Friday, July 10, 2009

Better by Atul Gawande

If we wanted to save more patients’ lives in the medical system, is it more important to fund research that could perhaps find cures, or would it be more appropriate to invest time and money in improving the standards already in place? The tendency for us to say ‘more research’ is almost a given, but Atul Gawande, surgeon and staff writer for The New Yorker, argues that the later can have far more drastic effects.

In Better, Gawande explains that in medicine, as in nearly all human endeavors, variations in performance create a bell curve where most participants are merely at or below average. In this collection of essays, he studies this idea in the medical community and looks to find what separates the positive deviants from the rest.

Gawande writes about such the importance of hand washing, something one would think is a given in hospitals and doctor’s offices, yet shockingly staph infections in hospitals are transmitted to 30% of patients, a number that could be reduced dramatically using tools already in place. T
he doctor also covers ethics in medicine, from the use of chaperones when examining patients of the opposite gender and the role of doctors in capital punishment.

In covering medical interventions in slightly abnormal pregnancies, he makes a strong case that many caesarian sections are given when the old method of using the clamps on an infant would work just as well with an equal or better chance of complications. When studying the differences between a first class treatment center for cystic fibrosis and an average one, Gawande argues that the main difference is the ability of the medical staff to treat the person more than the disease and to be willing to think outside the box when it comes to diseases with which we have made relatively little progress on a cure.

In a stirring conclusion in which he offers five pieces of advice to medical students on making a difference in patients’ lives, Gawande says that it ‘often seems safest to do whatever everyone else is doing, but a doctor must not let that happen—nor should anyone who takes on risks and responsibilities in society.’ Technology provides many solutions and enables advances in areas previously thought impossible. But it is human ingenuity that underpins technological advance, and sometimes it is simple human practices that have the biggest impact.

Better is an entertaining and informative collection of essays with lessons that go beyond the specifics of practicing medicine. I look forward to reading more from Dr. Gawande in the future.

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