A very worthwhile if somewhat demanding read about the often underestimated margin of error in medicine. Gawande's book describes understandable human error when split-second decisions need to be made, doctors who burn out with others (colleagues, supporting staff, patients, and most of all the doctors themselves) slow to realize it and failing to make the necessary changes, mysterious ailments like chronic back pain, nausea, and uncontrollable blushing with elusive (nonexistent?) physical causes, etc., etc. Not surprisingly, Gawande is a friend of Malcolm Gladwell's and his book is somewhat reminiscent of that genre although it's a more challenging read -- perhaps not the best reading choice for someone who needs relaxing breaks in between Passover cleaning and cooking. Still, I enjoyed it and feel it deserves its high goodreads rating. Interesting, informative, and thought-provoking -- all the things a good non-fiction book should be.

4.5/5⭐️ I just love Gawande and his approach to medicine. He does an excellent job breaking down medical issues not only within the US Healthcare system but the greater systems at play including insurance barriers, personal bias, groupthink and other principles of human socialization which just make our healthcare system so imperfect and flawed but does it without sounding all doom and gloom and proposes actual feasible solutions. This book was raw, informative, and honest and I thoroughly enjoyed it despite his only being a resident when he wrote it! Makes me want to re read Being Mortal

Read this at the beginning of my nursing career and now again at 7 years in and I appreciate it even more!

It was kind of unsettling reading stories of illnesses and the way doctors deal with them. The sheer fallibility of them, the different things that can go wrong, which aren't in anyone's control. Scary!

The main point Dr. Gawande wants to drive home is this - "Doctors are human. Any factors that affect success/failures of people in other professions, affect them also." And there are a myriad other things here, like how updated the doctor is, what stage of his career he is, if she's dealing with depression, etc.

I was a big fan of Scrubs, the TV show. A friend who knew a resident had said that it's as close as possible to how things run IRL. It was hard to believe. Reading this book gives you a clearer idea. And yes, my friend was right!

There is one chapter which talks about patient autonomy and their right to choose the treatment they want, even the right to say no. This seems to have formed the basis for his most recent book - Being Mortal.

I many ways, it is good there are "writer-doctors" like Gawande and Siddhartha Mukherjee. There's so much that has stayed under wraps and has been Greek-Latin for the layman. Books like this which bring out the inner workings in a way people can understand and relate to are needed a lot more. Hopefully it's a trend they've set which more doctors will embrace willingly.

4.5 ⭐️ “What we’re drawn to in this imperfect science, what we are in fact covet in our way, is the alterable moment — the fragile but crystalline opportunity for one’s know-how, ability, or just gut instinct to change the course of another’s life for the better.”

I’ve been a fan of Atul Gawande ever since reading some of his articles in The New Yorker, and this book was no different. As a newly graduated PA, it felt almost reassuring to read how healthcare professionals like Gawande face uncertainty every day, emphasized through several patient cases he reflects upon. Truly an authentic discussion about the reality of medicine and the challenges it faces as an “art” form.

The man hits the spot once again. Atul does not miss

This book made me question expertise, and not just in medicine. He shows that doctor's titles can be stripped away when good doctors become less fastidious about treating their patients with utmost care. They can be overcome with issues that everyday people face—alcoholism, depression. He is candid in his account of how he learned to do a central line, his fumbling, and tentativeness in the beginning. I always love to read about people looking back at their own mistakes in hindsight. Most of all, I enjoyed this book because of his honesty and surrender, when he illustrates the dualities and complexities of being a surgeon who needs to make life or death decisions. Yes, medicine is constantly advancing with the amount of scientific research, but there is always a factor of uncertainty and randomness that cannot be surmounted by hard facts. In making difficult decisions about the outcome of someone’s life, it the job of the surgeon to guide the patient on what is it that they are willing to compromise and not compromise in their life, and then find the best action that corresponds. I think that is prevalent in any field where there is an expert.

An excellent peek behind the scenes of the surgery field when Gawande was a resident. He uses a good mix of anecdotes and research to speak about each topic. The bottom line and conclusion he comes to is that at the end of the day, there's just as many questions as there are answers in modern medicine. I found the discussion of the never ending battle of a doctor to go with gut instinct or second guess himself when lives are on the line. He did not shy to give personal anecdotes and feelings when he was on the other side of the fence particularly when his children needed medical care.


I really enjoyed the writing style as well and he had a flair for describing people which helped paint a picture of each anecdote almost like a play or movie scene. Despite being a doctor, the patients were obviously at the center of each story and ultimately their feelings and decisions shaped the outcome. As this was written about 15 year ago, it will be interesting to read his letter works and thoughts on medicine.

"Emesis" is a pretty little word, two palindromes side-by-side, but until I read this book I could never quite find the proper words to describe the actual process: "intensely aversive".

Dr. Gawande occupies a rarified Valhalla of people who understand medicine, who understand public policy and who understand how to write. You want facts? Got 'em:

She was in what physicians call the "prodomal phase of emesis." Salivation increases, sometimes torrentially. The pupils dilate. The heart begins to race. The blood vessels in the skin constrict, increasing pallor.

While all this is going on, the stomach develops abnormal electrical activity, which prevents it from emptying and causes it to relax. The esaphagus contracts, pulling the upper portion of the stomach from the abdomen, through the diaphragm, and into the chest...Then, in a single movement, known as the "retrograde giant contraction," the upper small intestine evacuates its contents backward into the stomach in preparation for vomiting...In the expulsive phase, the diaphragm and stomach undergo a massive, prolonged contraction, generating intense pressure in the stomach; when the esophogus relaxes, it's as if someone had taken the plug off a fire hydrant.

