Better

 
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The New York Times bestselling author of Complications examines, in riveting accounts of medical failure and triumph, how success is achieved in a complex and risk-filled profession

The struggle to perform well is universal: each one of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives are on the line with every decision. In his new book, Atul Gawande explores how doctors strive to close the gap between best intentions and best performance in the face of obstacles that sometimes seem insurmountable.

Gawande's gripping stories of diligence, ingenuity, and what it means to do right by people take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. He discusses the ethical dilemmas of doctors' participation in lethal injections, examines the influence of money on modern medicine, and recounts the astoundingly contentious history of hand washing. And as in all his writing, Gawande gives us an inside look at his own life as a practicing surgeon, offering a searingly honest firsthand account of work in a field where mistakes are both unavoidable and unthinkable.

At once unflinching and compassionate, Better is an exhilarating journey narrated by "arguably the best nonfiction doctor-writer around" (Salon). Gawande's investigation into medical professionals and how they progress from merely good to great provides rare insight into the elements of success, illuminating every area of human endeavor.

Customer Reviews:

  • A Medical Drama - an insider looking out
    Atul Gawande asks the hard questions. How can a doctor who is just a human be expected to be a god? Gawande looks at the profession from the mundane (hand washing) to the ethical mountain tops (physicians attending executions). The odd thing is that the death row docs have not killed nearly as many people, in the big picture, as the ones who forget to sufficiently scrub up.

    Dr. Gawande tells us about the challenges and changes in obstetrics, cystic fibrosis, and the use of chaperones in examining rooms, trauma practice and many other little niches in the health care system from an insider's point of view.

    This is a well written real life look into the daily life of a modern day physician documenting all the medical and ethical decisions that affect both the doc and the patient. He is quite frank with many of his judgment calls but never gets too technical that the book is difficult to read for the layman. This is a good read.....BG


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  • An insider's perspective which can help you be a more informed patient
    I'm always on the side of self-education when it comes to medical topics, especially in light of the current health care system and its looming problems. Gawande's skill is in writing movingly ab out all sorts of medical issues, including both failures and successes, in a way that illuminates the complexities of practicing medicine in today's world of HMOs, soaring premiums and more.

    Some of his essays may appeal more to you than others but I urge you to read the entire book, as well as to get his other one, Complications. I've read medical memoirs that put me to sleep and have been baffled by how someone could take life and death situations and turn them into dry writing. This isn't the case here and you'll come away from the book with a stronger understanding of all the factors (and possible solutions) that make up the world of medicine, medical ethics and patient care today....more info
  • Complications is better, better is still very good
    Gawande is a witty, practical, intelligent, and interesting writer who can relate and sympathize well with a wide range of people. On top of this, he is an innovator (see the recent article on [..] that describes his new protocols being applied in hospitals and drastically eliminating serious errors). I'm sure many professional writers wish they had half his talent. I think his first book Complications was better because it had more interesting stories and I was captivated about his admittance and depiction of MDs as fallible humans. With that said, Better is still a five-star read. My favorite part and the most valuable take away from this book is his last chapter, "For Performance" with five suggestions that everyone can use to better themselves, and as as result, better the world around them....more info
  • a captivating peek into medicine
    Better is an entertaining compilation of writings about different facets of medicine, I picked up this book and finished it during one travel day.

    Atul Gawande, a surgeon at Brigham's Hospital in Boston, weaves individual patient's stories with his thoughts about larger issues facing society. The stories remind us that medicine, given all of its dimensions, may be the most "human" of all endeavors.

    I am not related to any doctors, I don't have any friends in the medical field, and I see my own doctor as infrequently as possible. Meanwhile, 15% of our economy is based on medicine and health care. This book was a peek into that world for me, showing how engulfing it is, occupied by deeply dedicated professionals who are barraged by emotional, intellectual and physical challenges as part of their commitment to others' health.

    Gawande maps out his book in the Introduction. He says that there are three core requirements for success in medicine, around which he organizes his book: diligence, doing right and ingenuity.

    In the section on diligence Gawande talks about the effort to encourage doctors and nurses to wash their hands to stop the spread of superbugs, the diligence of doctors on the battlefield in Iraq (many soldiers' lives are saved that would have been lost before,) and lastly, the effort to rid polio from the earth, how complicated and human that effort is in its problems and issues.

