Release Date: 01 April, 2003
Paperback
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Amazon.com
Gently dismantling the myth of medical infallibility, Dr. Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science is essential reading for anyone involved in medicine--on either end of the stethoscope. Medical professionals make mistakes, learn on the job, and improvise much of their technique and self-confidence. Gawande's tales are humane and passionate reminders that doctors are people, too. His prose is thoughtful and deeply engaging, shifting from sometimes painful stories of suffering patients (including his own child) to intriguing suggestions for improving medicine with the same care he expresses in the surgical theater. Some of his ideas will make health care providers nervous or even angry, but his disarming style, confessional tone, and thoughtful arguments should win over most readers. Complications is a book with heart and an excellent bedside manner, celebrating rather than berating doctors for being merely human. --Rob Lightner--This text refers to the Hardcover edition.
From Publishers Weekly
Medicine reveals itself as a fascinatingly complex and "fundamentally human endeavor" in this distinguished debut essay collection by a surgical resident and staff writer for the New Yorker. Gawande, a former Rhodes scholar and Harvard Medical School graduate, illuminates "the moments in which medicine actually happens," and describes his profession as an "enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line." Gawande's background in philosophy and ethics is evident throughout these pieces, which range from edgy accounts of medical traumas to sobering analyses of doctors' anxieties and burnout. With humor, sensitivity and critical intelligence, he explores the pros and cons of new technologies, including a controversial factory model for routine surgeries that delivers superior success rates while dramatically cutting costs. He also describes treatment of such challenging conditions as morbid obesity, chronic pain and necrotizing fasciitis the often-fatal condition caused by dreaded "flesh-eating bacteria" and probes the agonizing process by which physicians balance knowledge and intuition to make seemingly impossible decisions. What draws practitioners to this challenging profession, he concludes, is the promise of "the alterable moment the fragile but crystalline opportunity for one's know-how, ability or just gut instinct to change the course of another's life for the better." These exquisitely crafted essays, in which medical subjects segue into explorations of much larger themes, place Gawande among the best in the field. National author tour. Copyright 2002 Cahners Business Information, Inc. --This text refers to the Hardcover edition.
From the New England Journal of Medicine, November 21, 2002
Atul Gawande's voice has become familiar through the articles he has published in the New Yorker over the past several years. With these and other pieces collected in Complications: A Surgeon's Notes on an Imperfect Science, his varied interests and anecdotes cohere into a fascinating meditation on medicine as a human endeavor -- a meditation not only on the state of medicine today, with its controversies, jumps in knowledge and practice, and very real limitations, but also in some ways on the intrinsic complexities and paradoxes of the profession. Gawande writes about the whole enterprise of learning surgery -- and by extension, of learning any kind of medicine -- by practicing, in both senses, on human beings. And so the discussion extends from his own experience in learning how to put in a central line to the question of why and how repetition -- practice and more practice -- brings expertise and smoothness, and then beyond to the moral dilemma of teaching medicine to new learners: "This is the uncomfortable truth about teaching. By traditional ethics and public insistence (not to mention court rulings), a patient's right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden, behind drapes and anesthesia and the elisions of language." After this introductory section about his own initiation into surgical technique, Gawande brings home the idea that everyone in medicine always needs to face questions of judgment, competence, and decision making. He looks at whether computers can read electrocardiograms more reliably than cardiologists and whether a team of nonsurgeons who perform only hernia operations, day in and day out, will do better by their patients than highly trained general surgeons. And then, inevitably, he takes on the issue of medical mistakes, both the error in judgment or technique by the otherwise reliable doctor and what happens to a doctor who makes mistake after mistake. He argues not only that uncertainty and some possibility of error come with the territory but also that many mistakes can be caught and prevented by applying lessons learned from other professions and other ways of thinking. But after all the discussion of how changing complex systems can reduce human error, Gawande, in telling the story of his own inability to obtain an airway in a trauma patient, is left with the truth that medicine remains a human endeavor, with responsibility and even blame to be assigned accordingly: "Good doctoring is all about making the most of the hand you're dealt, and I failed to do so. . . . Whatever the limits of the M&M [morbidity and mortality conference], its fierce ethic of personal responsibility for errors is a formidable virtue. No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it." In his discussion of mysterious syndromes, of severe blushing, chronic pain, obesity, and nausea, Gawande