have read Complications. Choose the physicians who have... they are the ones who strive to see the "bigger picture." And to be fair, the physicians should ask their patients if they have read this same book! Alas, the vast majority will not have even heard of it, and they will ask for the perfection that Gawande, sadly, cannot deliver....more info
  • Complications; A Surgeon's Notes on an Imperfect Science
    Open, honest, sometimes frightening, sometimes amazing. An outstanding and humble reminder to readers that medicine is an imperfect science and doctors are not God. Not only worth reading, worth re-reading....more info
  • Imperfect but ultimate human science
    Dear readers,very honest story from surgeon and I would say that if somebody wants to learn that how everybody is same even though no matter what your job is ! you should go ahead explore complications.I need more suggestions on this kind of books if you have list or some nice book let me know....more info
  • Excellent stories - few new insights into health care
    I read this book on the advice of a health care policy expert. It's very well written and I enjoyed the stories, which rang true, illustrated the challenges of 'practicing medicine' well, and offered some perspective on health care quality and administration. Particularly for someone with limited health care experience, this book may be very interesting.

    Despite the personal recommendation that led me to the book, I didn't find new insights into health care quality and policy. On the other hand, I've since heard the mentioned by others in health care quality and policy. It is an easy book to read, so it's probably a useful read just for the 'networking' and 'cocktail party' value. ...more info
  • Surgery Patient Weighs in on Surgery Book
    As a double lung transplant recipient, I am bewitched by stories told from the medical professional perspective. Not unlike when I was in my early twenties and discovered the shocking truth that my parents were in fact human just like me, I have grown increasingly aware that those who perform superhuman tasks like surgery are also just people--neither superior or inferior to myself. This is both a comforting and scary realization and one that has prompted my new found hunger to understand life on the other side of the exam curtain.
    Atul Gawande's book "Complications" seemed a perfect choice on this quest to discovering a window into the world of medicine and, in particular, surgery. While this proved true, I never anticipated the honesty with which Dr. Gawande writes of his experiences as a surgeon in training. At times his ability to expose the facades medicine uses to shield us patients from a physician's true lack of experience or confidence was almost too disturbing to take. I had to ask myself, "Do I really want to know this?" At other times, I felt vindicated in knowing that a suspicion I had about how things work was right on target. Often, I felt as though I was gathering useful inside information that would help me in advocating for myself in the future.
    As a patient, it is obvious that the world of medicine is both astounding in what it can do and broken in the way patients are treated and systems are run. Perhaps what I appreciated most about "Complications" was Gawande's willingness to investigate some of these "elephants in the room." With the intelligence of a surgeon and the heart of a compassionate man, he takes an honest look at medicine's tendency to blame the patient (psychologically) when no other solution can be found for chronic pain. In an in-depth and unique way, he explores the delicate balance of physical conditions and human emotion in relation to obesity. Gawande walks the thin line between using all that medical science has to offer while still allowing room for the mysterious. He does not blame anyone, physician or patient, for what is unknown--he only analyzes it in such a way that this reader could not help but be changed. There are many parts of this book which have altered my perspectives forever.
    I highly recommend this book--it is not overly technical and rarely boring.
    Overall, I find myself hoping that Gawande is not a physician out on a limb by himself, but a representation of the evolution of medical attitudes and approaches to complex problems. A hospital full of Atul Gawandes? Now, that's a place I'd like to go for my healthcare.

    Tiffany Christensen
    Author of "Sick Girl Speaks!"

    ...more info
  • A book of great service
    I just picked this book up by chance, didn't know much abt it, never heard of the writer but the subject matter sounded interesting. I finished the book in 2 days! What a great book abt humanity. I really like Dr Gawande - he always seemed so objective but compassionate at the same time. The stories and observations are from his point of view but he never makes it sound like it's all abt him. Dr Gawande explained the technical bits so simply and effectively - now I understand what the drama was all abt in "ER". There's so many interesting things, I had to stop reading and keep telling my husband abt them. Thank you thank you for such an eye opening book. Now I have more appreciation for doctors and the medical process. I've always been a bit confused abt how to approach doctors but Dr Gawande has at least given me the confidence to be more engaging and assert my rights as a patient. I realise now that it is a two way process - neither doctor or patient should have the upper hand. It's like what Donald Trump said - surround yourself with experts, hear what they have to say, consider what they have said, and use that to make the best decision you can. Because in the end, it is your life....more info

 

 
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