    In the chapters on doing right Gawande talks about doctors' pay, medical lawsuits, doctors who assist in prisoner executions (when they have sworn to "do no harm") and how to know when to "pull the plug" on a dying patient (hint: you can't know.)

    In the chapters on ingenuity Gawande talks about how medical centers can implement systems which improve survival. He describes in detail how a couple medical centers (and, arguably, due to the influence of a couple people in particular) are responsible for the life expectancy of cystic fybrosis patients now being up to age 45+, when in the 1960's the average patient could expect to live to age 3.

    For me, reading this book was like meeting a captivating guest at a dinner party who offered me a glance into a deep, engaging, world. I came away thankful for the author and others in medicine for their commitment to a tough field in which they make meaningful differences in people's lives and well-being (and, therefore, happiness.) I know that people in medicine are as human as everyone else, and that there are people in medicine who abuse power, are greedy, etc, just as in every other field. But I think, for the most part, people enter and stay in medicine for noble reasons. This book is about those people, whom I can only admire and appreciate.

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  • Better is Good
    On the cover of "Better" by Atul Gawande, the thoughtful Malcolm Gladwell exclaims, "Better is a masterpiece...". To be sure "Better" gets high marks for exploring territory that the medical profession might sooner forget, even Gawande admits to his discomfort level but to suggest that the bell curve tells us "...something unforgettable about the world outside" is to know very little about the world outside. However, I don't want this to be about Gladwell. Gawande is a good writer. He captures the medical world, a world alien to most of us, through the eyes of a surgeon in a way that makes those who heal, those we trust and respect more than any others in society, almost human. They are just like us. As the father of a daughter who was brought into this world with a mere 23.3 weeks gestation and a zero Apgar score, who just turned 10 years old this month, I considered these healers and decided they were superhuman. They were sheltered from a world of stress, financial worry, problems with relationships, and the like. I knew I was kidding myself but I chose to believe. I knew the doctors and nurses caring for my daughter in the NICU for 87 days were on top of their game. Gawande pierces the veil and I applaud the effort to capture his thoughts. To take the time from his busy schedule to think and to consider the meaning in what he does, to improve, to get better. He has a simplistic five-step method; Ask an unscripted question, don't complain, count something, write something, and change. Simple enough, and the beauty of his formula is that it will work, and it can be applied to all aspects of life - so do as Gawande asked, heath professional or not, improve what you are and what you do. However the real message, the journey Gawande takes us on to reach his formula, is the better part of "Better". And since we all get sick and need the medical profession, we should all stand in the shoes of a medical professional. Gawande let's us stand in those shoes, if just for a brief moment, to glimpse a world where life and death decisions hang in the balance. Followed shortly by a life and death decision in the next examination room. Most of us will never know this kind of life. So here is my formula, first go wash your hands. Second go read this book. It will not change your life, but it will change your perspective on your next visit to the doctor's office and how you perceive the hidden world of medicine. ...more info
  • Good, but not better than Complications
    A follow up to Gawande's earlier "Complications." This is a good, quick read, but it lacks some of the depth that the earlier parts of "Complications" had. Still, a worthwhile book....more info
  • A wonderful book, highly recomended
    "Better" is a wonderfully written collection of descriptions of people who have been committed to asking a question, implmenting a change, and truly helping many many people. The stories are focused on improvements of health care, which I enjoyed, but are useful for people thinking about and eager to improve any industry or situation.

    "Better" is easy to read and I learned from reading this book. This is a great book to pass to your children and colleagues.
    RCGoldszer
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  • Better: A Surgeon's Notes on Performance
    Sorry, unable to comment. This book was purchased for distribution to my Hospital Board of Directors. Thank you...more info
  • Mandatory Reading for All Involved in Healthcare
    Atul Gawende's "Better" should be mandatory reading for anyone engaged in providing, regulating, or legislating health services. Gawende, a general surgeon who specializes in endocrine surgery at Boston's Brigham and Women's Hospital, has written a provocative and insightful book on how we can improve healthcare today. He is quick to admit that true success in medicine is not easy. It requires will, attention to detail, and creativity.

