Better: A Surgeon's Notes on Performance

Atul Gawande

Jan 2008 · Sold by Metropolitan Books

About this ebook

NATIONAL BESTSELLER

The New York Times bestselling author of Being Mortal and Complications examines, in riveting accounts of medical failure and triumph, how success is achieved in a complex and risk-filled profession

The struggle to perform well is universal: each one of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives are on the line with every decision. In this book, 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 as in all his writing, 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.

At once unflinching and compassionate, Better is an exhilarating journey narrated by "arguably the best nonfiction doctor-writer around" (Salon). Gawande's investigation into medical professionals and how they progress from merely good to great provides rare insight into the elements of success, illuminating every area of human endeavor.

Ratings and reviews

Better is a very interesting read. Having read a book on medicine relating experiences and opinions on modern day medicine for the first time, I was happy that I picked such a book. Better focuses on one central theme: doctors’ attempt to improve their performance in order to meet the demands of patients and the new technology that doctors are expected to use to its fullest utility. Dr.Gawande uses his personal experience to talk about how he sees performance being increased, which is definitely a plus point for this book. His usage of informal tone makes the reader feel more empathetic towards his topics and it is very easy for the reader to understand his point. One of the examples he uses to show the undying dedication of doctors is his trip to India to observe the doctors and hospitals there. Dr. Gawande notes his feelings as well, and explains how having studied from USA, he truly felt superior to the doctors in India first—where there was not a basic stock of equipment such as stents or scalpels. The doctors in the public hospitals have to manage patients from about 60 rural districts—which has a total population of two million people. He describes how the doctors see about sixty patients a day and don’t deliberate with others doctors but just proclaim judgment and treat the patient according what is observed right then and there. Furthermore, Dr. Gawande notes details that would normally undermine a doctor’s service to his patients: the hospitals only contained sixty metal cots and they were always overflowing. The public hospital only had two emergency nurses and patients would sometimes have to be situated on the tiled floor to be treated. This outlines the poverty levels and the basic deficiencies that India’s public hospitals lack, which he shows through his description woven into his tale. The four main general surgeons perform all types of operations from giving chemotherapy and radiation therapy to patients—a practice not found in America. Dr. Gawande remarks with awe when a doctor asked him for his preferred technique for removing bladder stones. He had replied that he would call an urologist. The doctor, on the other hand, had done prostate obstruction, a thyroid goiter, diverticulitis of colon, tubercular abscess of the chest, groin hernia, gallbladder disease, a live cyst, and perfection reconstruction on a baby boy born without an anus. One doctor- Dr. Motewar, had even devised a technique involving a laparoscopic repair of the ulcerous perforations that he saw on a daily basis. By providing examples like these, Dr. Gawande shows that there are truly doctors who persevere despite such setbacks and constantly strive to improve their performance with regards to efficiency or meticulousness. His book made me opened my eyes. I generally took the system in USA for granted. The health standards that the hospital has to meet, the sanitation and the availability of equipment at a local hospital like UMC are exactly what I envision myself in. To be opened to such circumstances again, like the one that India faces in its public hospitals, is saddening. These people should be receiving the same care that I am privy to at an instance. My reaction was also filled with respect for these surgeons and nurses who are able to keep up with this hectic schedule. They make do with what they have and many times, they tell their patients to buy equipment for their impending surgery (many shops in India have medical equipment laying in stock for sale.) these doctors truly believe that they can face any challenge head on—and they achieved success with that mindset. These doctors in Nanded (the town which Dr. Gawande went to) had a courageous attitude and they were ready to improve themselves. The only aspect of the book that was displeasing was Dr.Gawande’s style of writing on one topic and then going on a tangent, which hinders the reader’s focus on the matter at hand. One specific time was when he was describing a pregnant woman’s situation and then goes into a long talk about obstetrics

I would definitely recommend this book to readers of all ages thirteen and up! You can easily connect your life no matter what profession you are in . It is a simple book to read but there are some medical terms you might have to look up. It is very interesting and enjoyable to read. A ton of surprises and interesting facts awaits you! Better is told in the perspective of Atul Gawande's experiences in the medical field. It has an overall motif of the human concept of trial and error. "What does it take to be good at something in which failure is so easy, so effortless?" This is one of my favorite quotes from the book it shows you the reality of life. In my opinion the overall theme is based off of this one quote. It gives advice on hoe to be "better" at what you do. The three key points that are emphasized are diligence, doing right, and ingenuity. There is a lot of potential in this book to learn from.

This book is full of examples of people who have made a positive change in medicine, to inspire those in medicine who read it to become a force for better outcomes. For the rest of us of it is still inspiring read about how sometimes small changes can lead to big improvements.

About the author

Atul Gawande is the author of four bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto; and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018–2020. He and his wife have three children and live in Newton, Massachusetts.