Super interesting view about doctors and the limitations of the medical field. He gives real life examples and admits freely to the lack of complete knowledge and guessing frequently present in medicine. I appreciated the realistic human view of doctors and modern medicine.

4.5 stars

I had a great time reading this with Heidi from My Reading Life. The book is broken up into three sections named for ideas that vex doctors - Fallibility, Mystery, and Uncertainty. He looks at the way surgeons are educated, advancements in medicine, hard to pin down diagnoses, and more with a liberal sprinkling of fascinating cases.

The pacing is perfect, there are edge of your seat moments to see if a patient makes it, and he brings up ethical issues that appear in his later books, such as medical error and treatment decisions at the end of life. Those in the know will recognize that medicine has changed over the years since publication, but even so it holds up incredibly well.

I kinda wish I had more to say but it's one of those books that's so good you don't need to say all that much in the first place. If you have any little interest in medical nonfiction you'll want to pick up Complications, as well as Gawande's other books, post haste.

4.5 stars. Extremely well written, engaging, thought provoking & entertaining book. If this guy is half the surgeon that he is a writer he can operate on me any day.

Scary for how true it is in the simplest ways. Doctors are human beings, we know that. But we also forget how human sometimes.

This is not the type of book I read or even gravitate towards. My professor got it as a gift and lent it to me. I read a random paragraph and immediately liked it.

If you're scared of doctors, don't read this. :) If you are a doctor or anything involved with the profession, or even if you're a veterinarian, like me, read it, you'll probably see yourself or your colleagues at one point or another... We all need a mirror sometimes, and we all need to see we're not alone in what we feel and experience...

"Three decades of neuropsychology research have shown us numerous ways in which the human judgement, like memory and hearing, is prone to systematic mistakes. The mind overestimates vivid dangers, falls into ruts, and manages multiple pieces of data poorly. It is swayed unduly by desire and emotion and even the time of day. It is affected by the order in which information is presented and how problems are framed. And if we doctors believed that, with all our training and experience, we escape such fallibilities, the notion was dashed when researchers put us under the microscope."

Gawande's first book foreshadows the topics that will receive their own binding such as the need in health care to decrease error, The Checklist Manifesto, and the ethical and medical issues regarding end of life care, Being Mortal. In various chapters, Gawande follows a patient case rabbit trail and although captivating, he strays from the thesis statement of the book. Maybe that is intentional as medical care is as complex, intricate, and unpredictable as the humans are themselves, and rabbit trails of intervention have led to cures and failures that shape current standards of treatment. The main idea from this book is the reinforcement of the certainty of uncertainty. This surgeon/author's humility and compassion takes the reader through the mine field of his residency to gain an appreciation of the difficult task healers encounter in every area of health care delivery. Worth noting are the descriptions in which the reader is taken to the bedside for a central line placement and to the morgue for an autopsy. These passages, accurate and detailed, are not for the faint of heart and may impose a barrier for the layman to grasp the arduous task of acquiring competency in what does become routine medical procedures.

This is more like a summary for my record rather than a review. ---Spoiler Alert---
Surgery is truly an art of uncertainty. While you learn through practice, no surgeons can ever be 100% sure of what they are doing. Surgery teamwork, resilience, and "I do not know".
1. Teamwork: A good surgery team doesn't necessarily need to have much experience (the members in the book are about 2 years in their residency at the start) but they stay with each other for a long time and learn together.
2. Resilience: Doctors have high suicide rate. Their mental health is affected by the long hours, the amount of knowledge, the loneliness, and the pressure from the patients and society. They are also more likely to abuse themselves, given the easy access to prescription drugs. What's uncommon is the availability of psychoanalytical treatment for doctors. They are humans too. They should be encouraged/ mandated to take necessary measures for their mental health.
3. "I do not know": Knowledge is limitless. However, doctors rarely say "I do not know" because if even doctors don't know, then how can the patients ever know what's wrong with them? Gawande discussed three cases: the broadcaster woman who always blushes, the man with the never-full gut, and the complicated cellulitis case.
This book is informative, and well-written (language wise). I would prefer a smoother transition between chapters and ideas to keep me hooked.

A book that looks behind the curtains in an operation theater. There is a broad look into the practical, ethical, and philosophical decisions the surgeons make day-to-day. It is a fascinating peek into the lives of Doctors. The writing is fresh and uncluttered, a pleasure to read. I would definitely read more books by this author.

Highly recommend this book to all my friends.

Wow! I loved this and I love Dr. Gawande.

The first section is about how it is necessary for medical residents to learn how to do procedures on people, but how it's just as necessary to sort of glide over that fact with patients. This was the most exciting part of the book because he went over his own early surgeries and the complications that arose.