    "Better" shows, however, that it is possible anywhere and by anyone. The author illustrates this with case studies showing how diligence, doing it right, and ingenuity can make a big difference.

    Gawende argues that once we've made a science of "performance" - as he shows with simple examples of hand washing, a polio "mop-up,"wounded soldiers, child delivery - thousands of lives can be saved. Today, the scientific effort to improve performance gets only a miniscule portion of scientific budgets. Yet it can arguably save more lives in the next decade than bench science, more lives than research on the genome, stem cell therapy, cancer vaccines, and all the other laboratory work we see in the press. The stakes are high.

    Gawende is arguable the best nonfiction doctor-writer around today.
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  • I'm getting his other book!
    A very human view of the great and the not-so-good aspects of doctors and doctoring.
    This was well-written, informative and enjoyable.
    It was nice to read about doctors doing it against the odds in real life and the practical obstacles in their way.
    I will recommend it to my friends....more info
  • A Disappointment
    I am a huge fan of Dr. Gawunde's work - "Complications" was an incredible piece of writing and an insightful look at the medical profession and residency and his New Yorker contributions (one of which was a chapter for this book) almost always provide new ways or at least valuable commentary on the state of the medical industry. So I had high hopes for this book, which were all dashed. Instead, I finished "Better" wondering what, if anything, I had learned. Instead of giving us a behind the scenes look at medicine, we got a rehashing of medical cliches and nothing really new or nothing people haven't known or gotten from other sources - medicine is like sports and other professions, only mistakes cost people their lives; medical malpractice has its supporters, but has many issues that need to be solved; there is a bell curve showing that some doctors are better than other - is this something we didn't know? Dr. Gawunde's strengths are always his anecdotal evidence and that is about the only thing that carries the book. At the end, he lists 5 suggestions to improve the profession, things like ask your patient an unscripted question, but again, is any of this new? The book has a strange crisis of identity since I wonder who it is being written for. Doctors I know who have read it have had mixed reactions, but the very end, where he tries to give advice, falls flat because the suggestions are too obvious, and it makes him come off as condescending. As if a doctor needed to know some of these things. In many respects, Dr. Gawunde seems to be trying to make himself into the voice of the medical profession, a conscience in print. Unfortunately, his writing does not lend itself to this position. Anecdotes work for pulling back the curtain and showing some of the things residents and doctors go through, but not for sweeping change. That's where statistics and actual studies work. Overall, it's a good book for people thinking about medicine and individuals who know absolutely nothing about medicine, but not much more. ...more info
  • Delivery of medical care
    This book concerns one of the important social issues facing us. It is both readable and comprehensive, covering everything from hand washing to our system of delivering medical care. It is important reading for anyone who votes....more info
  • Even "Better" than Complications
    Insightful, well-written, and goes beyond the limited scope of "Complications" to include medicine outside the walls of U.S. hospitals....more info
  • Thought provoking
    This is an easy read, but asks some profound questions about the status of medical practice in the U.S. today. Definitely worth reading....more info
  • Terrific
    This should be required reading for anyone wanting better service, whether from their doctor or from the internal revenue service. His stories are compelling and to the point. Over and over, he points out that often small, subtle factors make a huge difference in medical outcomes. Surprise -- the ability to listen turns out to be a key diagnostic skill. It helps that he writes so well. PS The next time you go into the hospital ask the nurse or doctor to wash their hands. Gawande tells you why!...more info
  • everyone should read this book
    a fast read and sooo helpful in the health system of our country, eveyone should read this book, very interesting and so helpful and so well written...more info
  • Better - A Surgeon's Notes on Perfomance
    This was my first book that dealt with medicine as the core subject and talked about perfomance. The average person rarely comes to associate both of these together and for some reason many of us treat doctor's as holier than thou. Dr Gawande raises some very pertinent questions specially in his essay's on the Battlefield and the Cystic Fibrosis - his notes on how the average lifespan of affected individual's(CF) has been rising over the years and how simple changes have made such big difference is very well depicted. His essay on how the surgeons in India were managing patients with such limited resources in such horrific conditions makes you think about the great divide between the resources of various nations - USD 4 in India compared to USD 7911 in US per person.
    Finally, its a very short book that should take not more than a few hours to finish, at the end of it, I started thinking will it be innovation, new drug research that will drive future medical advancements or small incrimental changes, ingenuity in the way we treat that will make a bigger impact.