confronts issues both at the limits of medical understanding and also, not coincidentally, at the intersection of mind and body. The sufferers he describes -- a woman who wants to be a TV anchorwoman but endures debilitating blushes, an architect with years of chronic back pain, a construction contractor who weighs 194 kg (428 lb) -- speak vividly through his clear and sympathetic writing, showing and telling how their lives have been damaged and circumscribed and even defined by these medical conditions. And yet there is always the nagging question of whether they are somehow "complicit" in their own destruction, whether the blushing problem is some compound of self-consciousness and vanity, whether the pain is "all in his head," whether the weight represents moral weakness. And in following some of these people through surgery -- an endoscopic thoracic sympathectomy to cure the blushing, a Roux-en-Y gastric bypass for the weight -- Gawande leads us to a fascinating surgical perspective. It is almost as if the more this surgeon becomes practiced and comfortable with the astonishing intimacies of surgical technique, with all possible invasions and manipulations of the human body, the more intrigued he becomes by the intricacies of the mind and the spirit and their power over the body and its progress, in sickness and in health. A beautifully written essay on autopsies includes an unforgettable image of a surgeon watching the much less gentle and elegant cutting done on the body after death: "Surgeons get used to the opening of bodies. . . . Nevertheless, I couldn't help wincing as she did her work: she was holding the scalpel like a pen, which forced her to cut slowly and jaggedly with the tip of the blade. Surgeons are taught to stand straight and parallel to their incision, hold the knife between the thumb and four fingers, like a violin bow, and draw the belly of the blade through the skin in a single, smooth slice to the exact depth desired. The assistant was practically sawing her way through my patient." The point of the essay is the necessity of autopsy and the high likelihood of discovering a different cause of death than had been assumed -- a misdiagnosis or complicating condition -- and by extension, the continuing presence of uncertainty even when decisions must be made and action taken and even though human beings cannot be completely understood by algorithm and experience. In the closing essay, Gawande confronts intuition -- what it is, how it works, and how it plays out in medical practice -- by taking us through the remarkable story of his "great improbable save," a 23-year-old woman who came in with what looked like a cellulitis of her leg and who turned out to have necrotizing fasciitis -- a diagnosis Gawande raised early in the course of her illness partly because he happened to have seen another case of it recently. When you are through with your initiation, when the systems work to support your practice, how do you finally make your decisions? When does inconsistency in how patients with the same problem are treated reflect problems in the system or bad doctoring, and when does it reflect tiny but real differences in human presentation or in instinct and choice on the part of well-trained experts and a willingness to live with the necessary degrees of fallibility, mystery, and uncertainty? Given the nature of the questions, of course, and the nature of the problems, there can be no resolution and no answers, but this book is a wonderful tribute to the complexity itself and to the intellectual, personal, and professional consequences of taking it on. Perri Klass, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.
From AudioFile
Never has a more sincere and honest book documented the training and practice of doctors, and never has a surgeon written so eloquently. The author uses his own educational experiences to explain how physicians learn on patients, at medical meetings, and in mortality/morbidity conferences. Later Dr. Gawande adds to his captivating teaching stories with absorbing commentary on the impaired physician, chronic pain, and the surgical treatments of blushing and morbid obesity. The sea of scientific and medical terms poses no problem for the charming and animated William David Griffith, who is a skilled complement to an audiobook not to be missed by general readers interested in medicine. J.A.H. Winner of AudioFile Earphones Award © AudioFile 2003, Portland, Maine-- Copyright © AudioFile, Portland, Maine--This text refers to the Audio CD edition.
From Booklist
New Yorker readers will recognize writer-physician Gawande because of his article on the TV anchorwoman with an almost career-ending blushing problem. He exhibits the same smooth, engaging style and choice of unusual subjects in the 13 pieces in this collection, many of which amount to medical detective stories. Typical of those is the last piece, about a young woman who had, it seemed, a simple rash on her leg. But Gawande had earlier seen a patient with necrotizing fasciitis, the flesh-eating bacteria of tabloid fame, and had an uncomfortable hunch that he pursued with his fellow surgeons and a dermatologist. The rest of the tale illustrates the emotions and reactions of the patient and her father as well as the role of the hunch in science. Several entries deal with medical ethics, considering doctors who "go bad" and the long-time failure of doctors and their organizations to police the profession, and whenever Gawande depicts the regular morbidity and mortality conferences in hospitals, he is downright riveting. William Beatty
Copyright © American Library Association. All rights reserved--This text refers to the Hardcover edition.
