August 9, 2008

My brother is a long-time fan of the surgeon-writer Atul Gawande and my visits to LA have invariably included some description of a recent article or book by Dr. Gawande. My brother’s enthusiasm “bug” has bitten me too and I have read a couple of recent articles by Dr. Gawande in the past year or two.

This preamble explains why, when I opened a birthday package from my brother this past May, I was neither terribly surprised, nor disappointed, when Better: A Surgeon’s Notes on Performance fell out.

The book is entertaining and thought-provoking, an unusual combination. While the chapters are loosely coordinated around a theme of “improving performance”, each one can stand alone and would make an excellent basis for a serious group discussion of health and social issues.

My wife has often said that doctors do not wash their hands as much as they used to. A chapter in Better bears this out and describes the terrible consequences of this oversight. Other chapters talk about the global effort to eradicate polio, malpractice lawsuits, battlefield medicine, and how to pay for medical care.

After I had read a few chapters, I became aware of a repetitious aspect of the book (Gawande tends to open his chapters with half-told stories) that was mildly annoying. Still, the book was a page-turner right to the end. In fact, the only part of the book that failed to impress me was the Afterword, “suggestions for becoming a positive deviant”. Here Gawande changes from observer and explainer to mentor. His advice can be summarized as ask an unscripted question, don’t complain, count something, write something, and change. Not bad ideas, but each sounds like something you might hear at a graduation speech — “the future belongs to you, make a difference” — and probably makes about the same kind of impression.


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