I chalked this one up to “work research.” Healthcare is crazy!

Complications is a really interesting book about exactly what the title says: complications in the surgical field. How necessary practice is for surgeons to get better at their jobs, but how reluctant many are to be practiced upon; whether certain surgeries are ethical to do; the critical, yet ethically tricky role of the doctor's intuition. Gawande, in the humble and thoughtful way he always does, ponders these issues and conundrums while also telling patient stories to illustrate his points.

Is it as life-changing as I found Being Mortal: Medicine and What Matters in the End? No. But it was still very thought-provoking and enjoyable.

Hmmm... I love surgery, it means.. when a handy book of more-humanity-and-less-cut of surgery was published.. how can i resist?

Well.. for being honest, it makes me feel bored when i've red the middle-part. it turns 'in' again in a few last chapter. I agree to middle-rating, (in Indonesia means, lumayanlah.. bukan buku sampah) of this book. but i truly disagree when sumone gave only one star rating to this stuff. (Cari deh di tinjauan lain. Huh. You make me angry dude.. pelit amat sih. Gue nggak tahu ada penulis laen yang pernah, bisa, dan berhasil bikin tulisan tema ini) Nevertheless, Atul gawande deserve for sum appreciation, and He already had..

the Most interesting part from me.. is a chapter when Atul writes about "the curve of learning". He statistically showed about transision safety rate of "great artery transposition" surgery, between the convensional and the latest method. Now, Using the latest method, a child who has born with "great artery transposition" can reach the age of 40. But, when its was first introduced, the safety rate was really low. (i forget about its number.. hmm 8 survivals against 100 operations? sorry, i forget the number)

Then, surgeons keep practicing, keep using the latest method, do a preparation surgery, training the nurse, using a team who spesialized on its procedure, maintain the team.. then.. the safety rate increase. Like i said before, these days, a child with "great transposition artery" can celebrate his or her 40's birthday..

It means, we can never resist a failure. A medical student can never resist a failure..

Too bad, people dont care about it. A simple or even hard failure of a medical student (physicians is a life-long medical students, right?), is a condition that makes them an expert someday. But, people dont care.. they never care

Haah.. tiba2 gue kepikiran soal pendidikan di kampus gue..
= |

Oya, buku ini salah satu favorit gue (biarpun cuma 3-bintang) karena punya "kenangan" tersendiri. ^_^ huehehe...

Except for hypochondriacs, everyone should read this book. The surgeon-scribe Gawande is the perfect Virgil, escorting us through the Hell and Purgatory (and many happy endings) of uncertainties, mysteries and ambiguities of medicine. He shows us how physicians deal with learning curves in surgery, how they evaluate and deal with mistakes (discussed in large weekly sessions), what their trade conferences are like, and how institutions deal with bad doctors. Using unforgettable cases—a girl with a mysterious red patch that may or may not be flesh-eating bacteria, a pregnant woman who is seriously nauseous for months, the newscaster who has severe blushing, etc.—he illustrates the limits of medical knowledge. Gawande’s books tell us about the practice of medicine, but are in essence about the lessons of the virtues (and vices) applicable to any profession. Most of the chapters began as pieces for the New Yorker and retain that addictive informing-and-storytelling style; really fantastic!

This book was not bad. However, it was by no means great. Many of the goodreads reviews of this book mention how interesting the stories that Gawande shared were. I agree that they were interesting stories, but I also agree with reviewers that have complained about the formatting. This book is lacking when it comes to having a good flow. It is simply a collection of stories combined into one book with little separation between stories. Had the different anecdotes been tied together with better transitions, then perhaps I would have enjoyed the book more. However, while reading this book, I found that I did not want to keep reading it. Because there was a lack of flow, I was entirely uninterested in what would happen next. This is unfortunate considering medicine is such an interesting subject, and I was looking forward to reading this book. The interesting stories and the poor formatting make it difficult for me to rate this book. The stories themselves were so intriguing, but when they were all clashed together they lost some of their impressiveness. Many of the goodreads reviews were very positive. I cannot exactly disagree with them, considering that this book provides a glimpse into the medical field’s view. The primary, and pretty much the only reason I did not love this book was the formatting. I feel that if the way that the stories were placed together was tweaked a bit, it could have been a whole lot better. Different formatting would have made the book more of a page turner, and it would probably have made me actually want to continue to read it. Since the stories were so interesting, but I really did not like the formatting, I can only say this book was mediocre. However, I think that it definitely has the potential to be a great book to someone who does not mind the formatting.

