I recently finished reading Atul Gawande’s book Better. As a general rule I try not to get too wrapped up in writers and their backgrounds so the lens through which I read is not too clouded. The best ideas should be able to stand on their own. It would be a disservice to Dr. Gawande, however, not to mention his M.D. from Harvard and his M.P.H from the same school. In addition to writing bestsellers, he practices general and endocrine surgery, is a professor of surgery and public health and holds leadership positions in various organizations innovative healthcare companies. Contrary to the typical focus on pharma and technology, these innovations are focused on performance, the simple pursuit of being better.
“A Surgeon’s Notes on Performance.” His subtitles often take this form. They lower the bar for his composition and set the tone for what molds itself into relaxed storytelling akin to Malcolm Gladwell. In a style that seems to be making a comeback, Gawande uses a multitude of anecdotes to surreptitiously sneak in salient lessons. In these stories he maintains an air of errability about himself and the other physicians he encounters that reminds us of the limits we face, even in a field filled with brilliant minds. It’s non-fiction that is humanized and immediately relevant by the ubiquity of healthcare, and is best swallowed by the spoonful.
Gawande carefully approaches a variety of topics. Sometimes introducing new ideas; sometimes shining a surgical light on a traditional one. His stories are broken up based on how they fit into his core components in the pursuit of betterment: diligence, do right and ingenuity.
For “diligence” he covers everything from the seemingly mundane efforts to prevent nosocomial infections, to the front lines of eradicating polio, to the military care in war zones.
For “do right” he tackles payment for services, lethal injections and the ever ethically challenging world of malpractice and what to do about it.
For “ingenuity” he catalogs the fascinating advancements of a field as old as human existence, obstetrics, and provides sobering examples of the persistence of the bell curve in medicine.
When Gawande reviews the performance of doctors facing the harsh conditions of war and the trials of a patient with a genetic illness like cystic fibrosis, he finds case studies of doctors who refuse to compromise performance. In fields that people spend there whole lives dedicated to, Doctor Gawande is able to write narratives with just enough detail to impress the importance of the litany of nuances while staying focused on the characteristics that should garner attention in the first place. The good doctor’s notes on performance ultimately call for evidenced based medicine to respect the importance of performance. For many conditions, even a minor shift to the right from the bell curve in treatment care would likely improve the lives of patients far greater than any technological advancement in the next five years. He dispels any notion that full ownership of performance in the often high stakes profession of healthcare is commonplace. As is often the case with his books, he enables us to question not only the systems in healthcare, but the systems pertinent in our own lives as well.
Reviewing books is mad uncomfortable and it feels impossible to do without sounding pretentious. Now my thoughts on are organized though and that’s what I need for a quick future reference.