The rest of the book is about how, even though medicine is a 'scientific' field, it's ultimately human and fallible. My anxiety was high during most of this, because being a doctor is so high pressure! It was a rollercoaster ride because I kept changing my mind. For a while, I'd think, "Oh, I guess you should never have surgery unless it's absolutely necessary," but then a while later, I'd think, "Oh shit! Just have the biopsy! Don't be ridiculous!!!!" I loved this. I can't wait to read "Better."

Sarah Montambo Powell

His writing really pulls you into the story and allows you to visualize the cases and surgeries. He does an amazing job of weaving stories, data, and commentary together to create a more accurate depiction of the mysteries and complexities of the medical world.

Read these sentences and tell me that this writer isn't an unbearable idiot:

"If choice [of one's surgeon] cannot go to everyone, maybe it is better when it is not allowed at all."

"Taking time to bond with patients is fine, but every X ray must be tracked down and every drug dose must be exactly right."

"Hospital lawyers warn doctors that, although they must, of course, tell patients about injuries that occur, they are never to intimate that they were at fault, lest the 'confession' wind up in court as damning evidence in a black-and-white morality tale."

"This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong. And yet I also knew that a surgeon can take such feelings too far [...] One surgeon with a national reputation told me about an abdominal operation in which he had lost control of bleeding while he was removing what turned out to be a benign tumor and the patient had died. [...] The case affected his performance for months."

"In its way, the M&M is an impressively sophisticated and human institution. Unlike the courts or the media, it recognizes that human error is generally not something that can be deterred by punishment."
So sophisticated that it doesn't include compensation for negligently injured patients! Or consequences for negligent doctors besides ~*shame*~ in the conference room!

"There are all sorts of reasons that it would be wrong to take my license away or to take me to court. Those reasons do not absolve me. Whatever the limits of the M&M, its fierce ethic of personal responsibility for errors is a formidable virtue."
Personal responsibility so long as it's a fifteen minute shaming directed at your mentor. And note that he doesn't discuss why it would be wrong to take his license away - wow, what a great look at the complexities of the situation! rme

"But the problem of bad doctors isn't the problem of [frightening aberrations like James Burt, a notorious Ohio gynecologist who subjected hundreds of women, often they had been anesthetized for other procedures, to a bizarre, disfiguring operation involving clitoral circumcision and vaginal 'reshaping' which he called the Surgery of Love]. It is the problem of what you might call everyday bad doctors [...] the illustrious cardiologist who has slowly gone senile and won't retire [...]"
Ahahaha, trying to treat James Burt as an isolated freak when other doctors knew what he was doing, said nothing and later refused to testify against him. Years wherein they said and did nothing about this man who was not licensed as a surgeon and was bragging about mutilating women while they were unconscious. James Burt is an illustration of the extent to which the medical community are willing to look the other way. If doctors will ignore the James Burts of the world, then how can we expect them to turn in the hypothetical illustrious but senile cardiologist? It is the same problem. Nice try though, Gawande.

"Was money part of the problem?"
Gawande tries to portray a surgeon who admits to booking far more patients than he could handle and rushing through their care in order to make more and more money (despite making 400k) as a poor little rich boy. Sorry, no. The question is, was greed part of the problem and the answer is yes.

"There are both honorable and dishonorable reasons for [doctors finding themselves unable to do anything decisive about bad doctors] [...] The honorable reason, and probably the main reason, is that no one really has the heart for it. When a skilled, decent, ordinarily conscientious colleague, whom you've known and worked with for years, starts popping Percodans, or becomes preoccupied with personal problems, and neglects the proper care of patients, you want to help, not destroy the doctor's career."
I love that his first concern isn't the patients or even the doctor, but the doctor's career. I also love that the example bad doctor he discusses didn't end up getting the sack for ruining a 28 year old woman's life but because he didn't go to M&M conferences. Injure all the patients you like, but don't you dare thumb your nose at our rituals wherein we discuss these injuries!! And then he cries about how this poor disgraced doctor only succeeded in getting malpractice insurance after a year. Oh gosh, a whole year? How terrible for him.

"People actually prefer the world of don't ask, don't tell. Just ask yourself, could you abide by a system that rehabilitated drug-addicted anesthesiologists, cardiac surgeons with manic psychosis, or a pediatrician with a thing for little girls if it meant catching more of them?"
...one of these things is not like the others... and that isn't your only option. and rn, there are plenty of doctors who have been disciplined for egregiously terrible stuff and should never be allowed to practice again and yet somehow, are so what would be the difference.

