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 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.
Medicine is unforgiving because every mistake could be a disaster. Wrong prescription, wrong dose, wrong operation site, wrong treatment… any of these could kill a patient. But how can you be error-free every time, never mind a job with so many technical details and judgement calls?
Perfection is impossible, of course, so Gawande looks at how doctors can improve their performance. The three main sections cover diligence, doing right, and ingenuity, and while the stories are interesting only a few moments have stuck with me. For example check out this cystic fibrosis doctor working with a teenager:
At school, new rules required her to go to the nurse for each dose of medicine during the day. So she skipped going. “It’s such a pain,” she said…. Warwick proposed a deal. Janelle would go home for a breathing treatment every day after school and get her best friend to hold her to it. She’d also keep key medications in her bag or her pocket at school and take them on her own. (“The nurse won’t let me.” “Don’t tell her,” he said, and deftly turned taking care of herself into an act of rebellion.)
Points of brilliance like this and the afterward with tips on how to become a “positive deviant” are my highlights. Gawande’s writing is as good as ever but this isn’t as game-changing as The Checklist Manifesto. I’ll get back to you once I read Being Mortal. 😉