Saturday, May 05, 2007

Atul Gawande on the art behind medicine in Better

Atul Gawande’s debut collection of essays Complications: A Surgeon's Notes on an Imperfect Science changed the way I looked at doctors and the medical profession. It gave me an innate understanding of the process of medical treatment and forced me to become a highly active participant in my own relationship with my doctor.

His second set Better: A Surgeon's Notes on Performance is similar in its structure and selections. And it’s just as good.

A general surgeon at the Brigham and Women’s Hospital in Boston and an assistant professor at Harvard Medical School, Gawande draws us in with his crisp, engaging descriptions of patients, their illnesses and struggles to get better. And building on such episodes, he shows us that medicine is as much art as science.

He starts with a seemingly innocuous topic: washing hands while treating patients in a hospital ( excerpted on Desicritics previously). He tells us how infections pass from doctors to their patients. He gives us examples, delves into history and quotes research. He then introduces us to an infectious disease specialist and a microbiologist who are campaigning for germ-free hands in a hospital. And he tracks their efforts and results. It’s an absorbing first chapter and one that forms the template for the rest of his essays.

Gawande follows this by giving us the details on surgeons caring for soldiers on the frontlines in Iraq. He accompanies a team on a mop-up operation dealing with an outbreak of polio in Bellary, Bangalore. Later, he dives into malpractice suits – their impact on doctors and the medical system. He lands an interview with a doctor who has left his profession to turn into a malpractice lawyer. He talks to doctors who have been victims of suits and relates this to his own practice.

One of the features of Gawande’s writing is that he is a fearless humanist. He often talks about his own shortcomings in ways that less confident surgeons would have jitters putting in print. His best work comes when he writes about topics that are heartfelt – issues that strike close to home.

His notes are built on the backs of a series of questions that he seems to ask himself. He then looks for details in places that strike our own curiosity. It’s a wide-then-selectively-deep analysis. He interviews people to get personal takes. And he has a research assistant help him put together facts gleaned from studies that bolster his arguments.

Yet when Gawande’s opinion emerges, it always feels well thought out with due consideration for multiple points of view. It is with empathy for those in disagreement.

All of this comes together in the last third of the book, which I found to be the most enjoyable. In one fascinating chapter, the good doctor gives us a brief history of child birth procedures and then goes on to show us how innovation in this area has been fundamentally different from the evidence-based improvement in other areas of medicine.

He switches gears to try and understand why different centers that treat a complex, genetic disease like Cystic Fibrosis differ so much in their end results. He ends his book with a first hand look at how overburdened surgeons in a remote rural corner of India innovate to meet the demand for treatment.

Better is divided into three sections. The chapters collected in each section are loosely related. And each chapter is a standalone piece of work. When switching between chapters, you’ll have to stop and make an adjustment before moving on. There is also an afterword where Gawande dispenses advice on becoming “a positive deviant” that potentially talks to a small section of the book’s intended mainstream audience.

These are minor infractions: Better remains as page-turning as any thriller I’ve read this year. It’s endlessly fascinating because it is rooted in reality and written with precision and depth.


Anonymous said...

I remember having read this article before but I dont remember you referring to Gawande as Gawanade. I like it. A long cool drink of hygiene.

Unknown said...

All right! I fixed those. And thanks for extending the courtesy outside of DC too :)