Better: A Surgeon's Notes on Performance

From Barnes & Noble

In one of the most readable science titles of recent years, surgeon and MacArthur fellow Atul Gawande applies his gift for limpid prose to medical and ethical dilemmas in this collection of essays, some of them adapted from articles in the New England Journal of Medicine and The New Yorker. From battlefield surgical tents in Iraq to delivery rooms in Boston, the bestselling author of Complications uses riveting accounts of medical failure and triumph to show how doctors can and must better their rate of success while confronting daunting obstacles and grappling with what are often literally life-and-death issues.

From the Publisher

"Better is a masterpiece, a series of stories set inside the four walls of a hospital that end up telling us something unforgettable about the world outside."--Malcolm Gladwell, author of Blink

"Atul Gawande's insightful book illuminates the challenging choices members of the profession face every day."--Susan Salter Reynolds, Los Angeles Times

"Remarkably honest and human accounts . . . describing professional moments of fear, guilt, embarrassment, and humor . . . Rich in fascinating detail."--The Economist "It's hard to think of a writer working today who makes such good use of man's quest to avoid pain and death. Atul Gawande is not only adding to the small shelf of books by doctors that every layman should read. He's using medicine to help anyone who hopes to do anything better."--Michael Lewis, author of The Blind Side

"Gawande . . . manages to capture medicine in all of its complex and chaotic glory, and to put it, still squirming with life, down on the page. . . . With this book Gawande inspires all of us, doctor or not, to be better."--Pauline W. Chen, The New York Times Book Review

"Gawande is unassuming in every way, and yet his prose is infused with steadfast determination and hope. If society is the patient here, I can't think of a better guy to have our back."--Gail Caldwell, The Boston Globe

"This is a book about failure: how it happens, how we learn from it, how we can do better. Although its focus is medicine, its message is for everybody. . . . It has already been described as a modern masterpiece--and so it is."--Jeremy Lawrence, The Independent (UK)

"I found I had been gripping the book so hard that my fingers hurt. . . . It calls to mind one of the great classics of medical literature, Mikhail Bulgakov's A Country Doctor's Notebook. Few modern authors could stand that comparison, but Gawande can."--John Carey, The Sunday Times (UK)

Pauline W. Chen

As with his first book, Complications, Gawande provides a cleareyed view of the medical profession that both resonates and gives pause. Once again, he spares no one, himself included. Gawande, a surgeon, manages to capture medicine in all of its complex and chaotic glory, and to put it, still squirming with life, down on the page. While fans of his work may be disappointed to find they've already read half of the chapters in The New Yorker (where Gawande is a staff writer) or elsewhere, Gawande's meditation on performance is not only an absorbing collection of essays on how some doctors manage to do better but also an exhilarating call for the rest of us to do the same.
—The New York Times

Perri Klass

Better makes a compelling case for medical self-awareness in the operating room, on the hospital ward and even on the battlefield. Gawande succeeds in looking at medical achievement -- and lapses -- from a new perspective. His stories evoke the profound desire that doctors feel to cure, along with our besetting anxieties about poor performance and its consequences. He makes his case that failure is "so easy, so effortless," but also that "positive deviance" -- deliberate and determined individual improvement -- is possible. His own self-consciousness, his ability to ask questions about the nuts and bolts of medical practice, and his storytelling skills make this a book about the complex grandeur of the human endeavor that is medicine.
— The Washington Post

Publishers Weekly

Surgeon and MacArthur fellow Gawande applies his gift for dulcet prose to medical and ethical dilemmas in this collection of 12 original and previously published essays adapted from the New England Journal of Medicine and the New Yorker. If his 2002 collection, Complications, addressed the unfathomable intractability of the body, this is largely about how we erect barriers to seamless and thorough care. Doctors know they should wash their hands more often to avoid bacterial transfer in the ward, but once a minute does seem extreme. Using chaperones for breast exams seems a fine idea, but it does make situations awkward. "The social dimension turns out to be as essential as the scientific," Gawande writes-a conclusion that could serve as a thumbnail summary of his entire output. The heart of the book are the chapters "What Doctors Owe," about the U.S.'s blinkered malpractice system, and "Piecework," about what doctors earn. Cheerier, paradoxically, are the chapters involving polio and cystic fibrosis, featuring Dr. Pankaj Bhatnagar and Dr. Warren Warwick, two remarkable men who have been able to catapult their humanity into their work rather than constantly stumble over it. Indeed, one suspects that once we cure the ills of the health care system, we'll look back and see that Gawande's writings were part of the story. (Apr.) Copyright 2007 Reed Business Information.