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  • A good read
    I enjoyed reading this as an anecdotal account of a surgeon's experiences. I did not feel it contributed much for those of us who already work in the medical field other than confirming that the system is broken. It does hint at suggestion for fixing it, and the author takes some personal responsibility as a physician for contributing to the current ineffectiveness of the system that in itself was refreshing. ...more info
  • Becoming better? More art than science
    Gawande's essays contain honest observations of the conflicting roles that the medical profession play in the life and death of individuals and populations. He also asks seemingly obvious questions about why things are done in medicine and public health despite clear evidence that there are simple changes that can radically improve patients' health outcomes. There are no clear answers naturally, but the narratives provoke much thought.

    What is really striking is the humility in his advice about being a positive deviance through simple principles of diligence, doing right, and ingenuity. His suggestions to fellow doctors and medical students to ask an unexpected questions, not complaining, measure and write about one's experience, and adopting best practices continually are underpinned by the recognition of medicine more as art than science. That there is always uncertainty in how human beings respond to the best of care in the medical setting. That much is unknown, and even more is unknown about what the profession does not yet know. Perhaps a healthy dose of scepticisim, coupled with a dash of irreverence for sacred cows, and continually asking "Why not?" in medicine, may be what is needed to "do right".

    In Better, the anecdotes show just how unpredictable and irrational human behaviour can be despite the best of intentions. How surgeons who are obsessively sterile in the confines of an operating field ironically seem to blatantly disregard their own obsession once they are out of the OT. Stories about communities who reject the life-saving (and tragedy-preventing) public health measures to ring-fence polio outbreaks with vaccinations.

    A fascinating (and fast) read....more info
  • collection of previously published essays is big disappointment
    I'd read the cystic fibrosis and c-section articles, and while the first was interesting, the second was an appalling disappointment for me, as I, like just about everyone else, really enjoyed _Complications_. While Gawande still has interesting things to say, his conclusions have become simplistic and seem at odds with the stories he tells in the course of each discussion. This was particularly apparent, as another reviewer has already noted, in the essay on the death penalty.

    In general, I got the sense he is papering over some very, very serious concerns with medicine as he is accustomed to practicing it. He gives slight recognition to the possibility of _not_ deploying every piece of technology available and describes glowingly, for example, the treatment of very low birth weight babies and inaccurately characterizes the value of the current system of treatment (never mentioning the greater success of kangaroo care elsewhere) both in terms of immediate preservation of life and in terms of long term quality of life.

    If cheerleading makes you feel good, this might work for you. But look elsewhere for a thoughtful, balanced assessment of our medical system and how it might be improved....more info
  • Lacks humility and nuance of Complications
    This book is far less engaging than his first, and espouses a mildly distasteful and shockingly simplistic message about doing better in the medical profession. Don't look for a enlightened analysis in Gawande's small-minded views here. In each chapter, Gawande examines the complexities of the topic and then tops it off with a conclusion that ignores all the subtleties of the issues at hand.

    Nowhere is this more evident than in his essay on the death penalty. There he, as always, weaves a truly engaging narrative about the doctors who aid in capital punishment. At the beginning he suggests that its a complicated issue with no clear moral conclusion. At the end, he asserts his own conclusion in a moral black and white. No matter that he has just finished a very convincing essay about how it is basically impossible to come to such a clear conclusion. The whole message comes off as arrogant and, inexplicably, uninformed.

    If you want a thinking person's analysis of similar topics, read "How Doctors Think" by Jerome Groopman. There, the author seems to understand the complexities of the issue and doesn't aim for hubristic conclusions....more info
  • A timely book for improved performance in healthcare
    At a time when comments on U.S. health care are loaded with inflammatory speech and defensive posturing, Gawande offers us a refreshing, moderate, and reflective look at modern health care delivery. Using his journalistic/investigative approach to answering questions, Gawande puzzles through current issues in medicine. His candid presentation helps to strip away the reader's preconceptions.
    Gawande uses engaging clinical scenarios to describe medical improvement as a sometimes untidy plunge into the unknown. He discusses how progress can be made in improving physician performance and offers advice to those who want to make a positive difference in the world. With his introspective, poignant observations and engaging style, Gawande breathes new life into the conventional medical establishment and demonstrates a clear understanding of the human condition....more info
  • Better Health Care for All
    My father was a surgeon, so when my wife checked "Better: A Surgeon's Notes on Performance," by Atul Gawande, out of the library, I decided to open it and see if it was worth a read.

