It documents messy tracheotomies, a stomach-stapling operation on an obese man and a surgical procedure to help a woman who cannot stop blushing. One of the most striking features of Complications is the unsparing detail about what happens in the operating theatre. The book is also about split second decisions that could mean life or death and the limits - often unsuspected by the patient - of both doctors and medical science. Human skin, he discovers, is thick and springy and he has to make two attempts to get through. What are the psychological effects of cutting open the unconscious bodies of patients you have talked to and in some cases come to like? Although Gawande has a philosophical turn of mind - he studied PPE as a Rhodes Scholar at Oxford before training as a surgeon at Harvard - these are not questions he chooses to pursue.
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I have the book in front of me at the moment and I am paging through rereading sections that I noted along the way: "I had come into residency to learn how to be a surgeon. I had thought that meant simply learning the repertoire of move and techniques involved in doing an operation or making a diagnosis. In fact, there was also the new and delicate matter of talking patients through their decisions - something that sometimes entailed its own repertoire of moves and techniques.
However, given the audience of this book everyone he does well to treat people about how uncertain medicine really is and how it really comes down to the tricky nature of making decisions and how they should be made in the medical setting: "But the conundrum remains: if both doctors and patients are fallible, who should decide? We want a rule. But such hard and fast rule seems ill-suited both to a caring relationships between docotr and patient and to the reality of medical care, where a hunderred decisions have to be made quickly The doctor should not make all of these decisions, and neither should the patient.
Something must be worked out between then, one on one - a personal modus operandi. Where many ethicits go wrong is in promoting patient autonomy as a kind of ultimate value in medicine rather than recognizing it as one value among others The best part of the book is the last two paragraphs and is all you really need to read have said that you have read the book, in my opinion. In the actual situations that present themselves, however, [ Even less clear is whether the actions we choose will prove either wise or helpful.
That our efforts succeed at all is still sometimes a chock to me. But they do. Not always, but often enough. There is so much talk about the fallibility and humanity in medicine right now However, as is apparent in this book, the medical community is only at the stage of recognizing this fallibility. In all his articles, he seems to be advocating a technocratic answer using checklists etc. The biggest problem I have with the book is the way Gawande seems to view the profession medical community of independently-acting people, who, in the aggregate, are not too of an impressive lot.
In this, Gawande is entirely old-school. He fails to recognize the possibility of alternative ways to approach patient care. In a way, I think that he is dangerously anecdotal.
He treats them like data points. However, I believe there to be value within this book. It will serve to empower people and get them involved in their care and think about how they want it to go down. But, to me, I really did expect a lot more from this guy. The reviews that it got are ridiculous, they are way over the top! It is pretty incredible- it goes to show how easy it is to be heard once you have written for the New Yorker and got a MD from Havard.
I will keep reading his books, though, for no other reason than that he is so hot right now, millions are reading him. I at least have to know other people are thinking about.
I gaped. It was the idea that a mere person would ever have the confidence to wield that scalpel. I wondered how the surgeon knew that all the steps would go as planned, that bleeding would be controlled and organs would not be injured. Later, I was allowed to make an incision myself. It was, I remember, still warm. I put the blade to the skin and cut.
A surgeon opens his heart (well, almost)
The student, who had never operated before, was observing an abdominal procedure when it came time to make the first incision. It was a lot tougher and springier than I thought it would be, so I had to cut twice. He asks: How much input should a patient have? How can young doctors gain hands-on experience without endangering lives? And how responsible are these doctors for their mistakes? The son of two physicians, Gawande attended Oxford on a Rhodes scholarship, then worked in a research laboratory and as an adviser to the Clinton administration on health policy before earning his M. Soon after, Slate editor Jacob Weisberg, a friend, approached him about writing a column on being a doctor.
Complications: A Surgeon's Notes on an Imperfect Science
Cancel anytime. People who bought this also bought His stories of diligence and ingenuity take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. Longer training, ever more advanced technologies - neither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist.