Atul Gawande

"Better: A Surgeon's Note on Performance"

(Reviewed by Poornima Apte APR 23, 2007)

Better by Atul Gawande

Reading Dr. Atul Gawande’s new book, Better, brought me back to a summer many years ago when my husband and I were browsing at a renowned art fair in New England. We had fallen in love with a beautiful piece of art and were trying to justify spending a significant chunk of money on it. After a while, the artist got impatient and she complained: Nobody ever thinks twice about the paying a doctor for a surgery” and her voice trailed off. The implied message in there was that an artist’s work is just as precious and important as a surgeon’s. While one could certainly debate that point endlessly, Gawande, in his skilful new work points out that actually, a physician might not make a big killing all the time and certainly not as easily as the rest of us would like to believe. In an essay in the book called “Piecework,” Gawande explains that more than 20 years ago a Harvard economist set about quantifying what a physician should get paid for a variety of procedures and most insurance companies use this pay scale for reimbursement. Even with these established pay scales, the system is so complicated that entire jobs revolve just around filing the right paperwork and getting the claims processed. The essay is just one of many in Better that explores a wide variety of topics in medicine.

Gawande, whose first book Complications, was one of the finalists for the National Book Award, sets up the new book into three sections: Diligence, Doing Right and Ingenuity. Many of these essays have been culled from the New Yorker where Gawande is staff writer. There is a beautiful essay on the miracle of childbirth and controversial ones that address malpractice lawsuits and a doctor’s presence at executions. One of Gawande’s many strengths is his skilful reporting and it shines through in all the essays in Better.

Even better, each story is peppered with real examples that make the stories come alive for the reader. There is the example of a young student of medicine whose cancer was allowed to fester despite telltale signs having showed up in an earlier X-ray. And there’s Mr. Thomas who has to come to terms with a diagnosis of Cushing’s syndrome, where his muscles gradually start wearing down.

Arguably the best part of the book is the first, Diligence, where Gawande shows how persistence with what might seem even the most trivial of discoveries makes big differences in the outcomes in medicine. Simple hand washing, for example, helps cut infection rates dramatically yet many skip it probably because the lesson seems unglamorous or its implementation in every single case not that vital. Diligence matters yet again when one doctor in India is out chasing the last cases of polio in the world. Through this section, Gawande expertly shows us just how tenacious medical professionals need to be to keep patients really healthy.

Call it a coincidence but the most e-mailed article in the New York Times today had a headline that read: Lessons of Heart Disease, Learned and Ignored. The article explained that “medical research has revealed enough about the causes and prevention of heart attacks and that they could be nearly eliminated. Yet nearly 16 million Americans live with coronary heart disease, and nearly half a million die from it each year.” It perfectly illustrates one of the most telling points Gawande brings out in his book--that in search for the elusive cure for many a disease, we have not effectively used the abilities that science has already given us.

As the Times’ story illustrates, medicine is never lacking for such stories just waiting to be told. In fact, Gawande himself maintains a running list of such potential stories to work on. It takes his finely honed writing skills, however, to distill them in a language all of us can understand and learn from.

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About the Author:

Atul GawandeAtul Gawande was born in 1965 in Brooklyn, New York. He is the son of Indian immigrants, both doctors. His father runs a urulogy practice in Athens, Ohio where Atul grew up. His mother is a pediatrician. He received his B.A.S. from Stanford University in 1987, M.A. (in politics, philosophy, and economics) from Oxford University as a Rhodes Scholar, M.D. from Harvard Medical School, and Master of Public Health degree from the Harvard School of Public Health. He served as a senior health policy advisor in the Clinton presidential campaign and White House from 1992 to 1993.

He is a general and endocrine surgeon at Brigham and Women's Hospital in Boston, Massachusetts and an assistant professor at the Harvard School of Public Health as well as an assistant professor of surgery at Harvard Medical School. He has written extensively for the The New Yorker magazine for Slate. In 2006, he received the MacArthur Award for his research and writing. He is the director of the World Health Organization's Global Challenge for Safer Surgical Care.

He lives in Newton, Massachusetts and has three children. About Us | Subscribe | Review Team | History | ©1998-2014