Eye opening

I've read several books by doctors about the medical profession and always find them intriguing. My favorites are those by Richard Selzer (Confessions of a Knife, Letters to a Young Doctor, etc.), who, like this author, is a surgeon.

Where Selzer is more literary, this author is more informative and practical about the realities of medicine, such as the necessity of practicing on patients, the role that class plays in quality of treatment received, and the shot-in-the-dark nature of making diagnoses.

I was so fascinated with this book that I read it straight through. It's easy to read, but not facile, and the author doesn't shy away from making it personal. I highly recommend Complications for anyone interested in health care, especially from the doctor's point of view.

“Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.”

I have always been intrigued by medicine. I know it’s a scary thought, but inevitably, illness will impact each of us in one way or another. Either we will get sick or somebody we love will get sick. Which is why learning about medicine and healthcare is so important. However, a lot of books about medicine and healthcare can be pretty dry, which is where Dr. Gawande comes to the rescue. His clear prose makes even the most difficult medical concepts easy to understand.

In this book, Gawande is just starting out his medical career. Like most new graduates, Gawande is excited yet nervous about the new challenges that await him in the workplace. But he soon realizes that medical school only teaches you a tiny smudge of what being a doctor is actually about. Medicine is so much more than just a science - it is a messy and imperfect art. A lot of what doctors do is intuitive; they piece together symptoms to formulate a treatment plan. However, uncertainty feels grander in medicine because human lives are at risk. And as a doctor, you not only need book smarts, but the ability to navigate unforeseen challenges with integrity and fortitude.

A lot of this book comprises of fascinating case studies: a victim who was shot in the buttock leaves the hospital virtually unharmed, a pregnant woman with nausea so debilitating that she has to leave work, a neurosurgeon who copes with severe blushing, and a young woman whose inconspicuous leg pain turns out to be a deadly infection. If you like suspense, then this book is for you. The saying “everything can change in an instant” is ever so applicable to medicine.

Although I enjoyed this book, I thought it was a bit dull at times. I think it could have been improved if it contained a tad bit of humor. But overall, I did enjoy it. I would recommend “Complications” to medical professionals or anybody who is interested in learning about the healthcare field.

Recently I had to see a doctor for something that was bothering me. I went to my normal family physicians group, who referred me to a gastroenterologist, and eventually had to have a couple procedures in the hospital before I was offhandedly diagnosed with IBS. I say "offhandedly" because that's what it was: the gastroenterologist at first said I seemed to have had some kind of stomach bug that threw me out of whack, and then, when I asked further, finally said "Yeah, I think you have IBS." He didn't tell me what kind of foods I might try avoiding, only to take a probiotic every day, and didn't give me much more information.

I walked out of his office feeling a little confused. The doctor seemed almost dismissive of everything I had explained to him even though he was willing to do tests in the hospital. So when I read this book, I kept thinking of that office visit, which was rather unlike other visits I have had with other doctors, who have always seemed willing to listen and be open. By the end of the book I was kind of wishing that Atul Gawande (or any of the other good doctors mentioned in the book) were my doc. I enjoyed Dr. Gawande's openness and his very thoughtful approach to medicine. So often doctors are looked upon as omniscient beings with the whole of medical science at their fingertips, but Gawande blasts away this notion and effectively conveys that they are just as human as the rest of us.

A few things bothered me about the book: at times Gawande seems almost too thoughtful, making him seem hesitant and ineffectual; many of his stories are from him just starting out, which may have contributed to this impression. Also, he seemed at times a bit reserved from the patient themselves, reporting simply the facts and very little emotion. It seemed at odds with the way he made sure to follow up with many of his surgical patients at their homes, and the way he still remembers such specifics years later. Perhaps some of the emotional writing would have gotten in the way of the story, but it was hard for me to see the patients beyond simply what was wrong with them.

