Better: A Surgeon's Notes on Performance

The author brings you into his last year of residency through his first few years of practice with interviews of other practitoners. His unflinching examination of the health care system gives an accurate protryal of how we are in the mess we are in. From his negotiaion to joining a surgical practice in the Boston area, to looking at rural health care, this is about a 3-4 (cross country) read on how different areas receive different medical care from a doctor who is willingly publically to question the system. Yes, it is in an essay format, but that makes it easy to pick up and put down.

Atul Gawande is one of the rising stars, maybe THE rising star, amongst those publishing on the subject of American health care. After an undergraduate degree at Stanford, a stint as a Rhodes Scholar, and graduating from Harvard Medical School, he has gone on to become one of the best medical and public health writers in the U.S. Few people know more about the ins and outs of health care issues in America, and his dual associate professorships (Both the school of public health and the medical school at Harvard) keep him up to date. And...the guy can write. A long time contributor to The New Yorker and Salon, few do better at putting complex concepts into understandable language.

Better: A Surgeon's Notes on Performance, is a book that reads as what it is: a collection of essays that have been published elsewhere, and were often published for reasons other than figuring out how to deliver better health care. That said, Atul Gawande's voice is refreshing, and in this wide-ranging book he clearly outlines some of the most important challenges confronting 21st century medicine, including both quality and cost.

Gawande is convincing that measures for improving healthcare quality and affordability require stepping away from traditional viewpoints. His examples of how MRSA infection rates (endemic in American hospitals) were reduced to ZERO in one hospital, and dramatically reduced in several other hospitals, are engaging and fascinating. Similarly, his essay that traces the increase of lifespan in cystic fibrosis patients from less than a decade forty years ago to over sixty years in good pulmonary centers, is no less than amazing.

Gawande is less powerful when he wanders into medical ethics, expressing his desire that health care workers, especially doctors and nurses, be banned from having anything to do with state mandated executions. I'm not sure what this has to do with improving healthcare, and I find it just plain odd in other ways. Demanding that doctors adhere, under threat of law, to a government prescribed code of ethics is, well, kind of kooky. I know that I, as a family physician, don't want the government, be it Bush era, or Obama era, telling me what I can and can't do with my medical license, other than that I must comply with the law of the land in the way I use it. As an Oregon physician that lives in a state that allows both medical marijuana use and physician assisted suicide, I'm personally acquainted with what happens when government mandates regarding physician's code of ethics whipsaw between two administrations as different as those that had John Ashcroft and Eric Holder as attorney generals.

All in all, a fun and stimulating read. This book is provocative, informative, and intriguing. It will change your point of view, and solidly ground you in some of the issues that currently confront American medical care. Written in an easily accessible style, experience in the medical field is NOT necessary to fully enjoy this book. It is written for all comers, and almost all comers will truly enjoy it.

The medical system is filled with compromise, problems and lack of understanding. Variants of care vary drastically from place to place without a complete understanding of how or why. Questions of ethics, morals and codes doctors must abide by with little oversight. Understanding the medical system is a tedious and seemingly hopeless task. One must often wonder, what holds this system together?

Dr. Atul Gawande has taken a selection of real life stories of great and inspiring acts in the field of medicine. His portrayal of these stories is even inspiring to those who have no interest in medicine. His description of a hospital team that's primary job is preventing infection. There struggle to get people to simply keep their hands clean was daunting. However it proved when you involve everyone in the solution you can more effectively fix the problem. His description of FST (Field Surgical Teams) in Iraq was eye opening. Little attention by the press was given to this handful of surgeons who saved countless soldiers and civilians lives. One of their greatest accomplishments being the tedious collection of information, which ultimately helped shape war time trauma care. The depiction of the Adgars scale and how its creation dramatically increased newborn mortality rates. It was created by an unlikely Anesthesiologist, the second female in the country given this title. I could go on, however I will save the book for your reading.

Overall the book beat my expectations, so I would recommend reading it. It will inspire you to seek to do "Better". You will feel as though however small your achievements it's the collective efforts of us all that overcome all odds.

For anyone who wants an informed opinion on health care in America, reading Dr. Gawande's books is a must. He goes beyond just relaying the facts, he brings a new perspective to a much written about occupation. He goes through many of the modern health care concerns that many doctors do not speak of, such as defensive medicine.

His other book, "Complications" was written better, but this book is a great addition nevertheless. Through this book he takes the reader through the complicated issues in modern health care in the United States. My eyes opened in certain parts as realizations hit me. There are no easy answers, just fallible people.

Towards the end of my training when the reality of medicine hit and the basic sciences become rote, I began to see the faults of our health care system. I saw the awful decisions doctors had to make. I once commented to a friend, "sometimes it seems we are treating the `lawyers' first and then the patient.' This book allowed me to not feel alone in seeing fault in what we practice.

To quote Dr. Gawande: "The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality."

I was just as satisfied with this book as I was his first, "Complications: A Surgeon's Notes on an Imperfect Science." Dr. Gawande not only has a way with words, but he has some out of ordinary experience that contributes to a very unique way of speaking about surgery, healthcare, and ethics.