Complications: A Surgeon's Notes on an Imperfect Science

Doctors are trained to see things differently: to fix, to heal, to prevent, to listen, to guide, to solve. Amidst the successes of every doctor- in fact, despite and in conjunction with their successes the author would argue- are many uncertainties, inconsistencies, and mistakes that come with being human. The author puts himself in such a vulnerable position, making this book what I think is very brave, very real, very intimate, but also scary enough to make any public relations consultant cringe.

Having worked in the healthcare industry, I could relate easily to the author's stories. Even those without a background in science/healthcare would be able to easily appreciate these stories- they are very interesting and well written, and no medical knowledge is required (though those with it will have a deeper understanding). The only thing I wished for when I started reading was better referencing of research material and scientific articles throughout the book. Upon finishing the book I can see why it was written in this way- it reads more like a collection of short stories. Keeping all references and citations at the end keeps the book less cluttered and less intimidating.

Medicine is science, it is healthcare, it is politics. This book is an important glimpse at medicine through the eyes of one surgical resident and his experiences with patients, families, and colleagues. How he found time to have a family, pursue writing a book, write news columns, go through surgical residency/practice medicine practically all at once is beyond me. Maybe he will share his secrets in his next book. Until then, check this one out. You won't look at your doctor the same again, or at least you will hopefully ask more questions. Get a second opinion if think you need one, be a good patient, have patience, and remain in awe at the wonders that our doctors do on a daily basis.

Dr. Gawande is a genius! This is a view into the secret culture of medicine and surgeons. It's an exhilarating read that is a must for anyone who wants a little insight on medical science. He peels away the deception of the perfect doctor. He goes over all the tools doctors use in their decision making.

The best part of Dr. Gawande's writing is that he is a deep thinker and parses the medicine in a way that fly's over the head of many doctors. He offers ways to improve patient care and the decision making process.
I read this book at the beginning of medical school when diseases and pathologies were mere words on paper. It was a time I was trying to understand physiology, microbiology, and the rest of the basic sciences. This book opened the door to a deeper understanding of disease processes. Dr. Gawande describes cases of chronic pain to necrotizing fasciitis from both a patient centered and disease centered perspective.

Medicine is a profession where the clients (ie: patients) desire ... no, expect physicians to never make a mistake, never miss a diagnosis, and offer a cure that will magically take them to a healthy state.... Patients want their physician to be perfect in practicing a perfect science. In truth, medicine is made up of imperfect humans practicing an imperfect science.

Absolutely excellent!

As someone who is a true product of a Liberal Arts education, I found that I was able to digest the technical medical information by following a very clear story line. Each chapter poses a philosophical question about a medically ethical dilemma at hand--- be it ownership over your own body, or a doctor's fallibility.

Dr. Gawande humanizes doctors, and this is a bit nerve wracking at times. But their humanization also lets you come to terms with the fact that doctors are not gods; and this can be empowering in a way. Personally, it's good to know that one's research, intuition and communication can play a very essential role in curing an ailment, and this can be as essential as having someone who went through medical training by your side.

Above all else, I think Dr. Gawande poses an interesting questions about the social aspects of medicine--like choice, intuition, patient and doctor stubbornness, doctor/patient interaction, research, the limitations of modern science, as well as the strides that we made in medicine as a society. After reading this book, I'm truly in awe of friends, family members, and even strangers that have decided to pursue a career in the field of medicine and medical research. It's definitely not a nine to five job!

I was also pleasantly surprised when Dr.Gawande mentioned Malcom Gladwell and David Remnick in his acknowledgments. Both men are among my absolute favorite authors and Dr. Gawade's writing style is reminiscent of theirs: clear story lines, full of useful knowledge, leaving you with food for thought.

My only caution to the reader is this: I would be apprehensive about reading this book during a hospital stay. It will leave you slightly or extremely paranoid...

Have a trusted friend or a family member do it for you, and ask them leave out all the unsettling parts until you get better.

Gwande is my favorite medical writer since Berton Roueche. Particularly catch the chapter on bariatric (weight loss) surgery.

This book is the most involved, evocative, and well-written medical narrative I've ever read. "Complications" was recommended to me by an emergency medicine physician whose medical opinion I hold in the highest regard. We recently talked about some of the troubles plaguing the health care industry, and we also discussed the doctor-patient relationship and their relationship to the course of treatment and the decisions made by both patient and doctor, particularly when they stand in opposition. He recommended this book, and I can't thank him enough for doing so.

As a patient I realize that it's difficult, if not impossible, to know what it's like or what it means to be a doctor, to hold someone's life in your hands (almost literally), to possess that overwhelming sense of responsibility, to face the most challenging and confounding problems we encounter, and to face human trauma every day. These problems strike moral, emotional, and rational chords in all of us, and Gawande's stories explain why. Often in medicine the simplest things can have life-altering effects (vaccinations, antibiotics, preventative care) but Gawande's book takes a serious and perspicuous look at some of the more confounding cases in medicine when treatment protocols are unclear or unsuccessful; he takes a close look at the "bringing up" of surgeons through their residencies; he explains medical negligence, hubris, and incompetence ("why good doctors go bad"); he details cases in surgical specialties as well as emergency care; he examines medical mysteries and applies scientific analysis to them; he assesses and questions our assumptions, our methods, and, perhaps most markedly, our philosophies; he sees patients as human beings, not just cases.

