Friday, July 16, 2010

Book Review: Complications by Atul Gawande

I can’t believe I haven’t read this book until just now. It’s been on my list for ages. But that is neither here nor there. The subtitle of this book is “A Surgeon’s Notes on an Imperfect Science.” And that pretty accurately describes what the book is about. Medicine is an imperfect science, and yet because medicine fundamentally deals with human life (and death), it is a science which many- doctors and patients alike- at some level expect to be perfect. We all know it’s not, but yet somehow we think it should be. Yes, doctors receive nearly a decade of training, but the first time they actually draw blood, put in a central line, or cut open a patient, they’re learning. And they’re learning on a real live human who will suffer real consequences if the doctor makes a mistake. The first time they see a rare disease or experience an unexpected complication during a surgery, doctors are learning. And sometimes they make mistakes. Sometimes those mistakes cost lives. Furthermore, medicine and medical technology is a rapidly advancing field, so even the smartest and most disciplined of doctors have difficulty keeping up with the newest treatments and procedures. And when there is a new technique, a new device, or a new medication, well, the learning starts afresh. 

Gawande, a surgeon, talks about this issues in a transparent and candid way. He reflects on our current medical education system and its strengths and weaknesses. He discusses the delicate balance of the freedom for a patient to choose between treatments and a physician’s professional decision making and (perhaps more objective, at times) ability to choose between treatments for a patient. He then writes several essays about some of his cases- ones that went well and ones that didn’t go well. A case in which the treatment seemed clear, obvious and “by the book”, yet because of a rare complication, the patient died. A case in which the treatment seemed clear, obvious and “by the book” but his gut told him to test for a rare and deadly disease which in its early stages would look exactly like the more common disease but which, if not treated early, would result in death. Though “cost efficiency”, “protocol” and “statistics” would have led him to treat for the more common disease, he went with his gut, and he was in fact right. The patient’s life was spared. These are just a few of his essays, but they are all riveting. At least to my nerdy medical self. Complications is a realistic and thoughtful examination of the “fundamentally human endeavor” of medicine and surgery and worth a read for individuals on either side of the scalpel.

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