"Could it have been a mistaken, then, even to have told him about the surgical option? [...] People are rightly suspicious of those claiming to know better than they do what's best for them. But a good physician cannot simply stand aside when patients make bad or self-defeating decisions - decisions that go against their deepest goals. [goes into an anecdote about how a doctor convinced a woman to start her physical therapy and it was all for the best]"
Yeah, because not giving a patient the full range of their surgical options is the same as encouraging a patient to do rehabilitative therapy! Definitely! Has this man done zero law in the zillion years it must have taken him to get a MPH and become a surgeon?

Ok, I've parsed enough. I will say that his musings on patient autonomy are truly disgusting though (he thinks we should replace the autonomy principle with a concept of 'kindness' because paternalism is not the enemy, what the everlasting fuck) and show that he doesn't understand the concept of patient autonomy or the emergency exception doctrine (I only know about it through canadian law but I'm sure Americans must have the same thing).

This was probably the most hateful thing I've read in years. Wow.

In a series of thrilling accounts, Gawande explains the deepest mysteries of work in the medical field. The text toggles between the philosophical issues of decision-making and intuition in the medical field, and countless anecdotes of real patients Gawande has encountered during his years of residency. If you are not easily repulsed by stories of gastric-bypass surgery, screws embedded in people's feet, and flesh-eating bacteria, I would highly recommend this book. Like The Hot Zone and Being Mortal, it offers in-depth insights into the darkest areas of medical science.

This book wss filled with about 25 anecdotes flimsily tied together by Gawande's less than inspiring reflections. I have the book in front of me at the moment and I am paging through rereading sections that I noted along the way:

"I had come into residency to learn how to be a surgeon. I had thought that meant simply learning the repertoire of move and techniques involved in doing an operation or making a diagnosis. In fact, there was also the new and delicate matter of talking patients through their decisions - something that sometimes entailed its own repertoire of moves and techniques." pg 217

Next to this paragraph I had written "NO SHIT!"

The book is full of these minor, pseudo-epiphianic moments that come off as weak aphorisms. However, given the audience of this book (everyone) he does well to treat people about how uncertain medicine really is and how it really comes down to the tricky nature of making decisions and how they should be made in the medical setting:

"But the conundrum remains: if both doctors and patients are fallible, who should decide? We want a rule. And so we've decided that the patients should be the ultimate arbiter. But such hard and fast rule seems ill-suited both to a caring relationships between docotr and patient and to the reality of medical care, where a hunderred decisions have to be made quickly... The doctor should not make all of these decisions, and neither should the patient. Something must be worked out between then, one on one - a personal modus operandi. Where many ethicits go wrong is in promoting patient autonomy as a kind of ultimate value in medicine rather than recognizing it as one value among others...(A)s the field grows ever more complex and technological, the real task isn't to banish paternalism; the real task is to preserve kindness." pg 223-4

This simply makes sense, nothing new here.

The best part of the book is the last two paragraphs (and is all you really need to read have said that you have read the book, in my opinion.):

"The possibilities and probabilities are all we have to work on within medicine...What we are drawn to in this imperfect science, what we 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. In the actual situations that present themselves, however, [...] we can never be sure whether we have such a moment or not. Even less clear is whether the actions we choose will prove either wise or helpful. That our efforts succeed at all is still sometimes a chock to me. But they do. Not always, but often enough." pg 251-2

In a way, the whole thesis of this book (which I think is summed up in the sentence in bold above) is pretty remarkable. There is so much talk about the fallibility and humanity in medicine right now... fallibility is so hot right now. However, as is apparent in this book, the medical community is only at the stage of recognizing this fallibility. Gawande doesn't do what I thought he would: suggest what we should do given the increase visibility of the fallibility of the practice of medicine. He really doesn't have any good ideas. In all his articles, he seems to be advocating a technocratic answer (using checklists etc.). The biggest problem I have with the book is the way Gawande seems to view the profession medical community of independently-acting people, who, in the aggregate, are not too of an impressive lot. In this, Gawande is entirely old-school. He fails to recognize the possibility of alternative ways to approach patient care. In a way, I think that he is dangerously anecdotal. Maybe it is just me being tired of reading anecdotal medical non-fiction, but it just seems like a lame format (don't hold these words against me because I really don't know what I am looking for, or what type of book I would write). He treats them like data points. I believe that the book could be reduced by about 80% for someone like you or I who are as far in the medical field as we are.

However, I believe there to be value within this book. I am really really happy that millions of people (future patients) are reading books like this and Groopman's "How doctor's think" as it really does educate them to get real about what medical care is all about. It will serve to empower people and get them involved in their care and think about how they want it to go down. But, to me, I really did expect a lot more from this guy. The reviews that it got are ridiculous, they are way over the top! It is pretty incredible- it goes to show how easy it is to be heard once you have written for the New Yorker and got a MD from Havard. I will keep reading his books, though, for no other reason than that he is so hot right now, millions are reading him. I at least have to know other people are thinking about.