    Happily, it was absorbing reading! In spite of the title, it was not a collection of stories of successful heroic surgeries, but a series of essays on widely varying medical topics dealing with decision-making in the absence of complete data, morality, ethics, doctor-patient interaction, etc. Dr. Gawande deals with real-life issues that possibly could confront any member of the healing professions--supervising lethal injections of convicts, for example--in spare, straightforward prose packed with well-researched statistics, extensive interviews with doctors and nurses, and exposure to all sides of the issues. Although I paced myself, reading one chapter a day, I could have finished the book in a few hours, as it was interesting and written in down-to-earth terms.

    Perhaps the greatest value of this book is the emphasis on performance measurement--"benchmarking," if you like. Dr. Gawande's research into treatment of diseases like cystic fibrosis, for example, revealed that the most successful treatment centers (1) kept detailed records of treatments, (2) were eager to try any seemingly logical approach, and (3) learned quickly from their successes and failures.

    I'm going to recommend this book to all of my physicians--all of whom I regard as exceptional caregivers, but I heartily recommend it to anyone concerned with the state of health care in America....more info
  • Better is best
    Beautifully written and wide ranging investigation and analysis of extraordinary medical care by a leading surgeon. Its message, that real diligence, as well as time and attention to detail and listening to patients, are the keys to improved medical treatment, not newfangled technology. It is a shame that most medical practice ignores these fundamental principles....more info
  • Atul Gawande is superb!
    Atul Gawande has done a superb job describing the ins and outs of practicing medicine. His account of the work being done and the difficulties that physicians have to face in different situations is very thoughtful and many times touching. The writing flows and the story lines are touching....more info
  • Closing the gap between intentions and outcomes.
    Dr Gawande may have written this book specifically about improved practice in medicine, but many of the points he makes are valid in other fields of human endeavour. Dr Atul has provided eleven essays around the themes of Diligence, Doing Right and Ingenuity. The question posed in the introduction, and explored throughout the book, is ` ..having accepted the responsibility, how one does such work well.'

    The topics of the essays are:

    Under the heading of `Diligence', Dr Gawande writes about the importance of handwashing, attempting to eradicate poliomyelitis, and the treatment of casualties of war.

    Under `Doing Right', Dr Gawande addresses the use of chaperones during medical examinations, medical malpractice, income earned by doctors, the roles of doctors in capital punishment, and issues around aggressive medical treatment.

    Under `Ingenuity', Dr Gawande covers medical intervention in the process of birth, excellence in treatment for cystic fibrosis, and medical care in India.

    Finally, Dr Gawande offers suggestions to medical students (and others) about making a difference by becoming `positive deviants'.

    In summary, the answer to the question posed by Dr Gawande could well be the following `Do what is right and do it now' (Dr Virginia Apgar, as quoted on Page 186).

    This is well written book which, while it draws on examples in the field of medicine, contains lessons for each of us who strive to make a difference. Technology provides many solutions and enables advances in areas previously thought impossible. But it is human ingenuity that underpins technological advance, and sometimes it is simple human practices that have the biggest impact.

    I recommend this book to those who are interested in striving for excellence more generally.

