Complications: A Surgeon's Notes On An Imperfect Science (2003) - Plot & Excerpts
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.
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.
What do You think about Complications: A Surgeon's Notes On An Imperfect Science (2003)?
With honesty and humility Dr. Gawande provides the reader an insight into the practice of medicine. A general surgeon at Boston's Brigham & Women's Hospital, Dr. Gawande writes movingly about the challenges and uncertainties doctors face each day as they strive to provide the best treatment possible for their patients.The book jacket aptly sums up this outstanding book, "In gripping accounts of true cases, surgeon Atul Gawande explores the power and limits of medicine... Complications lays bare a science not in its idealized form but as it actually is--uncertain, perplexing and profoundly human".For anyone interested in the practice of medicine, this well written, informative, and absorbing National Book Award Finalist is well worth the read!
—Cheryl
Gawande gave a captivating look into the truth behind being a surgeon. He illustrated stories that were hard to imagine and put the reader into perspective of not only a doctor who is responsible for saving human lives, but for the patients as well who are trying to deal with the difficulties of illness and disease. He expertly gave readers a look into how the practice of medicine is still so unknown and uncertain. His novel humanizes surgeons and is a must read for anyone even remotely interested in the medical field.
—Brittany
First book of its kind that I read.. Interesting and did not regret reading it. I consider it a new different perspective to look at the medical fields, surgery in particular. The process of the decision making has been described perfectly ! It is not about how to do surgery, it is when to do it.. Most of the time, you make a judgment based on your feelings, and is hard to describe how you reached such diagnosis or conclusion."Judgment is rarely a calculated weighing of all opinions, which are not good anyway, but instead an unconscious form of pattern recognition" I loved the cases involved, especially when it gets complicated with ethical problems.. It is not easy dealing with patients, right of autonomy or confidentiality. It is too complicated, and depend on who you are, how you work, where you are !! It showed me that even the best of us makes mistakes. the "when good doctors go bad" is quite scary or something that make you think about yourself. One comment though, it discussed some cases in too much details. Like the one with the gastric-bypass surgery. The author kept going on and on about the same issue ! Overall, I loved it. I can see that I understand the book more if I had some background info about the cases.meaning, I loved the ethical case because we just had them at school and finished discussing the major problems, like the autonomy, or the ventilation part. I recommend the book, you shall all read it !
—Mariam.394
