[PDF] Complications A Surgeon's Notes on an Imperfect Science ☆ Atul Gawande
Bat Ode get sick or somebody we love willet sick Which is why learning about medicine and healthcare is so important However a lot of books about medicine and healthcare can be pretty dry which is where Dr Gawande comes to the rescue His clear prose makes even the most difficult medical concepts easy to understand In this book Gawande is just starting out his medical career Like most new Bitter Choices: Blue-Collar Women in and out of Work graduates Gawande is excited yet nervous about the new challenges that await him in the workplace But he soon realizes that medical school only teaches you a tiny smudge of what being a doctor is actually about Medicine is so much than just a science it is a messy and imperfect art A lot of what doctors do is intuitive they piece together symptoms to formulate a treatment plan However uncertainty feelsrander in medicine because human lives are at risk And as a doctor you not only need book smarts but the ability to navigate unforeseen challenges with integrity and fortitude A lot of this book comprises of fascinating case studies a victim who was shot in the buttock leaves the hospital virtually unharmed a pregnant woman with nausea so debilitating that she has to leave work a neurosurgeon who copes with severe blushing and a young woman whose inconspicuous leg pain turns out to be a deadly infection If you like suspense then this book is for you The saying everything can change in an instant is ever so applicable to medicine Although I enjoyed this book I thought it was a bit dull at times I think it could have been improved if it contained a tad bit of humor But overall I did enjoy it I would recommend Complications to medical professionals or anybody who is interested in learning about the healthcare field A year or ago I mistakenly placed a review for Gawande s book Better under this title I have fixed the mix up and I have now read ComplicationsGawande is pure pleasure to read His writing is fluid and full of ermane examples as he addresses big issues like error and incompetence as well as topics that seem less significant but which he makes worthy of consideration such as blushing and nausea The headings for each section of the book Fallibility Mystery and Uncertainty are thematic in the text As one reviewer wrote Thank heaven someone wrote this book Gawande is unapologetic and totally direct in his appraisal of medicine What I really appreciate is that in Better which he wrote after Complications he ives eual time to discussing ways in which medicine can improve I m a fan A ood
*writer and a ood doc What could I ask for I finished this *and a ood doc What could I ask for I finished this about a week ago and the next day my mom fell and f % broke her hip So this is NOT the type of book to read or even think about when you have someone in the hospitalMost doctors especially surgeons are viewed as infallible but in reality they are just like us They have bad days they make mistakes and some of them should really change careersThe author writes elouently with compassion and a clear love for surgery which made this a fascinating book to delve into Most of the stories felt anecdotal rather than a deep dive into the details which for a layman like me was perfectThe author also poses a lot of ethical uestions about the profession and how much patient autonomy should be allowed when making health d Not uite a 4 star read but close enough It s fairly short does make his major points fairly well They boil down to medicine isn t perfectDoctors are humans so need to learn will make mistakes even with the best intentions Do I want a doctor to learn on me or mine Hell no Gawande admits that he doesn t either "he makes sure they don t BUT we won t et any new ones if they don t start "makes sure they don t BUT we won t Back to the Breast: Natural Motherhood and Breastfeeding in America get any new ones if they don t start So what s the solution There isn t aood one Deal with itPatients are humans so they re complicated They do things that are bad for them all demand the highest level of care Since the mid 80 s they ve been etting say in what their treatment is often they re not well euipped to do so either due to ignorance or just feeling like crap Balance between what the doctor recommends what the patient wants is toughMedicine has come a LONG way in a short time but they still don t know a lot As it becomes complicated it s tougher for doctors to stay on top of even their specialty Unspoken but obvious in the subtext is that it takes people to do the job a lot depends on every one thing s availability doing their job properly Facilities are often stretchedOverall it was an interesting tour inside the field from a young surgeon s point of view I think this was his first book it suffered a bit from that It s also a bit dated "in some respects having been written 15 years ago or so Still it s well worth reading Read "some respects having been written 15 years ago or so Still it s well worth reading Read sentences and tell me that this writer isn t an unbearable idiot If choice of one s surgeon cannot o to everyone maybe it is better when it is not allowed at allTaking 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. Ly is uncertain perplexing and profoundly human Complications is a 2002 National Book Award Finalist for Nonficti. 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 wayI had come into residency to learn how to be a surgeon I had thought that meant simply learning the repertoire of move and techniues 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 techniues pg 217Next to this paragraph I had written NO SHITThe book is full of these minor pseudo epiphianic moments that come off as weak aphorisms However Black Nationalism: The Search for an Identity 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 settingBut 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 uickly 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 ethicitso wrong is in promoting patient autonomy as a kind of ultimate value in medicine rather than recognizing it as one value among othersAs the field rows ever complex and technological the real task isn t to banish paternalism the real task is to preserve kindness pg 223 4This simply makes sense nothing new hereThe 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 opinionThe possibilities and probabilities are all we have to work on within medicineWhat 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 ut 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 2In 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 Boggs: A Comedy of Values given the increase visibility of the fallibility of the practice of medicine He really doesn t have anyood 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 to view the profession medical community 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 of book I would write He 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 Blood Runs Green: The Murder That Transfixed Gilded Age Chicago get real about what medical care is all about It will serve to empower people andet them involved in their care and think about how they want it to Berlioz and the Romantic Century go down But to me I really did expect a lot from thisuy The reviews that it Building Ideas: An Architectural Guide to the University of Chicago got are ridiculous they are way over the top It is pretty incredible itoes to show how easy it is to be heard once you have written for the New Yorker and ot 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 Although I am interested in the medical profession motivation to learn about it often elludes me Gawande was able to keep my attention and present points that I could understand in spite of my limited medical knowledgeAdmittedly some of his information scared me After reading some points about surgery I wondered how I ever allowed anyone to cut into "me and place a plate and seven screws in my leg Also some of his writing made me sueemish I "and place a plate and seven screws in my leg Also some of his writing made me sueemish I to pause or skip places that became too raphic for my weak stomach Some of his writing discouraged me Why am I trying to lose weight if no one is able to succesfully lose weight and keep it off unless they are dangerous and intensive surgery I also felt discouraged over the problems he presented that really have no attainable answersIn spite of my difficulty with his unanswerable uestions I appreciated Gawande s straightforward honesty about the medical profession and its weakness Ironically his admission of the fallibility of doctors and medicine makes me willing to approach a doct. Inching view from the scalpel’s edge Complications lays bare a science not in its idealized form but as it actual.
Atul Gawande ì 2 Free readComplications is a book of anecdotes about a surgical resident s experiences and impressions of the current health care environment Gawande divides his stories into three sections fallibility mystery and uncertainty The fallibility section demonstrates that doctors can make mistakes Some fallibility arises from there being a learning curve For example it is hard to do a central line correctly the first time But for a doctor to learn how to do a central line he must have a first patient to try it on The concern then arises as to which patients receive care from the inexperienced versus the experienced Yet fallibility occurs in even the most experienced doctors Gawande reports on one doctor who became so careless that he was no longer allowed to practice The frightening part of that story is how long his colleagues let him continue when they had concerns The Doctor also brings up this issue It is understandable that doctors are reluctant to come down too hard on their colleagues They need each other as a support system and thus need to maintain trusting relationships Further medicine is uncertain and it can take a long time to see a pattern of truly irresponsible behavior as opposed to just having complicated cases Gawande makes the point that discipline of doctors works best when it done by a Building the Cold War: Hilton International Hotels and Modern Architecture group outside the doctors peerroup or employer because it is objective Then this outside One Touch of Scandal group can propose a plan of action which the employer can implement Unfortunately this model has been too expensive to be much of a viable option The mystery section details stories of conditions that cannot be explained by current medical science like blushing pain and nausea In each of these cases the doctors could not explain why the patient had the condition Much of the time the patient just wanted the doctors to believe them even though there did not seem to be a physiological source of the problem It is interesting that the patient is willing to accept that there is no medical explanation than the doctors Yet the doctors are the ones with the training and have probably seen many circumstances when they cannot make a diagnosis The uncertainty section deals with how to make the right diagnosis or judgment There are several points in this section that have come up in the other literature reviewed for this independent study First is the declining use of the autopsy The autopsy is how doctors can determine what was actually wrong with the patient It is the final way toet rid of uncertainty Its purpose is to help the doctors recognize such conditions in the future Yet autopsies are done less and less Although many times the family is opposed to the autopsy and will not allow it Another recurring point is the decision making power of the patient Patients have become pro active in their desire for decision making ability but they are much ambivalent about actually exercising it Especially in situations where there is uncertainty patients do not feel comfortable or emotionally able to make the decision Some do not "think they can handle the responsibility if it turns out to be the wrong decision Gawande notes "they can handle the responsibility if it turns out to be the wrong decision Gawande notes doctors also prefer to make the decision One of the things he had to learn as a resident is how to persuade patients to the decision he thinks is best As health care becomes consumer driven the debate over the level of physician agency is likely to continue 45 starsI had a reat time reading this with Heidi from My Reading Life The book is
*Broken Up Into Three *up into three 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 with a liberal sprinkling of fascinating casesThe 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 wellI kinda wish I had to say but it s one of those books that s so ood 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 Let s play the who wants to be horrified Carson Pirie Scott: Louis Sullivan and the Chicago Department Store game Complications made it hard to sleep Not because ofore necessarily but because it made clear to me that doctors are just people who were Charting an Empire: Geography at the English Universities 1580-1620 given a scalpel Yes they have a ton of education but at some point they mustet experienceIn one section Gawande discusses a procedure in which he must put in a central line which oes into a major vein in your chest which can technically kill you All he tells the patient is that he must put in a central line not that it is dangerous or that it is his first time doing this procedure I completely understand why he didn t tell the patient but that doesn t make it any less terrifying I have thought about how doctors have to start at some point but it was never so clear to me that there is a "first patient for every procedure for every doctor For every surgeon there will "patient for every procedure for every doctor For every surgeon there will the first surgery There is a first time for cutting into the flesh of a still living personIt was published in 2002 so I m sure some things have changed but it s still current enough about how the training takes placeIt s an important realization of how much control doctors have over our bodies and how little they have over everything else in the hospital They don t et to chooseFor the full review please visit This book wss filled with about 25 anecdotes flimsily tied together by Gawande In vivid accounts of true cases surgeon Atul Gawande explores the power and the limits of medicine offering an unfl. ,