Better – Atul Gawande

Subtitled A Surgeon’s Notes on Performance, this second collection of essays by the brilliant author of Complications doesn’t disappoint. As he did last time, Gawande explores a range of topical and relevant medical themes, beginning with an individual situation or case, expanding out to encompass the wider aspects of the issue, then bringing it back to the starting point. Each section articulates an aspect of good practice and positive deviance – the qualities that distinguish an ordinary practitioner from an extraordinary one.
Gawande’s exemplary qualities are Diligence (“both central to performance and devilishly hard”), Doing Right (the issues and conflicts that arise as a consequence of being a flawed human being), and Ingenuity (“a willingness to recognize failure… and to change.It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.”). Each section contains a number of thematically-connected essays that between them cover topics as wide ranging as the problems of hand washing in hospitals, the participation of health care professionals in applying the death penalty, medical litigation, and what separates a good cystic fibrosis service from a great one.
Gawande writes in an accessible, lucid and vivid manner that appeals as much to lay readers as health professionals. Tags and annotations distort my copy, because I found something valuable on almost every page – he articulates complex matters clearly and concisely, illustrates the macrocosm of medicine with vivid personal stories of individuals, and left me inspired. He is also refreshingly honest about his own failings, as an intern (in the introduction) and practitioner (particularly in the opening essay, about the difficulty of translating the acknowledged importance of vigilant hand washing into action). A valuable companion piece to How Doctors Think in terms of medical philosophy, Better should be required reading for all undergraduate medical students, as well as anyone who wants to write in the health care field. - Alex