I was surprised to see that this book was published in 2002. A few things about it seemed somewhat dated. I would have pegged it at 1995 or thereabouts.

All in all, a solid book. I enjoyed it even if I didn't get much insight into why my gastroenterologist was so rushed (unless he's like the surgeon in the book who works 80 hours a week to pull in a $400k income and seems surprised when he gets burned out). But I certainly learned a lot about the way hospitals work and the way doctors think.

I think my main take-away from this book of essays by the gifted Dr. Atul Gawande is that medicine is not an exact science and surgeons, or doctors in general, are human and not infallible. I never thought of doctors as God but they were certainly high on a stack of pedestals. Gawande shows how disparate the decisions of treatment can be among any given group of doctors. It actually seems a bit frightening to me in that there is not one specific answer that will always fit the criteria for any one case. Of course, most attacks of appendicitis are exactly that and are treated the same. But sometimes it is not appendicitis even with all the expected symptoms present. What then? A good example in the book is the last patient discussed: a young woman presenting with an obvious case of cellulitis. Something niggling in the back of Gawande's mind suggested this was so much more. Could it be necrotizing fasciitis, "flesh-eating disease"? Even with biopsy it still looked like the highly treatable cellulitis but several doctors had the same uneasy feeling and, upon surgery, the leg was almost completely taken over by the deadly bacteria. The young woman's leg was spared as was her very life. Where does that unease come from; and thank goodness it does! The case studies in this book are fascinating and, no, not all of them have such dramatically happy endings. It is eye-opening and thought-provoking.

A must read both for doctors and patients. once you read this book you will never look at health care the same way.

Complications is a book of anecdotes about a surgical resident’s experiences and impressions of the current health care environment. Gawande divides his stories into three sections: fallibility, mystery, and uncertainty. The fallibility section demonstrates that doctors can make mistakes. Some fallibility arises from there being a learning curve. For example, it is hard to do a central line correctly the first time. But for a doctor to learn how to do a central line, he must have a first patient to try it on. The concern then arises as to which patients receive care from the inexperienced versus the experienced. Yet fallibility occurs in even the most experienced doctors. Gawande reports on one doctor who became so careless that he was no longer allowed to practice. The frightening part of that story is how long his colleagues let him continue when they had concerns. (The Doctor also brings up this issue.) It is understandable that doctors are reluctant to come down too hard on their colleagues. They need each other as a support system and thus need to maintain trusting relationships. Furthermore, medicine is uncertain, and it can take a long time to see a pattern of truly irresponsible behavior as opposed to just having more complicated cases. Gawande makes the point that discipline of doctors works best when it done by a group outside the doctors peer group or employer because it is more objective. Then this outside group can propose a plan of action which the employer can implement. Unfortunately, this model has been too expensive to be much of a viable option.
tThe mystery section details stories of conditions that cannot be explained by current medical science, like blushing, pain, and nausea. In each of these cases, the doctors could not explain why the patient had the condition. Much of the time, the patient just wanted the doctors to believe them even though there did not seem to be a physiological source of the problem. It is interesting that the patient is more willing to accept that there is no medical explanation than the doctors. Yet the doctors are the ones with the training and have probably seen many more circumstances when they cannot make a diagnosis.
tThe uncertainty section deals with how to make the right diagnosis or judgment. There are several points in this section that have come up in the other literature reviewed for this independent study. First is the declining use of the autopsy. The autopsy is how doctors can determine what was actually wrong with the patient. It is the final way to get rid of uncertainty. Its purpose is to help the doctors recognize such conditions in the future. Yet autopsies are done less and less. (Although many times the family is opposed to the autopsy and will not allow it.) Another recurring point is the decision-making power of the patient. Patients have become more pro-active in their desire for decision-making ability, but they are much more ambivalent about actually exercising it. Especially in situations where there is uncertainty, patients do not feel comfortable or emotionally able to make the decision. Some do not think they can handle the responsibility if it turns out to be the wrong decision. Gawande notes that doctors also prefer to make the decision. One of the things he had to learn as a resident is how to persuade patients to the decision he thinks is best. As health care becomes more consumer-driven, the debate over the level of physician agency is likely to continue.