Complications, by Atul Gawande

I have a fair amount of distrust for the medical profession. Much of this distrust is admittedly irrational; I project unpleasant personal experiences with individuals onto the entire profession which I know is unfair. The physician that operated on my wife’s brain tumor and saved her life a decade ago has my endless thanks, but the dozen of separate doctors that before the procedure kept sending her home with a migraine diagnosis have had a more profound impact on my opinions. When I came across this account of the industry written by a surgeon, I was interested to see if my views could be altered.

Gawande does a fantastic job of honestly looking at how we educate and train surgeons. There simply isn’t any way to gain experience other than doing something, and every surgeon at one point conducts his first operation. This makes sense to me, but I was a bit disturbed at how the doctors aren’t always forthcoming about this fact. While we all want to think that our doctors are the ones directly caring for us, the reality is that interns do a huge amount of the work. I agree with the conclusion that some deception here makes for a more comfortable patient, it seems unfair to be charged the same regardless of the experience of the person wielding the scalpel.

Another interesting discussion is on how mistakes are handled in medicine. Gawande looks at research into defects from many professions and concludes, “Not only do all human beings err, but they err frequently and in predictable, patterned ways.” He goes on to say malpractice lawsuits don’t reduce errors, and in fact probably contribute to them because it makes the industry less likely to admit mistakes which is a key part of reducing or eliminating them in the future. Academic hospitals are trying to counter this aversion to admitting errors in a weekly meeting called a Morbidity and Mortality Conference but this is an internal, private discussion. It seems that the profession at large could greatly benefit from sharing the results of these meetings, but with our culture’s seeming love affair with lawsuits I don’t see more public airings of mistakes happening anytime soon.

After my pleasant discovery that at least the author is frustrated at the difficulty in improving health care, a discussion about a doctor’s responsibility to steer patients to do the “right thing” renewed my original cynical view. Gawande believes that a doctor should hold his beliefs in a higher regard than the patients. “A good physician cannot simply stand aside when patients made bad or self-defeating decisions—decisions that go against their deepest goals.” This kind of arrogant thinking drives me crazy: when I talk with my doctor I want to be presented with all options and consequences, not just the one the physician believes I should choose.

It is comforting to see that at least one surgeon recognizes that there are many more things that can be done to improve quality, but the reality that virtually none of these are likely is unfortunate. Gawande does a good job of demonstrating his heart and honesty, and he made what I see as a largely arrogant profession much more personable. I thoroughly enjoyed reading this, but I still cast a largely cynical eye towards modern medical practices.

First Sentence:

The patient needed a central line.