Better: A Surgeon's Notes on Performance

Better: A Surgeon's Notes on PerformanceThe first chapter of this book was on the effect that hand washing has on infection rates of MRSA and VRE in hospitals It was fascinating I never thought I would find twenty pages on hand washing so engrossing I have high hopes for this book The book got better and better Proper review will be forthcoming, definitely But when Better is a collage of essays by Atul Gawande, MD, MPH and its intent is to enrich outcomes via mindful application of Diligence, Doing Right and Ingenuity as it applies to his profession Listening but not really listening and filtering are qualities of an astute surgeon knowing exactly what the patient needs On one such case of a hydrocephalic child requiring immediate resolution Unless surgery is performed to provide a new route out of the brain and skull for the fluid, the resulting brain damage becomes severe Atul Gawande Better is a rocky complicated emprise with a bubbling stream of truth ever flowing and his mindful goal on becoming better is illuminated He converts the complicated to simple by breaking it down to a basic level of understanding as it hums loudly in our delicate ears so we fully comprehend In this book the achievements of military medicine thus imparting decreased mortality rates from battle wounds are discussed and focused attention to detail to reduce error is no doubt a requisite Gawande provides a cleareyed view of the medical profession that both resonates and gives pause In analysis, he spares no one himself included As Better quickly comes to its last page, Gawande compares his orderly life with his patient cases within And how a surgeon is equated to an automaton and it can be hard not to feel that one is a milky coated cog in a machine Via this seemingly insignificant text he inspires all of us surgeon or not to be better Buy The second of Gawande s four books so far , a collection of eleven essays on the practice of medicine and its context within human society and the world He takes a clear eyed and searching view to such topics as physician compensation, malpractice, and the limits of treatment He has an eye for anecdote the way Medicare fees were constructed in 1992, or stories from his time in CF clinics He also notes the human ability to survive under extreme odds these are stories from battlefield medicine to an Indian anti polio campaign to vaccinate millions of children in days A thoughtful book, recommended for anyone involved in medicine which is all of us, to a degree. This is my 4th book by Gawande It s good, very similar to most of the rest His best so far has been Being Mortal Medicine and What Matters in the End, but the rest are well worth listening to I m listing the TOC below will try to note anything of significant interest It s all interesting, though.Introduction Doctors are human, but are held to very high standards often fail to meet them No surprises pt 1 Diligence Keep on trying to do everything exactly right.On washing hands It s incredibly easy to transfer deadly diseases between patients A clean stethoscope should hang in each room If a doctor doesn t glove touches you with anything he used on a previous patient, especially in a hospital, you re in grave danger of contracting a deadly disease The mop up Casualties of war There is a lot of bad press about VA hospitals now, but Gawande concentrates on the battle field here it seems like the military is doing very well by its men pt 2 Doing right isn t as simple as it seems.Naked Patients react differently I was surprised there were so few guidelines.What doctors owe 30K 300K per year for malpractice insurance Gawande says doctors are sued once every 6 years on average all have a crazy story He tells a couple, but also delves into how badly our current system of malpractice lawsuits is While there is the occasional big settlement, like 99 out of 100, get zip zero New Zealand has a different method, one similar to the one we use for vaccines each vaccine has 0.75 added to its cost which goes into a fund for the 1 in 10,000 that has a problem He doesn t think that would work for medical procedures, but he knows the current one isn t either.Piecework is about how doctors are paid gets pretty involved Very interesting complicated While a few sell out, he doesn t think most do it for the money he has the figures to back it up.The doctors of the death chamber He s dead set against it, but does a good job of presenting the other side of the argument first I disagree with his stance because I think he ignores some facts, such as people that can do continue to order murder torture from their cells.On fighting asks how long hard a doctor should fight for a patient s life Having seen a few horrific, lingering deaths at their hands growing up on a farm where we put suffering animals down, we have differing ideas He makes a case for fighting, but discusses thisbetter in his other book Being Mortal pt 3 Ingenuity isn t always being brilliant, but in looking at things a different way