Complications: A Surgeon's Notes on an Imperfect Science

This book was a fascinating look into the modern doctors world. It is a job more defined by statistics than in the past, but personality and experience still play a great part. I really enjoyed reading this doctor/author's book book on Checklists and their usage in medicine so I was not disappointed with his more random thoughts on doctoring in general. Some of it is quite unsettling as in the case of surgery and interns learning. You hate to be a learning experience when your life is at stake, but how else do interns learn? Still...most doctors insist that their loved ones, are not part of this experience. Doesn't seem really fair; does it? Doctors like everyone else do better with practice, and this is well demonstrated with these specialized practices that only do Hernia operations. It also makes it possible for robots and computers to be quite effective at simple procedures. However that gives me pause. Here the blue screen of death might have greater implications than a reboot. I liked the fact where he dealt with some of his mistakes and diagnoses of patients and how there was a struggle of procedure and how to approach things. One person was nearly harmed by a minor oversight and another person was saved with a hunch. Given that both of these areas (oversights and hunches) are in the gray areas of human cognition it shows how much luck plays a factor, or a sixth sense, that doctors with experience start to develop. A quick synopsis of what this book includes: INTRODUCTION FALLABILITY *Education of a knife: How interns are trained in surgery. Odds are, you are their training. *The computer and the hernia factory: Repetition = perfection and efficiency *When doctors make mistakes: How mistakes happen. Like all of us they are human, but unlike all of us the ramifications are greater. *Nine Thousand Surgeons: Conferences provide an opportunity to compare notes and keep up to date. *When Good doctors go Bad: Peer review is necessary but whistle blowing on a colleague is rare. Not surprising there are remediation schools, but few and far between. Important note, if some doctors push you away from others...take note. MYSTERY Full Moon/Friday the 13th: Is there any truth to this. Statistically no, but the jury is still out. The pain perplex: Pain stumps most doctors as how and why it exists is not clear cut.There is no test for pain. A queasy feeling: Nausea is not one symptom, nor does it have a single cause and can be very difficult to treat. Crimson tide: Blushing, for some it undermines their confidence, but is it only cosmetic? The man who couldn't stop eating: Overeating is a life altering issue and surgery to address this is gaining ground as in the case of the morbidly obese, it works. UNCERTAINTY *Final Cut: Autopsy is not done as much any more unless there is a mystery surrounding the death. However, it helps educate doctors as to the accuracy of their diagnoses. Unfortunately to many it is a violation of the dead, who will gain nothing in return. *The dead baby mystery: Sometimes the answers are obvious *Whose body is is anyway: Doctors these days advise, not dictate and patients struggle to make the right choices. *Doctors have to let patients make bad choices despite their objections. *The case of the red leg: Gut feeling are sometimes all you have and often they are dead on. In the absence of this all that is left is statistics. SUMMARY This book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea. Others associated with medical errors, bad doctors, cases that were swayed by errors and hunches. If you have any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific.

Having worked as an analyst in the healthcare industry, Atul Gawande's name is no stranger to me. His high profile work as an advisor in healthcare reform and authoritative figure in the world of medicine prompted me to pick up his most popular book, Complications. To my surprise, this book turned out to be quite different from what I expected. I began reading with the impression that it would be more in tune with the healthcare reform-directed rhetoric ubiquitously heard in the media and other public debates these days. Instead, I found Complications to be an intriguing narrative on a wide range of lesser known issues in the medical practice. Complications explores a hodgepodge of topics through each chapter. Through captivating anecdotes, situations explored include areas such as the systemic problems resulting from the way healthcare is practiced, philosophical thoughts relating to limitations in understanding the human body, and the vital role that a physician's intuition still plays in decision making despite the improvements in technology and evidence based studies. Some of the systemic issues addressed include: the ethical dilemma in training new doctors by allowing inexperienced hands to operate on patients, how a good physician can go "bad" because of a the perverse incentives of our reimbursement system, and how performing autopsies can help improve the delivery of care. I was particularly fascinated by the medical mystery chapters of the book, which presented some common but poorly understood areas of medicine such as pain, nausea, and eating disorders. I think an underlying theme is the uncertainty of medicine - that doctors are human and the complexity of their work requires intuition based decisions, even if at times such decisions may lead to unforeseen error. Although the memoirs make some very suspenseful reading and provide an eye-opening perspective on certain problems facing healthcare, I feel that Atul steers clear of the potentially politically charged ideals. While the reading is informative, it isn't very opinionated. I think this makes the book more enjoyable to read and leaves the reader with a greater sense of awe from the narrative. I feel like it was written not with the intention of advocating an ideology, but to tell a good story. If you are looking for a specific commentary on the social issues of healthcare familiar to public debate, you won't find it here. However, you will find interesting views on a number of other intriguing areas in medicine, from the eyes of a surgeon. Even though Complications turned out different than I anticipated, I found it to be a very entertaining and worthwhile read.

Very interesting read for anyone interested in the medical and health system, especially regarding the uncertainty surrounding surgery. Some doctors might have a tendency to talk over your head with medical terminology but that is not the case in this book. I'm a nurse and so my interest in this book came from seeing patients everyday blindly taking the advise of doctors that spent 5 minutes (sometimes even less with them)and letting these doctors make huge life altering decisions for them. The author discusses issues regarding the surgery and the OR. Some people want to believe that surgeons are infallible and that their health decisions are black and white. Gawande talks candidly about the world "behind the OR door" pointing out that doctors are only human, and are limited by several factors discussed in the book. He writes about some touchy end-of-life decision making and the life/death decisions doctors and patients have to make. He even writes about how patients in fact don't really want to make theses decisions and want the doctors to make them. I found the medical stories and example the author used to be engaging and interested, they kept me engaged amid statistics that might otherwise have been dry and boring. If you have blinders when it comes to Doctor and healthcare and don't really want to face the infallibility of our medical system, this book is not for you. I gave this book 4 stars instead of 5 because I think the author could have gone even deeper into several of the subjects he discusses and that would have made for and even more interesting read but in all fairness I think I'm probably in the minority there.

Atul Gawande mostra com exemplos e com linguagem simples um mundo que é vivenciado por médicos e por vezes incompreendido pelos pacientes. Mostra ainda a arte que cerca essa ciência imperfeita que é a Medicina. Recomendo tanto para médicos quanto para pacientes.

I thoroughly enjoyed reading this book. The author takes you on a journey through just a few issues within their industry, dabbling on personal experience, hardships, and backs it up with factual research. In addition, I found the grammar to be nearly perfect, which I personally find makes for an easier read.

Un libro molto interessante da leggere se masticate l'inglese. Drammatico e comico allo stesso momento. Lo scrittore ha avuto un grandissimo successo con vari libri basati sulla sua esperienza da neurochirurgo che ho immediatamente ordinato poco dopo. A me è piaciuto molto e l'ho finito in meno di due settimane.

It is so refreshing to read what a doctor really thinks, with honesty about the mistakes they might make (as any of us can in our own professional lives) rather than the old model where the doctor always knew best, even when they made a mistake. It made me want to have a different relationship with my health professionals, to acknowledge that they are human, and have them also acknowledge, as any of us should, that they might not have all of the answers. Gawande writes, as he speaks (I discovered him giving the BBC Reith lectures in 2014) in such an open, easy, and eloquent way: I just enjoyed every story, and his humanity shining through. His compassion is life affirming. And his respect for his parents' experiences in India, and in the US just shine through the pages. He puts all health professionals in their appropriate places: as card carrying ordinary human beings, and I'm recommending reading him to all the health professionals I've had to deal with lately!

Lucid, well-researched