Gawande, Atul - Better: A Surgeon's Notes on Performance

[oyceter]

As noted in the subtitle, this is a book about bettering performance in the medical sphere, though Gawande's findings can be applied to more general situations as well. He covers hand-washing compliance in hospitals, medical professionals and legal executions, the standardization of child-birth, the increasing rates of success for medical procedures in the battlefield, and many other topics.

Some feel like they're more related to the topic than others: the chapter on legal executions and doctors was fascinating, but more tangentially related to betterment. Still, Gawande is clear, accessible, uncondescending, and very thoughtful, so I didn't particularly care if he went off-topic or not. He does note his biases, particularly in the chapters on what surgeons and doctors earn and on malpractice cases, but I liked that he looks at the other side, particularly how he interviews the surgeon-turned-malpractice-lawyer.

I'm not sure how interesting or new these essays will be for people already in the medical profession. My sense of it was that Gawande's take on topics is thoughtful enough to be engaging to anyone, but given that I know nearly nothing about the medical profession, all these points of view could already be well-represented.

I enjoyed reading this a great deal, partly because I like reading about work in different industries and the specific complications and dilemmas that arise in them, and partly because Gawande is very good at presenting things in an engaging manner. While many of his insights about betterment aren't ground-breaking -- getting people to make suggestions makes for better compliance than top-down rules -- it's still a good reminder on what I want and expect from myself, particularly in terms of activism and getting my actions to match my beliefs. Several of his suggestions for betterment in the final chapter seemed particularly applicable to anti-racism and feminism, particularly "count something" and "change."

I left this book feeling like I could do better, in the sense of having something to strive toward and hope for, not in the sense of crushing lack of self esteem. Really neat book, recommended for people who like Malcolm Gladwell, and I am checking out Complications as soon as I can.

Links:
- sanguinity's review
- minnow1212's review

Comments

[buymeaclue.livejournal.com]

Oh, hurrah! I loved this and Complications both; very good stuff.

[kalmn.livejournal.com]

oooh. thanks. i just put both of his books on my wishlist.

[rachelmanija.livejournal.com]

I just loved this book. I recced it to you, right?

It was particularly interesting to me because I've seen institutions and smaller groups come apart or fail due to the the underlying principles he discusses. For instance, it is remarkable how rarely groups devoted to helping a particular population actually ask them, "What do YOU think you need, and what do you think would be the best way to make it happen?" If you've read Ann Fadiman's The Spirit Catches You and You Fall Down, that's basically a book-length case study in a failure to ask that question. (It's a tragic true story involving a little girl, so warning for being depressing.)

Also, he does a great job of explaining why you will get better results by installing a system that makes it easy and painless for people to do whatever it is you're trying to make them do (ie, wash their hands) rather than trying to either make them feel guilty or appeal to their sense of morality or both.

Complications is more specifically about medicine and less generally applicable, but is still fascinating and worth reading. Some of the issues in Better come up in that too, especially in his take on, of all things that don't sound like interesting subjects but are, anesthesia machines.

[oyceter]

Oh good! I'm really looking forward to Complications; more medical geekery!

[oyceter]

Yay!

[oyceter]

I can't remember if you recced it or not!

Also, he does a great job of explaining why you will get better results by installing a system that makes it easy and painless for people to do whatever it is you're trying to make them do (ie, wash their hands) rather than trying to either make them feel guilty or appeal to their sense of morality or both.

YES! Aka, reasons why I am interested in usability and simplifying systems.

Yay, really looking forward to Complications! I am particularly fascinated by anesthesia, and though I am sure some bits will scare me to death (reading about the C-sections here had me swearing off childbirth), I love reading about it anyway.

[cofax7]

For instance, it is remarkable how rarely groups devoted to helping a particular population actually ask them, "What do YOU think you need, and what do you think would be the best way to make it happen?"

I find this statement relevant in the context of OTW, because there's certainly a bunch of people saying, "No, this isn't what we need, stop that." Of course, it's complicated by the fact that OTW is basically a subset of the population in question...

[oyceter]

And how LJ was run by SixApart, ha. Am hoping SUP does it better.

[lady-ganesh.livejournal.com]

That's a really good point about The Spirit Catches You..., which was indeed a great and terribly depressing book.

[jinian.livejournal.com]

I liked this a lot too, but haven't read Complications yet.

[buymeaclue.livejournal.com]

Part of my interest in them was watching his concerns mature and focus from Complications to Better. Not that they weren't both good books in their own right! I'll just be intrigued to see what they look like to you, going in the other direction.

[buymeaclue.livejournal.com]

Oh, I totally lied. I read them backwards, too. Never mind!

[buymeaclue.livejournal.com]

>and though I am sure some bits will scare me to death (reading about the C-sections here had me swearing off childbirth)

Hee. All those stories in Better about people with HUGE HONKING TUMORS they didn't know about played a major role in convincing me to finally make the skin-check appointment my GP has been after me about for almost two years.

(Which reminds me that I should double-check when that appointment is. Sometime later this month, I think.)

[oyceter]

Argh! Someone got a hold of it before me at the library! Grrrr.

[jinian.livejournal.com]

That's what you get for being so popular. At least one other person in Seattle clearly puts holds on everything you write about, usually before I can get to them. :)

[oyceter]

Oh man, yes. As a kid, I used to read my mom's mass market Time-Life medical dictionary set and stories about epidemiology for fun, and I credit that with my thinking I am dying every time I cough!

[oyceter]

No way, really?

[jinian.livejournal.com]

Honest. I had to wait entire days for Tiger Eye.

[oyceter]

Wooow. Weird!

Still, excited that more people are getting into Liu!