Complications: A Surgeon’s Notes on an Imperfect Science
Complications: A General practitioner’s Notes on an Imperfect Science Books
- ISBN13: 9780805063196
- Shape up: NEW
- Notes: Brand New from Publisher. No Remainder Mark.
Product Description
Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look surrounded by with ones own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it really iscomplicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpels edge, where science is ambiguous, in rank is limited, the stakes are high, yet decisions must be made. In dramatic and revealing tales of patients and doctors, he explores how deadly mistakes occur and why excellent surgeons go terrible. He also shows us what happens when medicine comes up hostile to the inexplicable: an architect with incapacitating back pain for which there is no corporal cause; a young woman with nausea that wont go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet everlastingly alive to the possibilities of wisdom in this extraordinary endeavor.Amazon.com Review
Gently dismantling the myth of medical infallibility, Dr. Atul Gawande’s Complications: A General practitioner’s Notes on an Imperfect Science is essential reading for anyone caught up 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 awkward tales of suffering patients (including his own child) to intriguing suggestions for improving medicine with the same care he expresses in the surgical acting. Some of his thoughts will make health care providers nervous or even mad, but his disarming style, confessional tone, and thoughtful arguments should win over most readers. Complications is a book with heart and an brilliant bedside manner, celebrating rather than berating doctors for being merely human. –Rob Lightner
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This book is too much statistics, and no tale behind all their statistics. It is dull to the reader that likes medical tales.
Rating: 2 / 5
Atul Gawande is observably a thoughtful and accomplished physician and novelist and I loved the way in which he unfolded many of the vignettes about various patients and the do of medicine.
I was troubled, but, by the strong ego bestow throughout each tale. Dr. Gawande often places himself at focal top stage during the telling of the tale…even placing himself ahead of others when listing who was caught up in the tale, e.g., “I, another resident and an attending….” I found this do to be disruptive. Additionally, several times I found myself wondering if Dr. Gawande wasn’t telling a tale in a certain way in order to obtain the response “Thank God he was there to save him/her!”
I also felt that Dr. Gawande should have expressed more gratitude for the privilege of being able to have direct access into patients’ most intimate concerns and complications…and then have the opportunity to write (and reap benefit from!) the suffering (and sometimes healing) of his patients. I became concerned that Dr. Gawande viewed each later patient with an eye toward his or her potential to develop into his next New Yorker piece.
“Complications” was worth the read if you can overcome the strong “ego” emanating from the pages.
Rating: 4 / 5
When we reckon of science, we reckon of a lofty ideal full of certainty and devoid of doubt. After all, when we learn science in school, we are taught that a water molecule everlastingly contains only hydrogen and oxygen, if we drop something gravity will everlastingly pull it down, and we will all surely die. With inalienable certainties such as those, to say nothing of other certainties science offers us, then it should follow that medicine, which after all, is firmly rooted in the hard sciences of physics, chemistry, and biology, have no ambiguities or difficulties.
But then we guess our politicians to be above reproach, and are continually disappointed in them. This is the paradox Gawande explores in his book: society expects that medicine, that very scientific endeavor, be perfect, yet perfection is impossible when people are caught up. Mistakes are bound to happen, ambiguities are bound to occur, communication is bound to breakdown, doctors are bound to become terrible (or at least less capable) doctors, etc. In effect, Gawande points out that all doctors are human and all humans are fallible, and therefore, medicine is unable to live up to the lofty ideal of inviolability placed upon it by society.
That these are considered to be novel observations is a disquieting notion; it should be implicitly evident to anyone who has ever dealt with another person that mistakes are bound to occur. The waitress at the restaurant brings you coffee when you ordered tea. The elevator gets stuck between floors because the repairman left debris that blocked the elevator’s path. Your wife (or spouse) cooks steak, after you told her (or him) you are watching your cholesterol. In other words, anyone who has had to deal with the unpleasant imperfections in daily life (a populace which includes everyone) realizes implicitly that we are fallible because we are human, and humans make mistakes. But we do not apply this standard to medicine. All participants in medicine-patients, doctors, medical device manufacturers-wish to operate below the assumption that doctors exist on some lofty plane in which mistakes never occur. That, after all, is why they became doctors and not lawyers or businesspeople, aptly? Because law and business can tolerate mistakes, but, well, the stakes of medicine are too high.