    Jennifer Cameron-Smith
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  • Great book that everyone should read
    Whether you are interested in medicine or want to be more in touch with medicine and healthcare, this is a great book for you! I enjoyed the stories and the commentary about health care in the US. It was easy to understand and facinating. I am now reading Dr. Gawande's other book. ...more info
  • Wow - from start to finish!
    Even better than his first book, Dr. Gawande bravely speaks out about the very real aspect of human fallibility in our health care system and his quest to eliminate errors in medicine. Quite frankly, I can't remember which of his first two books, "Complications" or "Better" the discussion about 'pre-flight' style check lists for surgical teams was mentioned in - because I read both of his books back to back in one day, but the idea is catching on and showing staggering statistical success. Dr. Gawande's frank writing style is threaded through with human compassion and is quite pleasurable to read. I highly recommend both of his books!...more info
  • "When the stakes are our lives...we want no one to settle for average."
    Atul Gawande, in "Better: A Surgeon's Notes on Performance," asks, "What does it take to be good at something in which failure is so easy?" When someone's well-being is at stake, is mere competence enough? The author maintains that a great deal more is needed "to enable every human being to lead a life as long and free of frailty as science will allow." With so much on the line, knowledge is not enough. To do their best, doctors should be conscientious, technically proficient, morally scrupulous, resourceful, and compassionate. The author examines "three core requirements for success in medicine": diligence (attention to detail and avoidance of errors), "to do right," and ingenuity ("thinking anew"). Is a doctor willing to look at a difficult situation in a new light? Can she confront her failures, learn from them, and change? Dr. Gawande presents specific examples of medical professionals meeting a variety of challenges and, in the process, transforming medical care and saving lives.

    In this elegantly written book, the author makes the abstract real. He does not merely focus on dramatic events; he also demonstrates how the seemingly mundane can be crucial. One example centers on infection control. Deborah Yokoe, an infectious disease specialist and Susan Marino, a microbiologist, have done their utmost to reduce the spread of infection in their Boston-based hospital. Two million Americans acquire infections every year during their hospital stays and thousands die as a result. One way to cut down on infection in hospitals is for clinicians to carefully and consistently wash their hands. Yokoe and Marino have tried everything to get doctors and nurses to wash. They have posted warning signs, installed new sinks in convenient locations, given rewards to the units with the best rates of compliance, and even issued hygiene report cards. Nothing has worked. Doctors and nurses simply do not take the time to wash their hands as much as they should. As a result, the rates of infection in the hospital remain higher than they should be.

    Two other individuals in Pennsylvania, however, came up with innovations that actually made a difference. Peter Perreiah, an industrial engineer, devised an ingenious system that made each hospital room function like a mini-operating room. Jon Lloyd, a surgeon and colleague of Perreiah, promoted the idea of "positive deviance--the idea of building on capabilities people already had rather than telling them how they had to change." By inviting the staff to come up with their own solutions rather than imposing rules from above, "the norms began to shift." One year into the experiment, infection rates dropped precipitously.

    Gawande demonstrates time and again that when people rack their brains to come up with answers, they can solve seemingly intractable medical problems. The author's account of the Herculean efforts expended to eradicate polio in India and to save the lives of wounded soldiers in Iraq are fascinating and impressive. Equally engrossing are the sections dealing with best practices in obstetrics and effective treatments for cystic fibrosis. Dr. Gawande's remarks concerning how far physicians should go to keep their patients alive raise intriguing questions without offering facile answers. "In the face of uncertainty, wisdom is to err on the side of pushing, to not give up. But you have to be ready to recognize when pushing is only ego....You have to be ready to recognize when the pushing can turn to harm." The author believes that medical decisions should always be based on the best interests of the patient, and fruitless suffering should be avoided. This is a tough call and wise doctors will not hesitate to consult with their colleagues to get other opinions. My one quibble is that Gawande's segments focusing on doctors' income, malpractice, and the ethics of physician-assisted executions do not fit comfortably in a work about enhancing medical performance.

