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Wednesday, November 26, 2008

Review: Complications by Atul Gawande

A few years ago I ended up on jury duty for a medical malpractice case. We awarded the plantiff $552,000. It wasn't what she was asking for, but it was in her favor. In this particular case, the doctor had been sued over and over and was basically run out of town.

I was reminded of this while I read this book. The full title is Complications: A Surgeon's Notes on an Imperfect Science. summarizes it well:

Gently dismantling the myth of medical infallibility, Dr. Atul Gawande's
Complications: A Surgeon's Notes on an Imperfect Science is essential reading
for anyone involved in medicine--on either end of the stethoscope. Medical
professionals make mistakes, learn on the job, and improvise much of their
technique and self-confidence. Gawande's tales are humane and passionate
reminders that doctors are people, too. His prose is thoughtful and deeply
engaging, shifting from sometimes painful stories of suffering patients
(including his own child) to intriguing suggestions for improving medicine with
the same care he expresses in the surgical theater. Some of his ideas will make
health care providers nervous or even angry, but his disarming style,
confessional tone, and thoughtful arguments should win over most readers.
Complications is a book with heart and an excellent bedside manner, celebrating
rather than berating doctors for being merely human.

In the first half of the book Gawande writes in general terms about how doctors are human too. That medicine changes, but doctors don't go back to med school and are instead forced to learn on the fly. They are held to impossible standards, with no room for error. Now, I don't want to be ther person they make an error on, but it sure does make sense when put that way.

The second half of the book is individual chapters about different topics- gastric bypass, flesh eating bacteria, etc. Each chapter had one main case that Gawande uses as an example. Each one is an example of how things aren't always the way they seem. There is one very short chapter in this section that I did not read. I was reading after the boys were in bed, and the chapter was about SIDS. There was no way I was gonna read that before turning off the light. I will go back... eventually.

Overall, the book is a very fast read, and very interesting. Gawande has an easy style, it seems very much as if he's just another person talking to you and not a top surgeon. The medical details were occasionally a little heavy, but there are no pictures so it's not really gross. They would also be easy to skim and not lose a lot. I see on Amazon that he has another book called Better: A Surgeon's Notes on Performance, and I have added it to my PBS wishlist.

I wonder now, if I had read this before the trial if I would have felt differently. I've tried to remember as many details as possible, and I think we still would have found in her favor. While this book does soften my attitude towards doctors, the particulars of the doctor on my case were such that he did not inspire any goodwill. I do think that it would have changed some of the particulars of how I personally would have awarded the plantiff.


  1. Wanted to drop in and wish you a Happy Thanksgiving! :)

  2. Wow--what an experience! I have never been on jury duty, but I've heard that it will change your perspective. Sounds like an interesting book, but I can only take so much trial talk in my reading.


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