All of this is very compelling, and generally right. It is unreasonable and unusual to assume infallibility on the part of someone with whom you are dealing. But, this has some troubling implications, of which Gawande does not come to terms with. Implicit in the trust brilliant in a doctor, and the power that the law gives to a doctor to perform surgery, administer tablets, and so on is the assumption that, despite our human imperfections, doctors do everything humanly possible to avoid error.
Gawande proceeds to relate the tale of a `excellent doctor gone terrible’ by which he means a doctor that quickly became incompetent and who was not stripped of his license in due course. His is a sympathetic portrait of this incompetent doctor; sympathy is an inappropriate response to the doctor’s plight and tells us small but that doctors have distress confronting their unreliable colleagues and that it takes a even as before a doctor is stripped of his license to do. This is troubling, given the power doctors assume.
On the whole Gawande’s book is a remarkable portrait of the complexity and ambiguity of modern medicine. When he ventures outside that limited terrain, but, and explores the ethical questions surrounding the phenomenon of excellent doctors apt terrible doctors, he trips on his own innate sympathy and detachment. One wishes he took a firm stand; a doctor’s excuse that he is overwhelmed, or has worked too many hours does not wash. A person who assumes responsibility for the health of another simply cannot get away with the excuse that he works too many hours. If a doctor works too much, it is clear he has an ethical responsibility to cut back on the number of hours; this is neither a top of subtle debate nor a particularly trying concept to know. If it is right that doctors, like the rest of us, are fallible then it follows that doctors need to avoid situations in which the number of hours worked exacerbates deficient care of patients.
Gawande would serve his interests better if he quit trying to see the innate excellent in everyone he comes across. There are, of course, people who simply are not excellent people. A formerly excellent person can quite easily become a terrible person and focusing your attentions on the formerly excellent qualities of that person at the expense of the newly terrible qualities simply is a method by which to avoid the unpleasant duty of having to judge another person. A doctor who has worked himself to the bone, and has therefore become derelict in his responsibilities to his patient is neither a excellent doctor nor a excellent person. Such a doctor has absolutely failed to heed his responsibility for his patients; he deserves nothing less than to be rebuked for his actions.
Rating: 4 / 5
Each chapter deals with a different come forth or topic, such as medical error, surgical treatment of eating disorder, even the decline in the number of autopsies. The author draws on his private experiences as a surgical resident, as well as research, both textual and journalistic. The chapters are everlastingly fascinating. Gawande understands systems analysis and the scientific method, and is report has it that a very warm, caring personality, with a strong commitment to the best possible medical do. My only reservation is that in the chapters most indifferent from surgical do, Gawande reaches conclusions that may overstate the case, for example in identifying the role of obesity in causing snoring, or the role of the unconscious in causing chronic back pain (I don’t snore; I have mild chronic back pain). In general, but, he is very sensitive to the complexities of issues, even as not shying away from strong conclusions. One chapter is on the training of surgeons, and the consequent need to theme patients to procedures performed by inexperienced hands: I came away wondering why there is not more training on animals, and how much economics or animal rights inhibits use of such training (yes, I do judge in animal intelligence and even consciousness).
Rating: 5 / 5
A excellent and realistic book. When I was reading, it reminded me many things, like those practices at the beginning of the career, when you feel you don’t know absolutely anything and kind of clumsy. Yes, do makes the Master. Not perfect, but we humans, we try the best we can. And the medical and scientific meetings… ha ha ha, yes, just so how He said it is. Certainly, I urge it.
Rating: 4 / 5