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Complications: A Surgeon's Notes on an Imperfect Science
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Customer Reviews
Rating:  - Surgery Patient Weighs in on Surgery Book
As a double lung transplant recipient, I am bewitched by stories told from the medical professional perspective. Not unlike when I was in my early twenties and discovered the shocking truth that my parents were in fact human just like me, I have grown increasingly aware that those who perform superhuman tasks like surgery are also just people--neither superior or inferior to myself. This is both a comforting and scary realization and one that has prompted my new found hunger to understand life on the other side of the exam curtain.
Atul Gawande's book "Complications" seemed a perfect choice on this quest to discovering a window into the world of medicine and, in particular, surgery. While this proved true, I never anticipated the honesty with which Dr. Gawande writes of his experiences as a surgeon in training. At times his ability to expose the facades medicine uses to shield us patients from a physician's true lack of experience or confidence was almost too disturbing to take. I had to ask myself, "Do I really want to know this?" At other times, I felt vindicated in knowing that a suspicion I had about how things work was right on target. Often, I felt as though I was gathering useful inside information that would help me in advocating for myself in the future.
As a patient, it is obvious that the world of medicine is both astounding in what it can do and broken in the way patients are treated and systems are run. Perhaps what I appreciated most about "Complications" was Gawande's willingness to investigate some of these "elephants in the room." With the intelligence of a surgeon and the heart of a compassionate man, he takes an honest look at medicine's tendency to blame the patient (psychologically) when no other solution can be found for chronic pain. In an in-depth and unique way, he explores the delicate balance of physical conditions and human emotion in relation to obesity. Gawande walks the thin line between using all that medical science has to offer while still allowing room for the mysterious. He does not blame anyone, physician or patient, for what is unknown--he only analyzes it in such a way that this reader could not help but be changed. There are many parts of this book which have altered my perspectives forever.
I highly recommend this book--it is not overly technical and rarely boring.
Overall, I find myself hoping that Gawande is not a physician out on a limb by himself, but a representation of the evolution of medical attitudes and approaches to complex problems. A hospital full of Atul Gawandes? Now, that's a place I'd like to go for my healthcare.
Tiffany Christensen
Author of "Sick Girl Speaks!"
Rating:  - Almost a new age medical classic
I am a great fan of Dr Gawande.
Since the first time I read his essay in the New England journal of medicine, I have expected more from him.I have read most of his pieces from the New yorker.
I think he is amazingly talented and that he will only turn out more and better books.
As a layman, I would give this a 5 stars: for once Dr Gawande has been able to describe in a medical person's perspective that would register with a layman.without the glamour and jazz.
Our fears,doubts and tribulations.
For medical personnel: this would be a 3 stars: not because it is subpar, but because he tends to simplify this a little more than I would like him too. He lost me through 3/5 ths of the book when he hit the Bariatric surgery part. I had to struggle to get back in again.
I would have liked him to tackle the other part of patient care that we, being PC, tend to avoid: difficult patients, people who live of the system, a lazy and inefficient system which chews residents and fellows and makes a mockery of ideal medicine.Of a profit driven insurance system and a medicare/ medicaid system which promotes mediocrity.
But maybe that is another book.
a must read for pre meds and parents of pre meds.
Rating:  - Great insight into the medical profession and into people in general
This is an honest and open look at the medical profession. If you are suspect of doctors or if you look up to them, this audio book will bring you closer to reality.
Rating: - Written with candor
A very interesting account of what really happens in the medical community hidden from the average patient. The author writes an easy to follow, captivating book covering medical explanations, struggles of the physician and the fears and insecurities they deal with under a veil of confidence. The author treats the physician and the patient with compassion and respect, and poses some very pointed questions concerning medical practices and procedures. It will certainly cause a person to reconsider any unnecessary surgery!
Rating: - The hurricane and the ice cube
People often take medical care for granted, but anyone who lives through an injury or illness (their own or a loved one's) experiences the complex set of issues discussed in Atul Gawande's fascinating book.
"Complications" is presented in three sections, abstractly named Infallibility, Mystery, and Uncertainty.
INFALLIBILITY
We've all read other books about medical education and training, but Gawande states the realities chillingly: "Like the tennis player and the oboist and the guy who fixes hard drives, we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon."
From the inexperience of the intern to the ubiquitous medical error to the burned-out doctor gone careless, medical care is saddled with the variability of all human endeavors. In the second chapter of this section Gawande outlines two examples of reducing that variability -- what he calls "the quest for machinelike perfection in the delivery of care."
A Swedish study, led by an expert in artificial intelligence, fed EKGs and the multitude of factors involved in their interpretation into a computer and trained it to do 20 percent better than a cardiologist in determining whether a patient had had a heart attack.
The second example involves a medical center outside Toronto -- the Shouldice Hospital -- where hernia repair is the only operation performed. Due to "routinization and repetition," variations are ironed out of the process and near perfection is attained.
A particularly interesting chapter details how patient safety was deliberately engineered into the delivery of anesthesia, dropping the death rate to 20 percent of what it had been in only a decade.
MYSTERY
The second section of "Complications" explores several conditions that are particularly fraught with intangibles: chronic pain, nausea and vomiting, blushing, and obesity. These conditions and their possible treatments (gastric stapling and bypass, in the case of obesity) are explored with humility and respect.
UNCERTAINTY
The several issues covered in the final section highlight the frequent difficulty of knowing the best thing to do. Gawande explores the modern concept of patient autonomy in decision-making, a welcome turnaround from the paternalism of earlier times. These chapters detail cases where the best decision is by no means clear, even with a second and third opinion. Decision theory, he points out, is a good predictor in the aggregate, but of little use in the individual case.
Gawande's essays (some of which were previously published) are loosely linked in theme, but together they give a fascinating look at the realities of medical care and decision making. Though some treatments and statistics may have changed in the six years since "Complications" was published, the underlying realities are enduring.
The most telling metaphor in Gawande's book is that of the hurricane and the ice cube: science, he says, can give a good statistical prediction of what a hurricane will do. But it can state with 100% certainty that an ice cube thrown into a fire will melt. Medicine, he shows us, is more the hurricane than the ice cube.
Linda Bulger, 2008
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