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A review by tophat8855
Better: A Surgeon's Notes on Performance by Atul Gawande
4.0
September Book Club Book
I spent the first half of the book looking for a thesis. It starts with an introduction which makes you think there's going to be some sort of thesis, but I couldn't find it in the chapters. I gave up looking for one by the end. Some thoughts on random chapters:
He goes and shows how doctors and nurses don't wash their hands enough and lots of hospital-attained infections like MRSA could be prevented if doctors just washed their hands. One of his own patients gets MRSA under his care and admits he could have been the one who gave it to him. What does he do about this? Just says that's what happens. Couldn't find any guilt or remorse or desire to change his hand-washing ways. And I was still looking for a thesis at this point and was hopelessly let down.
Interesting discussion about medical personal at the front-lines of the war in Iraq. Something you don't think about every day.
Didn't find the chapters on litigation, doctor salaries, and professional-ity engaging. Interesting in that I don't sit around thinking about those all day, so it was interesting to consider the topics, but I didn't find it very engaging.
I found the chapter on doctors who are involved with lethal injection and death sentences really fascinating, though possibly graphic and triggering depending on the reader. And it's interesting how it's so hard to simply kill someone quickly and painlessly. Bodies are meant to preserve themselves. Also interesting that the AMA has statements concerning doctors' involvement in carrying out the death penalty.
I've been told by a couple of women at church that they are interested in my opinion of the maternity chapter. First, as always, the depiction of birth as a medical event was over-the-top. There were a few paragraphs about the process of birth and I skimmed those since I've got a pretty good understanding of how it works. Then the next couple of sentences are, "That's if all goes well. At almost any step, the process can go wrong...." Dun dun DUN!! And then lays on all the scary stuff really thick. And as I was reading all these "problems" I was thinking, "Breech? Breech isn't something that goes wrong. It just is..." And "Going over 24 hours with ruptured membranes isn't a problem... unless someone's doing cervical checks, and especially if they aren't washing their hands (see above)." Basically, birth is scary. Sigh. And we need evidence-based care. And some of his points have been nullified by a few recent studies (this book is 2007). I could go into more and touch on every sentence in that section, but I won't because it's also very exasperating. In the end, he's a doctor so he's going to favor a medical side and since he's not an OB, he's even more removed from the course of birth and labor than an surgery-minded OB. Grain of salt- but then I wondered how many other chapters need to be taken with salt. Hmm... I should probably re-read the book with that in mind, but I won't.
The chapter on cystic fibrosis and what they've done to prolong life expectancy for people with it was very interesting too. And the last couple of chapters on how doctors could improve. And that's when the thesis came together: we need doctors who actively working on "diligence, doing right, and ingenuity (the three sections together)." It just doesn't sound like he's putting that into practice (see hand washing above). It's getting 4 starts because the death chapter was so interesting as were a few of the other stories.
I spent the first half of the book looking for a thesis. It starts with an introduction which makes you think there's going to be some sort of thesis, but I couldn't find it in the chapters. I gave up looking for one by the end. Some thoughts on random chapters:
He goes and shows how doctors and nurses don't wash their hands enough and lots of hospital-attained infections like MRSA could be prevented if doctors just washed their hands. One of his own patients gets MRSA under his care and admits he could have been the one who gave it to him. What does he do about this? Just says that's what happens. Couldn't find any guilt or remorse or desire to change his hand-washing ways. And I was still looking for a thesis at this point and was hopelessly let down.
Interesting discussion about medical personal at the front-lines of the war in Iraq. Something you don't think about every day.
Didn't find the chapters on litigation, doctor salaries, and professional-ity engaging. Interesting in that I don't sit around thinking about those all day, so it was interesting to consider the topics, but I didn't find it very engaging.
I found the chapter on doctors who are involved with lethal injection and death sentences really fascinating, though possibly graphic and triggering depending on the reader. And it's interesting how it's so hard to simply kill someone quickly and painlessly. Bodies are meant to preserve themselves. Also interesting that the AMA has statements concerning doctors' involvement in carrying out the death penalty.
I've been told by a couple of women at church that they are interested in my opinion of the maternity chapter. First, as always, the depiction of birth as a medical event was over-the-top. There were a few paragraphs about the process of birth and I skimmed those since I've got a pretty good understanding of how it works. Then the next couple of sentences are, "That's if all goes well. At almost any step, the process can go wrong...." Dun dun DUN!! And then lays on all the scary stuff really thick. And as I was reading all these "problems" I was thinking, "Breech? Breech isn't something that goes wrong. It just is..." And "Going over 24 hours with ruptured membranes isn't a problem... unless someone's doing cervical checks, and especially if they aren't washing their hands (see above)." Basically, birth is scary. Sigh. And we need evidence-based care. And some of his points have been nullified by a few recent studies (this book is 2007). I could go into more and touch on every sentence in that section, but I won't because it's also very exasperating. In the end, he's a doctor so he's going to favor a medical side and since he's not an OB, he's even more removed from the course of birth and labor than an surgery-minded OB. Grain of salt- but then I wondered how many other chapters need to be taken with salt. Hmm... I should probably re-read the book with that in mind, but I won't.
The chapter on cystic fibrosis and what they've done to prolong life expectancy for people with it was very interesting too. And the last couple of chapters on how doctors could improve. And that's when the thesis came together: we need doctors who actively working on "diligence, doing right, and ingenuity (the three sections together)." It just doesn't sound like he's putting that into practice (see hand washing above). It's getting 4 starts because the death chapter was so interesting as were a few of the other stories.