His book The Checklist Manifesto How to Get Things Right covers this better, but this is all new material.The score is a discussion of the Apgar score what a difference it made to obstetrics He points out how this differs so much from the normal methods medicine uses to improve.The bell curve is about the outliers on the good end, the positive deviants, leads well into the next section using Cystic Fibrosis treatments as the platform.For performance concentrates on how so many do so much with so little Gawande doesn t spare himself as he relates some of his experience in India Afterword Suggestions for becoming a positive deviant are interesting apply to most any profession, especially one involving service to others I found some interesting ideas for IT help desk customer service.Notes on sources Another wonderfully written, informative walk through the medical field It s great to see it from their side. The science of performance doing things better and smarter Gawande applies this directly to medicine and public health as he shares stories of health care around the globe I particular liked his history of cystic fibrosis treatment, and the continued work on eradicating polio in southeast Asia and the subcontinent The afterword on postitive deviance was quite good and can be applied widely While not the same gravitas as Being Mortal , this book solidifies Gawande s place as an important thinker Love his work. To complicate matters, we in medicine are also only human ourselves We are distractible, weak, and given to our own concerns Yet still, to live as a doctor is to live so that one s life is bound up in others and in science and in the messy, complicated connection between the two It is to live a life of responsibilityI m writing this review from the perspective of a patient who has spent years in the medical system After reading this book, I haveempathy for the doctors that helped me throughout my treatment I think as patients, we expect nothing but the best from our doctors But just like all of us, doctors are human and even the best of them make mistakes What makes their errorspronounced, however, is the dire consequences they can have on human livesBetteris an introspective and well written account on how medical professionals can improve current healthcare practices What I love most about this book is Dr Gawande s willingness to discuss uncomfortable and taboo topics like, what do doctors owe their patients when they fail And how can hospitals improve hand washing compliance In doing so, he is starting an important conversation And while this book contains valuable information, it was too dry for my taste In my opinion, the best non fiction books have the skillful ability to make complicated topics entertaining Although I learned a lot from this book, it was not the most enjoyable read for me I am planning on readingComplicationsnext, which I think isup my alley It is a collection of essays Dr Gawande wrote while he was in residency, and I have heard it really puts you into the mind of a new doctor I look forward to reading it soon Better collects surgeon Atul Gawande s recent essays on medicine in three categories Diligence, Doing Right, and Ingenuity Each essay, on topics as diverse as washing hands to minimize infections in hospitals and doctors participating in executions, is a marvel of case study and comparative assessment, shifting back and forth between the particular and the general The simplicity and directness of Gawande s prose mirrors his mode of thought always looking for the basic truth, the underlying commonality between disparate conditions, the fundamental practice, or virtue, that can cause medical science or, the practice of medicine to generate better results.In many ways, the thesis of Better is that great improvements are often the result not through breakthrough discoveries or new paradigms but rather of minimizing error through tracking results, comparing them, and altering techniques.The hand washing essay focuses on the nuisance factor, reduced in some hospitals by the use of easy to use gels The essay on cystic fibrosis focuses on the improvements possible through diligently pushing patients minds and bodies to accept everdemanding but relatively simple treatments.Gawande s insights into medical history indeed, his mastery of ancient anecdotes is enlivened by his observations of practices he sees on a day to day basis He s great at finding just the right specialist to interview, or at getting a nurse or doctor to admit that he she moonlights in prisons, monitoring lethal injections.A fundamental principle Gawande honors is openness in admitting the limitations inherent in the practice of medicine It s important for doctors, and patients, to understand this principle in order to be realistic, focused, and determined to do better.Gawande s previous collection of essays, Complications, is less thematic and placesemphasis on fascinating medical detective work and biological conundrums He s terrific. Excellent He writes well.This covers several