Better

One of my favorite books on medical topics. Atul Guwande is a fantastic writer, knowledgeable, empathetic, just an all-around good read. The initial chapter on hospital-borne infections, hand washing, and the reference to the work on positive deviance and childhood malnutrition in Vietnam is eye opening. I've given away several copies.

This is a non-fiction book so compellingly written it begs to be read in one sitting like a novel. And luckily it's short enough for the reader to do just that and come away with useful insights. Readers seem to get different things from this book. Some are most interested in the chapters on medical ethics. What I found most interesting was what I took as the main theme: that the practice of medicine is complex; that through attention to detail in can be systematically improved in non-obvious, pragmatic ways that are far from the big-money, high-profile research our attention is usually drawn to; and that this improvement can come from dedicated individuals and groups all over the world. Even better, some of the lessons here can carry over to other disciplines. My job has no relation to medicine but I found this book to provoke lots of ideas for my own work. Thanks, Dr. Gawande. A previous reviewer felt that the author's work was becoming "conceited." I have to disagree; I found it refreshingly self-effacing. Unlike some books written by surgeons, this one isn't focused on the tribulations or poetry of the practice of medicine. Rather, it's focused on how practitioners with no more than average skills could help make medicine serve humanity better.

I appreciate the structure, narrative method, illustrative anecdotes, and efforts to present the range of positions one might consider related to each topic Dr. Gawande addresses. This orderly and seemingly for-the-most-part balanced approach is eye-opening, memorable, and compelling. Why not 5 stars? “For-the-most-part” suggests a few topics / issues where he leveraged a writer’s advantage to get the last word in. I’d have preferred he not.

The medical system is filled with compromise, problems and lack of understanding. Variants of care vary drastically from place to place without a complete understanding of how or why. Questions of ethics, morals and codes doctors must abide by with little oversight. Understanding the medical system is a tedious and seemingly hopeless task. One must often wonder, what holds this system together? Dr. Atul Gawande has taken a selection of real life stories of great and inspiring acts in the field of medicine. His portrayal of these stories is even inspiring to those who have no interest in medicine. His description of a hospital team that's primary job is preventing infection. There struggle to get people to simply keep their hands clean was daunting. However it proved when you involve everyone in the solution you can more effectively fix the problem. His description of FST (Field Surgical Teams) in Iraq was eye opening. Little attention by the press was given to this handful of surgeons who saved countless soldiers and civilians lives. One of their greatest accomplishments being the tedious collection of information, which ultimately helped shape war time trauma care. The depiction of the Adgars scale and how its creation dramatically increased newborn mortality rates. It was created by an unlikely Anesthesiologist, the second female in the country given this title. I could go on, however I will save the book for your reading. Overall the book beat my expectations, so I would recommend reading it. It will inspire you to seek to do "Better". You will feel as though however small your achievements it's the collective efforts of us all that overcome all odds.

I enjoyed reading Better for the insights it gave into the various forces shaping medical practice, and how important the individual and collaboration are in a profession one often thinks of as the being dominated by individual practitioners with highly specialized skills. What was especially interesting to me was how this book brought to mind parallels with what seems to be a vastly different profession: software development. ALmost every chapter brought to mind a parallel. The stories of practice in rural India seemed to make a case for the value of "generalizing specialists," the discussion of infection prevention was an echo of the value (and difficulty) of getting a team to be disciplined in using a few simple practices, etc. I suspect those in other fields that require individual skill, judgement, and collaboration might find the same thing. This wasn't unexpected, as I had first read The Checklist Manifesto: How to Get Things Right , but that book was explicit about the parallels. If you are interested in health care, want to understand how to apply skills more effectively, or simply just like a good story, Better is good, Gawande mixes anecdote, data, and an almost suspenseful presentation style to make what could be an academic discussion approachable and entertaining.

Atul Gawande asks the hard questions. How can a doctor who is just a human be expected to be a god? Gawande looks at the profession from the mundane (hand washing) to the ethical mountain tops (physicians attending executions). The odd thing is that the death row docs have not killed nearly as many people, in the big picture, as the ones who forget to sufficiently scrub up. Dr. Gawande tells us about the challenges and changes in obstetrics, cystic fibrosis, and the use of chaperones in examining rooms, trauma practice and many other little niches in the health care system from an insider's point of view. This is a well written real life look into the daily life of a modern day physician documenting all the medical and ethical decisions that affect both the doc and the patient. He is quite frank with many of his judgment calls but never gets too technical that the book is difficult to read for the layman. This is a good read.....BG

I saw Dr. Gawande on C-SPAN and was impressed at his willingness to tell stories in which he was not heroic, in which he "goofed up." In this book he addresses what it takes to be successful in medicine. The three qualities he discusses are: diligence (giving sufficient attention to detail), to do right (questions of ethics), and ingenuity (recognizing failure and thinking anew). He demonstrates diligence by how washing hands can stop infection, a story of a massive vaccination operation to stop an outbreak of polio in India, and the saving of many wounded in Iraq by the diligent log-keeping of the medical teams to assess data and improve treatment. In discussing ethical dilemmas, Gawande says he would rather put the money he pays for malpractice insurance in a fund for patients who suffer complications from his care. He is opposed to physicians and nurses participating in executions, and since the death penalty, it seems, cannot be performed without their assurance of no pain or cruelty, then he believes the death penalty should be abolished. He also believes a doctor should never give up on a patient. His motto: Always fight. One of Gawande's examples of ingenuity is the doctors he observed in India at an institute where he spent three weeks as visiting surgeon expecting to teach. It turned out that the Indian physicians, with little equipment "outstripped any Western surgeon I know." They also had great camaraderie, always taking time between cases to drink chai and swap stories about their cases. What I like best about Gawande is his ability to reflect on himself, see and admit his shortcomings, and think anew about his situations.

The book is great . I ended up buying it for a school project, and I only had a couple of days to do it. I ordered it with prime expecting it to get here fast and for a good price. But when I revived the package there was nothing it there it was empty. It looked like it was never sealed. I had bought another one after getting a refund . But then it said it didn’t go through so I had to buys another one. In the end I ended up with three books because it turned out the first book I bought they had delivered it back. But great book.