Better; A Surgeon’s Notes on Performance
The dictionary definition of a note is ‘a brief record, especially one written down to aid the memory’, ‘a brief informal letter’ or ‘a comment or explanation’. Going by that definition, Notes is an extremely humble, modest, deprecating sort of name for an effort like Atul Gawande’s ‘Better; A Surgeon’s Notes on Performance’. For, this book is no brief record, informal letter, comment or explanation. Rather, it is a highly accomplished work on improving performance in the medical field, the result of much thought, introspection, research, and really what makes it shine through, the result of much heart.
Dr. Gawande is the sort of superstar surgeon who makes lesser mortals feel ridiculous when they complain of the lack of time. A working surgeon and medical professor in the United States, he nevertheless makes the time to write long and incisive works on the medical field, for the New Yorker. Having read and enjoyed many of those, I pounced on Better when I chanced upon it at the Bengaluru Book Festival, and have read it since, in two quick sittings.
In the introduction, Gawande says,
Betterment is a perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are only humans ourselves. We are distractible, weak and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two. It is to live a life of responsibility. The question, then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well. (italics mine).
This is the central thought that informs the book, and makes it so enjoyable for the lay reader. For, Dr. Gawande does not focus purely on what many of us may think of as medical marvels - the new discoveries, the excitements in genetic studies, the availability of radical new theories. There is little of these. Instead, he gets down to the basics, which may be applied to hospitals in the US with their cornucopia of equipment, funding and specialized teams as well as to healthcare initiatives in the poorest parts of the world, often managed by a single doctor or surgeon working with a makeshift team. What Dr. Gawande does is to examine improved performance and success in surgery in the context of three essential elements - diligence, medical ethics and ingenuity.
He then takes of each of these elements and with the help of examples from live projects and cases around the world, illustrates how sometimes, simple solutions such as medical professionals washing their hands can make a big difference to infection rates, and at other times, how there are no easy answers at all. In the chapter The Mop-Up, on the drive to eradicate polio in India, he says,
People underestimate the importance of diligence as a virtue. No doubt this has something to do with how supremely mundane it seems… Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence.
Part of what makes Better such a good read is that, at every step, he shows us how doctors and surgeons are only human. Even in a developed country like the US, they must not only focus on their individual effort, but constantly keep in mind other things such as hospital logistics and issues with insurance providers. Above all, being human, there is always the possibility that, even if rarely, they will make mistakes. And since their work is to do with people’s lives, doctors’ mistakes are costlier than any other mistakes. Dr. Gawande addresses this issue with much honesty and clarity in the chapter What Doctors Owe.
Overall, it is this sense of I don’t have all the answers, but I’m working to find them that makes Better such a heartening read. In a general climate of cynicism, where medicine is no longer seen as such a saintly and esteemed profession, Better offers lay readers the hope that around the world, there are indeed good people working to make things better. For doctors and surgeons who may feel disheartened by the magnitude of the challenges they face, it offers no easy answers but provides reinforcement that being a positive deviant is a worthwhile thing.
Publisher: Penguin Books
Price: Rs. 250