subjects that are core to current medicine as it is presently practiced Ones which are RARELY discussed Like when are 3rd parties as witness in the room during exams deemed mandatory This varies with extreme difference for culture nuance or governmental law England has different practice for this as common, for instance And the paper drape issue There are several subjects of doctor experience now then and how change in medical practices occur Or not.But beyond, this taught me facts about current practices in India, in war zones and with childbirth norm directions for best that I was not fully aware had changed as much as they have And also about earned by doctors and when what sueing equates to salary But the best was his advice to COUNT something Anything It does matter if you keep COUNT records Results not obvious become revealed. Not nearly as good as his first, in a number of ways.What made Complications so exhilarating was that we were learning about being a doctor just as Gawande was learning about being a doctor Literally he wrote most of those essays while still a resident The humility this brought to Gawande s essays makes all the difference We were forced to consider the ethical implications of a healthcare system that has to deploy inexperienced doctors so that they can be trained and become better doctors Crucially, we did so, or were introduced to this problem, because the author brought us into his very first OR and lets us see his own anxiety at being one of these inexperienced doctors.Not any Now we have Atul Gawande, investigative reporter extraordinaire He cruises around the world, looking for interesting stories about medicine, which are told fine, but they are not personal And, in that increasingly infuriating New Yorker way, the piece becomes as much about the author as the story Blah blah blah, he told me in an email or, I went to see him in his office He was wearing a purple shirt, green pants, and a top hat Which, again, was fine when we really seemed to be looking out from Gawande s wide eyes.A consequence of this is that the book promotes a very odd and simplistic message As you can tell from the title, it s about Doing Better, but the three divisions the three ways we are told we can do better are Diligence, Doing Right, and Ingenuity True enough but do I need an MD to tell me this More unfortunately, potentially revelatory stories about, say, containing a polio outbreak in Africa become bookended and framed as stories about Diligence Maybe, but that the docs are Diligent is the least interesting thing you can say about that story.This sort of oversimplification worried me from the introduction It sounded like Malcolm Gladwell s doing, I thought, and I don t like Gladwell, whose M.O is to oversimplify things and categorize them into Big Themes, often to the point of getting them wrong see his piece on Enron And lo in the acknowledgments, Gawande says he has become best friends with Gladwell Another great topic ruined by the frizzy haired Canadian. The Struggle To Perform Well Is Universal Each One Of Us Faces Fatigue, Limited Resources, And Imperfect Abilities In Whatever We Do But Nowhere Is This Drive To Do Better Important Than In Medicine, Where Lives Are On The Line With Every Decision In His New Book, Atul Gawande Explores How Doctors Strive To Close The Gap Between Best Intentions And Best Performance In The Face Of Obstacles That Sometimes Seem Insurmountable Gawande S Gripping Stories Of Diligence, Ingenuity, And What It Means To Do Right By People Take Us To Battlefield Surgical Tents In Iraq, To Labor And Delivery Rooms In Boston, To A Polio Outbreak In India, And To Malpractice Courtrooms Around The Country He Discusses The Ethical Dilemmas Of Doctors Participation In Lethal Injections, Examines The Influence Of Money On Modern Medicine, And Recounts The Astoundingly Contentious History Of Hand Washing And As In All His Writing, Gawande Gives Us An Inside Look At His Own Life As A Practicing Surgeon, Offering A Searingly Honest Firsthand Account Of Work In A Field Where Mistakes Are Both Unavoidable And Unthinkable At Once Unflinching And Compassionate, Better Is An Exhilarating Journey Narrated By Arguably The Best Nonfiction Doctor Writer Around Salon Gawande S Investigation Into Medical Professionals And How They Progress From Merely Good To Great Provides Rare Insight Into The Elements Of Success, Illuminating Every Area Of Human Endeavor

Atul Gawande is author of three bestselling books Complications, a finalist for the National Book Award Better, selected by .com as one of the ten best books of 2007 and The Checklist Manifesto His latest book is Being Mortal Medicine and What Matters in the End He is also a surgeon at Brigham and Women s Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard

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  • ebook
  • 546 pages
  • Better: A Surgeon's Notes on Performance
  • Atul Gawande
  • English
  • 07 February 2019
  • 9781847651235

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