Complications: A Surgeon's Notes on an Imperfect Science

An inside look at medical complications: what can and does go wrong with some medical procedures. Well written, clear and no overly filled with jargon.

Dr. Gawande's essays are thoughtful and very well written, and it blows my mind that he was able to be such a prolific writer while doing a residency (let alone a surgical residency). I read these essays one at a time originally when they appeared in the New Yorker during my pre-med and med school days, and I enjoyed rereading them recently, now that I'm a resident myself. It is always refreshing to see honesty when it comes to the imperfections of the medical profession. His stories about dealing with his own children's medical problems are very compelling, struggling with when to relinquish control to other doctors and when to step in and advocate. I also currently find myself much more interested in the cognitive science of decision making, having to make potentially life-altering decisions in a split second, balancing multiple confounding variables along with personal styles, experiences and instincts. Another topic given well deserved scrutiny is the phenomenon of physician burnout and how the profession deals with, and often fails to deal with, "good doctors gone bad." Dr. Gawande comes across as the type of person I wouldn't expect to enjoy working with the typical surgeon colleagues. In fact, I would love to see him address this topic in his future writings. It would take a writer of his skill to explore the stereotypical personalities and cultures of the different specialties. No one wants to over-generalize, but medical students from various schools will have very similar descriptions of the types of O.B. residents versus psychiatrists versus pediatricians versus orthopedists that they worked with. The broad, simplified version of this is along the lines seen on the TV show Scrubs, with surgeons being the jocks and internists being the geeks. That is too generalized but not entirely untrue. It's an interesting question, what perpetuates these sub-cultures, whether it is the type of person drawn to a specialty or whether people pick their careers based on who they want their colleagues to be. In the end, even with all the discussions of mistakes, burnout, and imperfections, I found this book to be affirming about the medical profession. Affirming both as a physician and as a sometimes patient or family member of a patient. Medicine doesn't always work like it should, and doctors should not be placed on pedestals. There are real problems in the system, but there are also plenty of very dedicated, hard-working, medical professionals doing their best to overcome those problems, working to provide the best care possible to their patients, to make the best decisions possible given the limitations of our knowledge. In times of crisis, you just have to take a deep breath and then put your faith in the system.

"Complications", by Dr. Atul Gawande is a very gutsy and honest discussion about medicine in general, and surgeons in particular. The book is also unique, for unlike others of its type it is written by a surgeon that is starting his career, and not looking back upon it. I would imagine that the book caused some consternation amongst his peers. The book does nothing to minimize the skills and accomplishments of the men and women who can reach in to the body and do some pretty spectacular work. The book does portray them as human beings that come with all the normal traits that any of us do. The pressure they must deal with is that when they make a mistake, it can irreparably harm or cause the death of the patient they are trying to help.The vast majority of careers that people practice does not involve decisions that can cause the outcomes I mention above. And few occupations require of their practitioners near perfection, that if not delivered has a major legal industry prepared to hammer them with lawsuits. Incompetent or negligent doctors should be punished and removed from practice, but what about a human error, or a doctor that makes every single decision that is correct and appropriate for the patient he or she sees, and misses the 1 in 250,000 cases where doing everything correctly can cause a patient to die. The final chapter of this book deals with exactly those type of odds. Whether those odds are beaten often depends on the instincts of the physician. And these intuitive feelings they may or may not act upon are certainly helped by experience, but younger doctors without the years that familiarity brings can often make a decision largely because they are so new. Dr. Gawande makes clear that all the sophisticated technology available does not replace the one on one interaction with the patient.If we ever need a surgeon we want a person we perceive as experienced, a person we are literally willing to risk our health and our lives with. The problem is that virtually no one wants to be part of a new surgeon learning his craft even with very experienced surgeons standing right at the table, watching and even directing the path the surgery takes. Dr. Gawande also shares his feelings when his children are ill and the contradictions he deals with as a parent, even as he is often on the other side with people judging him and his youth.The statistics say that a surgeon will make a given mistake once every 200 times he or she performs a surgery that is described in the book, and that is also fairly common. If the mistake is made the results range from terrible to potentially terminal. The author does a great job of sharing what it feels like to be told that you will make the mistake, that doing the task 99.5% of the time without error can still cost a life.A person who decides to become a general surgeon will study and practice until their mid 30's before they are able to operate on their own. That type of commitment is rare, and recent articles h

I read this book while convalescing from surgery,therefore with recent 'experience" from both sides of the blade. I was amazed at the impressive insight and expressiveness of this surgical resident who only starting his medical career. His descriptions of various controversial medical themes and dilemas evoked many of my own experiences,emotions and my own impressions of how it is that we solve our daily medical mysteries that rarely conform to the textbooks. I've recommended this book to my son who is contemplating a career in medicine, I think he'll understand better what he might be getting himself into. I am anxious to follow any subsequent writings of this writer to see what I think will be an interesting evolution as he becomes first an attending physician and then deals with many more challenging experiences that will leave him even more perplexed,doubting,dispirited,uncertain but at the same time elated by his many clinical triumphs.

Yes, this is a book by a surgeon, and there are certain, um, "graphic" descriptions in this book. But it's well worth your while to read them, even if they make you feel goosy, in order to learn from this incredibly talented writer, surgeon, and ethicist.Some ethical questions: - Should a doctor act on hunches? - What if the action might be risky? - Should a teaching hospital let a junior doctor operate on YOU? - Will the hospital even tell you if this happens?A big one: - Is it ever right to ignore a patient's plea to "Please don't put me on a machine"?You may think you know the answer to the last one, but after you read his description of an actual patient who said this, you'll be much less sure.And what about when a doctor is sure of his diagnosis - is the doctor right? How often? Well, it happens that there _is_ a way to find out, and it was commonly used 50 years ago. We just don't like to use it much, anymore. It's called an autopsy. But in the few cases where it is still used, there are surprises.What an incredibly informative book. Read it. Get past the blood, you'll be glad you did. You'll see your doctor, and medicine, and your own body, in a whole new light.

There are other writing doctors around, but there's nobody like Atul Gawande. I'd first got to know his voice, his distinctive approach -- immense vivid medical detail combined with an almost philosophical interest in the systemic or ethical dimensions of the problems he explores--in the pages of The New Yorker. But there's a lot here that never appeared in that magazine, and, besides, the whole really is greater than the sum of its part. His arguments -- about the fallibility of medicine, about judgment under conditions of uncertainty, etc. -- run through the chapters like sinews. "Complications" is a genuine page turner, but you come away not only entertained, but enlightened, too. I've recommended it to a lot of my friends, and nobody's been disappointed yet.