Better

"'What does it take to be good at something, when failure is so easy?' asks writer/physician Gawande in his follow-up to Complications (2002). Diligence, ingenuity and "doing right," he answers. Gawande illustrates each of these qualities with stories from his own experience, as well as his observations of and conversations with other physicians. Being diligent about the simple act of hand-washing dramatically reduces hospital infections, he demonstrates, and through diligence, army surgeons in Baghdad have greatly enhanced the survival rate among casualties in Iraq. The section on doing right tackles such troublesome moral issues as whether doctors should participate in executions and at what point treatment of a patient becomes mistreatment and should be stopped. Discussing ingenuity, Gawande shows how the rating scale devised by Virginia Apgar, neither an obstetrician nor a mother, transformed the practice of obstetrics. A similar rating scale for every medical encounter, he believes, would inform patients and improve the performance of doctors and hospitals. He lauds the innovative thinking of Don Berwick, head of the Institute for Health Care Improvement, who is challenging the medical profession to measure and compare the performance of doctors and hospitals and to give patients total access to that information. When such information is available, medical professionals can identify the best performance and learn from it, as Gawande illustrates with an account of exceptional results in treating cystic fibrosis at Babies and Children's Hospital in Cleveland. Monitoring and improving clinical performance would do more to save lives than advances in laboratory knowledge, he contends. For young doctors wondering how they can make an individual difference, Gawande suggests five strategies: Ask unscripted questions, don't complain, 'count something' (be a scientist as well as a doctor), write something (to make yourself part of a larger world) and change in response to new ideas. A must-read for medical professionals—and a discerning, humanizing portrait of doctors at work for the rest of us."—Kirkus Reviews

 

"Gawande, a Harvard-trained endocrine surgeon, contributor to The New Yorker, best-selling author, and 2006 MacArthur fellow, examines the nature of how success and excellence are achieved in medicine and how diligence, doing right, and ingenuity can combine to do better—in not only medicine but also all other human endeavors. In a narrative style reminiscent of Oliver Sacks, Sherwin B. Nuland, and Abraham Verghese, Gawande candidly weaves a tapestry of essays on topics as varied as hospital hand washing, polio in India, surgical tents in the Iraq war, physicians' salaries, malpractice insurance, and doctors' roles in lethal injections. The essays are united, as they highlight opportunities for improvement within the medical community, which serves as a successful framework for Gawande's study of a profession predicated on betterment. These revealing, humanistic essays are highly recommended for all libraries. Gawande's varied accomplishments have been publicized, and this book is certain to be a best seller."—James Swanton, Library Journal

 

"Surgeon and MacArthur fellow Gawande applies his gift for dulcet prose to medical and ethical dilemmas in this collection of 12 original and previously published essays adapted from the New England Journal of Medicine and The New Yorker. If his 2002 collection, Complications, addressed the unfathomable intractability of the body, this is largely about how we erect barriers to seamless and thorough care. Doctors know they should wash their hands more often to avoid bacterial transfer in the ward, but once a minute does seem extreme. Using chaperones for breast exams seems a fine idea, but it does make situations awkward. "The social dimension turns out to be as essential as the scientific," Gawande writes—a conclusion that could serve as a thumbnail summary of his entire output. The heart of the book are the chapters "What Doctors Owe," about the U.S.'s blinkered malpractice system, and "Piecework," about what doctors earn. Cheerier, paradoxically, are the chapters involving polio and cystic fibrosis, featuring Dr. Pankaj Bhatnagar and Dr. Warren Warwick, two remarkable men who have been able to catapult their humanity into their work rather than constantly stumble over it. Indeed, one suspects that once we cure the ills of the health care system, we'll look back and see that Gawande's writings were part of the story."—Publishers Weekly (starred review)

 

"The follow-up to Gawande's critically acclaimed Complications (2002) is a sparkling collection of essays about medical professionals and places where "better" either has or is becoming the norm, where excellence is a journey rather than a destination. While acknowledging that varying levels of achievement are inevitable in any human endeavor, Gawande believes the medical profession must assume the burden of constant diligence to do better because lives hang in the balance. Rather than preaching about improving performance, Gawande bears witness to the remarkable levels of care that can be achieved by describing some incredibly innovative, adaptive, and even mundane (e.g., conscientious hand washing) practices in hospitals from Boston to the rural Indian village of Uti, from Pittsburgh to Iraqi battlefields."—Donna Chavez, Booklist