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The above citation was edited considerably for length. So why all this recounting of such an "intensively aversive" experience at all? Who wants to think about this stuff? Well, some women have such a problem with morning sickness during pregnancy that it threatens not only the embryo's life but the mothers as well. And part of the job of the doctor is to figure out exactly how to deal with this problem, which can be far from simple. After all, you don't want to poison the embryo with strong, potentially toxic medicines; hypersensitivity to toxins appears to be the root cause of morning sickness in the first place.

I've read a lot of medical memoirs, and encountered surprisingly few accounts of morning sickness. Generally the stories deal with emergency C-Sections, roadside surprises and the like. The fact that the author chooses to dwell at length on what is, for many women, the most awful part of pregnancy testifies that he actually listens to his patients, and takes their fear and suffering seriously.

Regarding public policy, Gawande is a well-known speaker and patient advocate, and writes clearly and well about things we could do to improve patient care (getting bad doctors away from patients, for example) and also about the impossibility of doctors knowing exactly what to do in any given situation. This puts part of the public policy back on the public: We're very complicated creatures, and we need to stop expecting miracles.

Unlike some of his other books (The Checklist Manifesto, for example), this was really a collection of unrelated essays and didn't quite hang together as well. But it was still packed with nice writing, fascinating science and humane stories. Recommended.

There was a time in my life when I looked to Reader's Digest as a more credible source of information; I even garnered some sort of feeling of being in the presence of wisdom when the correct stars were in alignment. The time when I felt such is as long ago as is the date of publication of this book, so perhaps, had I read it then, I would have liked it a great deal more. As it stands, I don't read nonfiction for the express purpose of being coddled into a feel-good view of a certain section of the world that views itself as above and beyond the influence of everyone and everything in and around it. If I did, I wouldn't have bothered to single out Gawande as hopefully a source that was somewhat free of the pale, comfortingly eugenicist meanderings that require black patients be wary of white doctors and fat patients be wary of pretty much everyone in the medical field. I didn't expect him to be an expert on the havoc that certain ideologies, probingly detailed in Medical Apartheid and other works, have wreaked and continue to wreak on the concepts of health, medicine, and healing in the United States, but it was rather pathetic to watch him fumble around seemingly mysterious patterns of occurrences that would be rather hard to parse if one didn't ever consider the state of health insurance in this country. In other cases, there was a nod towards systemic, dehumanizing biases that significantly the efforts of any well meaning doctor, but Gawande had already spent so much time normalizing the status quo that the critique seemed little more than the fine print of a drug ad. So, observations of a morally grey environment equipped with a healthy amount of cited literature? Sure. A rendering of the medical field that acknowledged "complications" stemming from far less good-intentioned sources? No, and it was the latter I was looking for.

n  The perfect test or scan may have been available, but the physicians never ordered it.n

As you may be able to tell, I don't have the best relationship with the health industry. I have enough separate things wrong with me to necessitate regular visits to one or more institutions, but ever since a youth filled with borderline Munchausen By Proxy experiences and my undergrad days when my collegial institution would only give me treatment if I agreed to being experimented on by students, I don't do more than is absolutely necessary. Successive years of being in a community with my fellow neuroatypicals has given me plenty of stories of forced institutionalization, fat-shaming, racism, transphobia, and general abuse that was often only marginally lessened by rigorous research on the patient's side. I didn't expect Gawande to be all doom and gloom, but there was a pattern of pointing out fat patients as particularly difficult to operate on that wasn't much alleviated by a later article that all but swore by gastric bypass surgery. I could go into experiments that found rats became drug addicts when not offered enough positive stimulation and generally good environments, the all but 100% monetization of public spheres, the nearly ubiquitous inhumane conditions of workplaces that refuse all semblance of a healthy amount of sitting, standing, and general movement, but I won't. All I'll say is, there are a number of times when my teeth cleaner, aware of my pretty optimal dental status and less than optimal financial means, has offered to let me skip the MD's visit and spend half what I would have otherwise, and I can't think of a time when I refused the offer. So, that perfect scan or test? Doesn't mean jack squat if it's a choice between that and rent.

I got some bits and pieces out of this, which is why this is a two star for the moment. Still, the obscenely high rating for a work that phrases increased rights for disabled people leading to more people being publicly disabled as a bad thing is little more than nonfiction that falls right in line with filth such as 'Me Before You'. It would've been a surprise had I viewed phrases such as "Harvard Medical School" and "The New Yorker" as having any measure of inherent credibility, but I knew plenty of pre-meds back in my BioE days at UCLA, and they were only ever in it for the money. Abusive (male) doctors mutilating, if not outright murdering, tens to hundreds of patients because their staff were too wibbly wobbly/genuinely afraid of retaliation to do anything about it, weight considered purely in terms of what is ingested and nothing else, egotistical rolls of the dice being favored over a scientific approach just so a single fallible individual can feel like a hero every once in a while: give me a break. The medical field truly is a complicated one, but I came to this piece expecting to be able to read up on some sort of MRI procedure (something which is, fun fact, I can't have myself due to my ink), not a fancier rendition of toothbrush and toothpaste. Now, I don't read a lot of this type of nonfiction, so this review may be suffering a tad from overdue-vent-itis. However, it's not like the evidence isn't there, so I'm fine with leaving it like this for now.

Fascinating. I only wish Gawande brought a biblical worldview into the topic. It was the missing dimension in many stories—What role does human depravity play here? How could prayer make a difference there? What if we applied basic principles of wisdom in this case? What if the gospel were presented in that one? Man is so complex—body, mind, and spirit so inextricably intertwined—that we're never going to understand the complexities of any one of them without bringing our knowledge of the others to bear. Someday we'll get there.

3.5/5 - The stories didn’t feel as connected and after learning many chapters were written as separate pieces, it makes sense. There was still a lot of fascinating cases though.