    The bottom line is that "arriving at meaningful solutions is an inevitably slow and difficult process." Common to all successful initiatives is the willingness to face challenges with a determination to do whatever it takes to find remedies. Atul Gawande is a thoughtful and intelligent writer; his graceful prose makes "Better" an absolute pleasure to read. We can only hope that Dr. Gawande's colleagues will pick up on his admirable enthusiasm for behaving more responsibly, creatively, and diligently.
    ...more info
  • Right on!
    This book gets it right. I started the book yesterday and finished it tonight. A very well-written look at the medical system, in all its pain, humanity, glory, and struggle. If you want to understand the medical system, I recommend this book, Hospital Survival:Lessons Learned in Medical Training by Grant Cooper, and How Doctors Think by Jerome Groopman. Speaking as someone who has been on multiple sides of the medical system, these are the books that speak the truth and give the accurate (and entertaining) behnd the scenes picture....more info
  • For doctors or future doctors, try Complications
    Good book with good advice. Dr. Gawande is an engaging, entertaining, candid writer. Better is nice for a general crowd, but Complications, his earlier book, is excellent for people interested in the medical sciences, especially surgery. I'd recommend both, but if I had to choose just one, Complications gets my vote....more info
  • Positive deviance
    Atul Gawande's collection of essays reflect on medicine in an amazingly even-handed way, considering the author is a surgeon. Rather than a defense of medical care, the author explores several controversial issues affecting health care and manages to not only see the various aspects of each issue, but to examine them in such a way the reader's mind is opened.
    Divided into 3 main sections, each a virtue that contributes to the development of modern medicine: diligence, doing right, and ingenuity.
    I was grabbed immediately by the first chapter regarding hand washing. Yes, hand washing! As an obsessive hand washer myself, I found the statistics regarding health care professionals and hand washing to be astonishing! And in the face of overwhelming evidence favoring hand washing, its pretty amazing that everyone is not donning exam gloves for everyday tasks. On the contrary, the cavalier attitude demonstrated by doctors and nurses towards hand washing would make a great psychology study. But luckily for us, there are people out there that not only appreciate the value of frequent washing, but took the extra step to figure out how to make it happen.
    I must apologize for not making this sound more interesting, because it truly is.
    While I found every chapter fascinating, I was particularly intrigued by the study of cystic fibrosis centers, and the description of medical care in India. In each chapter, we meet people who use their knowledge and skills to BE better.
    I especially appreciate Gawande's advice on becoming better, a 5 step program for improvement, or how to be a positive deviant. 1. Ask an unscripted question. 2. Don't complain. 3. Count something. 4. Write something. 5. Change.
    When are our efforts enough? Why do we always have to be better? Because we have not eradicated disease. We have not eliminated mistakes. We have not erased social inequities. Read about the people who are dedicating their lives to making things better. It will make you want to be better as well.
    Highly recommended to health care professionals and patients alike.
    ...more info
  • "Becoming a positive deviant"
    In any human endeavor, variations of performance create a bell curve and most participants are average or below average. Dr. Atul Gawande explores the challenge of practicing medicine and striving to be a "positive deviant" on that curve. Better: A Surgeon's Notes on Performance explores the pursuit of perfection in several areas of medical practice. Athletes, he writes, teach us a lot about "the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line." (p. 4)

    Several chapters of this book appeared first as articles in periodicals. Though the book follows a fascinating theme, do not expect it to be as well-integrated as Complications: A Surgeon's Notes on an Imperfect Science. The overall message is the dialectic between strict adherence to practices known to work (hand-washing) and an inspired ingenuity. How to achieve both?

    There is much interesting material here: the WHO campaign to eliminate polio, the history of Cesarian sections in obstetrics, the ethics of assisting in the death chamber, the story behind longer life span for cystic fibrosis patients. These and other chapters are tied together by the quest for improvement of outcomes.

    The afterword encapsulates Dr. Gawande's advice to medical students on making a difference in people's lives, and it alone is worth the price of the book. "It often seems safest to do what everyone else is doing ..." he writes in closing. "But a doctor must not let that happen--nor should anyone who takes on risk and responsibility in society."

    Altogether this is an informative and thought-provoking book with lessons that go beyond the specifics of medical practice.

    Linda Bulger, 2008...more info
  • Organization, People and Process in Medical Practice
    This book is a collection of previously published and some original essays. The core idea that connects these essays is the idea of better performance in medical practice. To explain this idea, author focuses upon the social and organization aspect, not on technical medical tools and techniques. The book focuses on processes and people to describe various ways of overcoming seemingly un-breakable barriers doctors face when doing their job. From the resource constrained polio eradication project to ethically difficult choices execution assisting doctors faces to plethora of mal-practice suites to compliance issues facing simple practitioner behaviors, it explores problems and quandaries doctors face in their "normal" day to day activities. The suite of essays is full of anecdotes, thought lines and candid self-reflections. These are well written and engaging essays....more info
  • Much better
    This book is a compilation of essays some of which have been published elsewhere as was the case with his first work, COMPLICATIONS. There the comparison ends. Dr Gawande's writing and attitude have grown and matured. Here we see the professor who provokes us to thought as well as teaches.
    The book opens with an introduction which was a story of how a senior resident senses that a patient may be sicker than her vital signs reveal. Following his clinical judgment he is more judicious than most would be. By his judiciousness he saves a patient's life. This essay sets the stage for book.
    The book is divided into 3 sections Diligence, Doing Right and Ingenuity, the qualities he feels doctors need to embody. Then he uses the power of story to illustrate those qualities. He raises procative questions.
    He shares with us fascinating stories some that are inspiring and others that are disappointing, others controversial. All give us pause for thought .
    This is a book that all of us should read especially now a health care reform must occur and we are facing the question How can we do better?