Despite how rationalistic Gawande's approach is (for which I applaud him), "Complications" has an interwoven warmth to it that no one can deny. Gawande's writing style is actually rather disarming and it became clear to me after the first ten pages or so that he does an incredible job of making you comfortable with these stories, bringing you in, and involving you, almost as if he's asking you to render a verdict in these cases. There are no artificial or contrived "shock value" stories. That's not what this book is about. It's written by a doctor who makes an honest confession about the fallibility of medicine when there is genuine uncertainty, the decision-making processes involved in treatment, and the potential aftermath of both.

I admire physicians for their strength and resilience in confronting these challenges every day. However, it wasn't until I read this book that I felt a strong sting of empathy for these doctors. I believe we take our doctors and nurses for granted. I think we assume, as patients, that doctors act with immeasurable confidence, autonomy, and omniscience, and because of that we expect miracles from people we believe to be masters (if not experts) of preserving human life and eliminating suffering, to fix every problem at any cost. What this book teaches you is that even the smallest decision, the slightest consideration, the briefest departure, the fleeting reflections, and all of the second-thoughts can have life-or-death consequences. That is an astounding thing to carry, and we need to understand that. There is no perfection, only the illusion and expectation of perfection. Medicine involves calculated risks, compromises, a variety of actions and inactions, and, above all, learning. Medicine is science with a human component, and Gawande never neglects to acknowledge that. He does not abandon science for humanity, or vice versa; they are inseparable. His observations and considerations humble me, and I did not expect that.

There are variables in medicine that we, as patients, are rarely aware of. This book encourages you to take a step back from the examination table and imagine that you're the doctor, thereby entrusting you with all of the trials and responsibilities and considerations of doctors; imagine that it's your call to make whether or not someone needs a major operation. If you walk away from this book with nothing else, you should at least learn how to empathize with your doctors, to understand that sense of duty. The kind of decision-making ability that doctors possess is astonishing, but this book also demands that you acknowledge their instinct as well. Being either too cautious or too hubristic will only get you so far before it does irreparable damage. They key is finding the intersection of intuition and diligence (as in the "red leg" story). Gawande appears to do that quite well.

I've read many medical narratives before but none of them ever moved me like this. I would like to thank Dr. Gawande for this book, for his work in general, and to applaud his surgical skills and dedication to public health, medical advancement, patient awareness, and physician excellence. When you read this book, you'll discover that he's a very thoughtful physician with incredible intuition and compassion that perfectly complements his devotion to observation, reason, and problem-solving where it is most critical. He is constantly learning and he encourages us to play a part in this process. Patients can help make better doctors. He's clearly intelligent and analytical, but this book has a heart that you cannot ignore. If you don't feel these stories from both the doctors' and patients' perspectives, then you don't appreciate the magnitude and complexity of modern medicine. I had a hard time putting this book down. In addition to being a talented surgeon he's also an extraordinary and gifted writer.

Interlaced in these stories are Gawande's own descriptions and reflections of the underlying problems with all of the cited cases, which color the book in a most fascinating way -- in a way that compels you to experience what the doctor experiences. Often we are so wrapped up in being an attentive patient that we forget that our doctors are human, and we forget that it is a dynamic relationship. For example, while reading this book, I felt as if though I was suffering from and treating each illness. I looked at it from both sides. I was impressed with Gawande's ability to relate both perspectives to the reader and allow us to see each case from multiple angles.

He also examines the problems that exist in both medical practice and theory. I absolutely loved his chapter on the surgical learning curve and I appreciated his long, hard look into "which specific treatment is best for this specific patient?" He also goes into detail about the evolutionary aspects and basic functions of certain physiological ailments (such as nausea, blushing, and overeating), which I found very interesting. It also seems, after reading this book, that fault seems to be the Achilles Heel of medicine, but medicine is rife with fault (shared by both doctors and patients), and yet our expectations are so high that we demand perfection and flawlessness as if fault always implies incompetence or negligence. He also opens the window to the elusive M&M meetings, which I found very illuminating. His story of the lonely, unvisited book-seller at the conference, I believe, demonstrates (more than any other story) Gawande's constant quest for knowledge and interest in medical practices. It also does well to separate him from the "pack" by distinguishing him as a doctor who responds to people, not just operations, not just protocol, and not just repertoire. I thought that particular story showed me a side of Gawande that was kindhearted and inquisitive.

People rarely, if ever, learn without critical observation and trial and error. We can't make good doctors without allowing them to learn through exercise. We all want the best doctors, but we aren't willing to help new doctors learn to become the best. Gawande notes that a patient may receive several different treatments or solutions from different doctors for the same ailment. One may amputate, one may operate, one may medicate, and one may be utterly negligent. The goal is to reduce the number of irreversible errors and improve knowledge and skill while minimizing patient cost. This book reminded me that there are still doctors who respect patients while still managing to adhere to certain critical and fundamental disciplines (like insisting on a course of treatment when a patient is against it, but doing it in a respectful manner). This is actually harder than it sounds, and his stories demonstrate that. He is full of compassion and kindness, but he's also highly analytical and rational. It's an ideal duality. All of his stories demonstrate his natural intuition while still reflecting his confidence in the intellectual process. He seems to find that impossible middle ground between care and treatment, which are two very different things, and that is no easy feat.

Thank you, Dr. Gawande. You've set an extraordinary standard to which all doctors should aspire, and you've shown the rest of us how to be better patients.