Review
“None surpass Gawande in the ability to create a sense of immediacy, in his power to conjure the reality of the ward, the thrill of the moment-by-moment medical or surgical drama. Complications impresses for its truth and authenticity, virtues that it owes to its author being as much forceful writer as uncompromising chronicler.” — The New York Times Book Review“No one writes about medicine as a human subject as well as Atul Gawande. His stories about becoming a surgeon are scary, funny, absorbing....Complications is a uniquely soulful book about the science of mending bodies.” —Adam Gopnik, author of Paris to the Moon“Gawande is arguably the best nonfiction doctor-writer around....He’s prescient and thoughtful...the heir to Lewis Thomas’ humble, insightful and brilliantly crafted oeuvre.” — Salon.com“Complications is a book about medicine that reads like a thriller. Every subject Atul Gawande touches is probed and dissected and turned inside out with such deftness and feeling and counterintuitive insight that the reader is left breathless.” —Malcolm Gladwell, author of The Tipping Point“Gawande is a writer with a scalpel pen and an X-ray eye.... He turns every case—from gunshot wounds to morbid obesity to flesh-eating bacteria—into a thriller in miniature. Diagnosis: riveting.” —Time “Gawande’s prose, much like the scalpel he wields, is precise, daring, but never reckless....Much like reading George Orwell, the reader emerges entertained, enlightened, transformed and immensely satisfied.” —Abraham Verghese, author of My Own Country and The Tennis Partner“Wrenching human tales...Gawande has pushed the medical yarn in a new direction.” — The Boston Globe“Atul Gawande is a rare and wonderful storyteller who portrays his profession with bravery and humanity.” —Ellen Goodman, Pulitzer Prize-winning columnist “The stories in cf0Complications are gripping medical mysteries that always have something extra. Gawande draws you in with the story but leaves you wiser about science, about health care issues, and even about the human condition.” —Michael Kinsley Rating 5.0
Good MedicineI highly recommend this book for all of us who entrust our lives to our doctors. This book gave me a good view behind the curtain of just how speculative medicine is and how fallible doctors are. It's made up of short pieces, previously published in magazines such as The New Yorker, which detail incidents and thoughts from the life of a resident who skillfully recorded medical cases and his involvement in them over the years. At first, I had a hard time just reading about medical procedures involving needles piercing heart walls and lungs being collapsed. But after the initial shock, I found the anecdotes and cases to be fascinating and instructive. I came away with a new appreciation of our fallibility and a stronger sense that we, as patients, need to take charge of ourselves and see to it that we get the best care out there from the most experienced hands. Perhaps this was not the author's intention in writing this work, but I thank him for opening my eyes to the need for constant vigilance. I give this book an A+. Compli-awesomeComplications by Atul Gawande is a testament to the Harvard M.D.'s excellent literary skills. His approach to this semi-autobiography is to offer a human perspective on the world of general surgery. As a surgical resident, Gawande invites the reader to partake in his stories that divulge information about surgery that the public might not be aware of, or even might not want to know. Gawande breaks his book into three sections: the fallibility of doctors, mysteries and unknowns of medicine, and on uncertainty itself. Gawande has a general formula for each of his chapters. He begins with an example from his own experiences as a surgical resident and then relates it to a broad topic about medicine that he is discussing. He then periodically returns to his personal story, or of stories of doctors he is familiar with. This style is effective in drawing the reader into his unique world and helping them understand and relate to the moral dilemmas and issues within medicine he experiences. This structure helps Gawande display effective ethos. For example, Gawande discusses a time in his career where he made a mistake with a patient that almost cost the person's life. He then goes on to talk about how doctors hold a Morbidity and Mortality Conference every week to discuss medical mistakes, and what they should do differently in the future. He then goes on to discuss how every doctor has made a terrible mistake in their careers, and talks about recent studies and statistics about this subject. As seen here and in every subject Gawande probes, he turns it inside out with opinions, patient and doctor viewpoints, specific examples, and breathtaking detail. Gawande does a brilliant job of helping the reader comprehend the extremely complicated and meticulous world of surgery. He explanations of surgical techniques are informative and fascinating, leaving the reader almost enlightened after one is explained. Also, Gawande makes sure to leave his personal bias at a minimum, hoping that the reader can form their own opinions about the fallibility of doctors and uncertainty of medicine. The only time he deviates from this non-bias is his criticism of mal-practice suits. However, it is hard to penalize Gawande for this opinion when he offers so many stories of doctors making incorrect life or death decisions. Overall, Gawande's book sucks the reader into an unseen world of surgery. Some people still prefer to believe surgeons are unflappable gods; however Gawande offers a viewpoint that surgeons are brave, but still very human characters. Gawande also shows compassion towards his patients, as he sees them not as medical rats, but as fascinating, intricate, and easily wounded human beings. Very Insightful The author Atul Gawande has become one of the foremost authors in relating the physicians art and the medical field to the laymen. The Author still has empathy for the patient. He has not forgotten the questions that patients struggle with. This book presents a series of true medical situations. It is the story of decisions that have to be made by physicians, sometimes fast paced decisions, maybe logical, rational or mundane decisions or forced decisions that have to be made, before all the facts are available. "Complications" is really the story of the consequences, the twists and turns of these decisions. This book will make one think about situations that the medical field faces. The author seems comfortable on either side of the fence, discussing the problems the physicians face and equally the concerns of the patients. The author's discussion on the hospital procedure for corrective action is an eye-opener. It certainly does not appear to be as effective as corrective procedures in critical industries. This book will draw you in, simply stories of medical situations that you'll think about it for a long time afterwards. |
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