    ...more info
  • Well written anecdotes about the state of modern health, health care
    This book is well written and passionately effective in its detailing the modern realities of health care from all sides of the "aisle."
    The choices that we all make, doctors, insurers, patients, family members are reviewed in an anecdotal way that's clear, concise and well structured.
    The author writes very well, the anecdotes themselves are interesting and illuminating and the book is a good read.
    It appears to be a collection of essays that were published in The New Yorker?
    A good book to read and pass on to others.
    ...more info
  • Buy This With PHYSICIAN, PROTECT THYSELF
    Really loved this book and its perfect companion: PHYSICIAN, PROTECT THYSELF: 7 SIMPLE WAYS NOT TO GET SUED FOR MEDICAL MALPRACTICE. These two books combined really give a great perspective!...more info
  • Insightful
    Atul Gawande is a fantastic writer and this book is no exception. This is a quick read that sheds a bit of light on to the ways the field of medicine has progressed. I really enjoyed Complications more, but I recommend this book as well. ...more info
  • Probing Plea For More Objective Performance Standards
    If you are searching for a physician, how do you go about determining who is the best one to serve your needs? Where is there published data which gives you the opportunity to make rational decisions about your medical care?
    I am not a scientist, and when a friend tells me so and so is a great doctor, I translate that to myself to mean my friend likes his/her doctor. How do we judge? Clearly, 50% of all doctors graduated in the bottom half of their medical schools. Not that that, in and of itself is a necessary determinant of whether or not someone is a good physician. But what is?
    Dr. Gawande uses many anecdotes to show how the nascent science of improving performance amongst medical professionals is the key to longer, healthier lives.
    Gawande asks hard questions of his profession, as well as of himself: if he's an average surgeon, should he be trusted with someone's life, or their child's life? Shouldn't we have a right to know how our doctors rate, when there are objective standards that can be applied to performance?
    Fairview Children's Hospital in Missouri treats patients with Cystic Fibrosis. The patients who are seen at that hospital, consistently outlive patients seen at other hospitals who have the same condition.
    Gawande argues that data, such as that, should be readily available both to patients and their families, so they can make informed choices about their care, but also for doctors so they can improve their own performance.
    You will read case after case of how our health care system can improve and has improved. Buy this book for yourself, and pick up an extra one for your doctor....more info
  • A good read
    The inspiration for this review has come from Dr. Gawande's fourth suggestion to `write something'. He has done a fabulous job of giving us a rare insight into the ecosystem of medical professionals. I must admit that his book has provided a very detailed picture of what the global healthcare system faces today. The three principles of a person being diligent, doing what is right, and using ingenuity are nicely elucidated with the help of stories from his own observations and experiences. This makes for a lucid and interesting piece of written work. However, this comes with a warning. He has tried to involve his reader emotionally throughout his stories, which can be uncomfortable for some. Also, his examples of clinical medicine in emerging countries have not been fairly portrayed, in my opinion, to explain the reasons for the disparities in care. He has praised individual achievement in spite of adversity, but has not delved deeper into the problem of mismatch between the sheer number of patients and resources available, something very uncommon in the West. He has ended his book well by giving five suggestions that are `lessons' from the book and these will prove handy most readers. The key lesson for me was, again, to write something as a way of participating in the process. Everyone will learn something new from this book.



    By Kunal Sood

    IIT Delhi MBA Candidate

    HIT Research Fellow, Columbia University



    ...more info