Publishers Weekly

Veteran character actor Lloyd does a commendable job in narrating Gawande's arresting exposé of the razor-thin margin that separates top doctors from the rest. While the book has its share of sensational and bloodcurdling tales of virulent infections and medicine gone wrong, Lloyd resists the urge to sensationalize his reading. He rightly senses that these tales do not constitute the heart of this book. Some parts are necessarily slow-moving and methodical, including a lecture on the proper way to scrub hands or a complex rundown of India's health care system. Lloyd's quietly authoritative reading lends an unhurried air that is appropriate for a book fundamentally about taking the time to care, and care diligently, about the things that matter most. Gawande's writing works well on audio as several chapters appeared as discrete essays in the New Yorkerand the New England Journal of Medicine, and still bear the stamp of stand-alone material. It's perfect for listeners who prefer thoughtful, short essays for a ride in the car or a walk on the treadmill. Simultaneous release with the Metropolitan hardcover (Reviews, Feb. 12). (May)

Copyright 2007 Reed Business Information

Library Journal

Gawande, a Harvard-trained endocrine surgeon, contributor to The New Yorker, best-selling author (Complications: A Surgeon's Notes on an Imperfect Science), and 2006 MacArthur fellow, examines the nature of how success and excellence are achieved in medicine and how diligence, doing right, and ingenuity can combine to do better—in not only medicine but also all other human endeavors. In a narrative style reminiscent of Oliver Sacks, Sherwin B. Nuland, and Abraham Verghese, Gawande candidly weaves a tapestry of essays on topics as varied as hospital hand washing, polio in India, surgical tents in the Iraq war, physicians' salaries, malpractice insurance, and doctors' roles in lethal injections. The essays are united, as they highlight opportunities for improvement within the medical community, which serves as a successful framework for Gawande's study of a profession predicated on betterment. These revealing, humanistic essays are highly recommended for all libraries. Gawande's varied accomplishments have been publicized, and this book is certain to be a best seller [For a Q&A with Gawande, see LJ3/15/07.--Ed.]
—James Swanton

Kirkus Reviews

"What does it take to be good at something, when failure is so easy?" asks writer/physician Gawande in his follow-up to Complications (2002). Diligence, ingenuity and "doing right," he answers. Gawande illustrates each of these qualities with stories from his own experience, as well as his observations of and conversations with other physicians. Being diligent about the simple act of hand-washing dramatically reduces hospital infections, he demonstrates, and through diligence, army surgeons in Baghdad have greatly enhanced the survival rate among casualties in Iraq. The section on doing right tackles such troublesome moral issues as whether doctors should participate in executions and at what point treatment of a patient becomes mistreatment and should be stopped. Discussing ingenuity, Gawande shows how the rating scale devised by Virginia Apgar, neither an obstetrician nor a mother, transformed the practice of obstetrics. A similar rating scale for every medical encounter, he believes, would inform patients and improve the performance of doctors and hospitals. He lauds the innovative thinking of Don Berwick, head of the Institute for Health Care Improvement, who is challenging the medical profession to measure and compare the performance of doctors and hospitals and to give patients total access to that information. When such information is available, medical professionals can identify the best performance and learn from it, as Gawande illustrates with an account of exceptional results in treating cystic fibrosis at Babies and Children's Hospital in Cleveland. Monitoring and improving clinical performance would do more to save lives than advances in laboratory knowledge, he contends. Foryoung doctors wondering how they can make an individual difference, Gawande suggests five strategies: Ask unscripted questions, don't complain, "count something" (be a scientist as well as a doctor), write something (to make yourself part of a larger world) and change in response to new ideas. A must-read for medical professionals-and a discerning, humanizing portrait of doctors at work for the rest of us.