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Complications: A Surgeon's Notes on an Imperfect Science
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Customer Reviews
Rating:  - A fine, examined look into such a controversial field
The author wrote many of these for The New Yorker and other publications; what is even more remarkable, however, is that he wrote these essays when he was beginning his career as a surgeon.
Surgery is among the most controversial, and difficult fields in medicine. The risks are so high, the complications so abounding.
I began reading this book with a jaded and jaundiced eye, hoping to find validation for my subjective impression of a field gone awry.
Intead, I had greater respect for the field of surgery, in the author's well-written and incisive book.
Rating: - Medicine - Mysterious and Uncertain Science
Similar to his other book titled Better, Dr. Gawande divided his book into three sections: Fallibility, Mystery and Uncertainties. As much as I enjoyed reading the five fascinating stories about medical mysteries (Mysteries about Friday the Thirteenth, pain, blushing nausea and food obsession), I found the two other sections more stimulating and inspiring. Speaking from his own experience (many of them gruesome and daunting), he successfully convinced his audience that medicine is full of uncertainties and doctors, just like any other human beings, are not infallible (even though we may hope that we are not).
In Education of a Knife, he candidly and modestly described the enthralling, and at times disappointing and frustrating, learning process he went through to administer a central line on live patients during his surgical training. The discomfort he caused during his first few unsuccessful trials led him into asking the question, "Is it possible to train the novices without harming patients or putting them at risk when only relentless practices can lead to perfection?"
Another story that caught my attention is When Doctors Make Mistakes. I was mesmerized by his honesty and morality in telling the mishap he encountered during his first emergency tracheotomy. We, human beings, have the natural tendency to hide our failure. When we make mistakes, we often shift the blame to others as a damage control. It is incredible that instead of hiding this episode of embarrassment, he laid it all out in complete details and full disclosure (just like a journalist would for the most controversial and intriguing story) to make the point that doctors are infallible no matter how much they strive for perfection because there are always other contributing factors such as "the lack of standardized protocols, the surgeon's inexperience, the hospital's inexperience, inadequately designed technology and techniques, think staffing, poor teamwork, time of day, the effects of managed care and corporate medicine, and so on and so on." If Six Sigma is not achievable in medicine (as possible in other industries) at our current time, the least we should do perhaps is to aim closer to this target?!
Whose Body Is It, Anyway? is another thought-provoking story included in this book. It examined the various questions about patient involvement in decision-making during the treatment process. The key question is not whether patient and their families should be involved in the decision making process, but how best can physicians guide them through the process and work collaboratively with them when they are clearly incapable of making the decision during such vulnerable moments in their lives when emotion overrules logic (as demonstrated by Dr. Gawande's own "childlike regression" during his daughter's hospitalization).
Rating: - great book for medical and non-medical professionals!
Excellent book on the imperfections of medicine. Keeps the reader interrested through the entire book - it's almost sad when finished...
Rating:  - Great book on surgery
Atul Gawande gratefully takes the reader to the back of the OR, a place open for a few, yet intriguing for many. Dr. Gawande is extremely frank and poignant, as he describes actual cases from his own surgical practice. He admits that cutting someone open for the first time is hell, praises surgery which gives chance to obese people, wonders about doctor's intuition, and remains human in every case.
As always, Atul Gawande is not just writing about medicine; this book reaches far beyond the realm of the operating room. He touches on the most complicated ethical questions of medicine and society as a whole. Gawande speaks of mistakes and our imperfect judgment; tackling the questions of good doctors gone bad along with malpractice claims and punishments. He makes the case for autopsy as a means of learning. He admits that medical students must practice on cadavers or animals in order to cut people open; all ethical questions are answered by means of vivid examples.
For instance, in the 1980s the death rate from a particular surgery would be about 10%. When the new surgical treatment of heart pathology arose, surgeons started trying the novice. At that training period, the rate of children death from this particular intervention increased to 25% of cases. Sounds horrible? Yes, but after surgeons learned, the rate fell down to just a couple percent. Was it worth it? Sure, granted the number of lives saved in the long run. Never, granted now many kids died just due to surgeons' learning. Would any doctor let anyone practice on his own kid? Never. At the same time, learning is a necessary part of medical progress.
Those questions dominate the book; Gawande ponders at the patient's right to choose, reminds us that doctors are human and prone to mistakes, reveals mysteries of complications, which are usually open only during the M&M - Mortality and Morbidity Conference behind the closed door. Gawande is not afraid to open the doors. Moreover, he is confident that openness is the only way to reduce the complications.
I almost wanted to say the book is too idealistic, except it's written by a person whose profession is to think realistically. Great book!
Rating: - Interesting insight into the world of being an intern and a doctor
The first part of the book is the typical medical error conversation - the system needs changes, but, instead, the last doctor to touch a patient is always ultimately responsible. The last two sections of the book are full of interesting patient stories and antecdotes, leaving the reader with a sense of "why do I pay so much for services that are not consistent and not scientifically proven?" Gawande does an excellent job pointing out some of the uncertaintaties of medicine and some of the major health disparities and inequalities - the poor are usually the ones that are used as training tools for interns and residents, and receive subpar-care compared to the well-insured.
A very easy and quick read.
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