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Book Reviews
Once in a while, you run across a book that grabs your serious attention for being topical, well written, courageous, and timely. Atul Gawande's Complications: A Surgeon's Notes on an Imperfect Science is such a book. Trained at Stanford and Harvard--with a side trip to Oxford University for a master's degree in ethics and philosophy as a Rhodes Scholar and a stint as a senior health advisor with the Clinton Administration while in medical school--Dr Gawande writes eloquently of both the fallibility and the pleasure of medicine, calling it an "enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line." Published while Dr Gawande was a senior surgical resident at Boston's Brigham and Women's Hospital, Complications consists of a series of vignettes, some of which were published previously in The New Yorker. An erudite writer, Gawande's selection of topics accompanied by scientific review and reflection is challenging, thought-provoking, and easily read in one or two sittings. In "Fallibility," one of the book's three sections (and to me the most engrossing), Gawande reports and reflects on what we as physicians are all too aware of: the need to "steal learning" from the public as we learn and relearn our trade as trainees, almost always at the expense of John Q Public. In the vignette on "When Doctors Make Mistakes," Gawande presents an eloquent treatise on medical errors (currently the topic du jour at most health care institutions) by reflecting not so much on the limitations of individuals as on the need to attend to and correct systems and processes to avoid constantly repeating mistakes. In the section on "Mystery," Gawande relates multiple instances where explanations defy both logic and science and where cultural belief in superstition may play a role. The best discussion here centers on the origins of pain (a discussion well worth visiting and eminently rereadable) and provides examples of intractable nausea and pathologic blushing. In "Uncertainty," the complexity of individuals renders medicine an "imperfect science," even in a perfect world where error is eliminated and science is rock solid. Following
in the footsteps of William Carlos Williams, Oliver Sacks, Lewis Thomas,
and many other eminent physician-writers, Atul Gawande is a rising star
to be reckoned with. Although his stories--each of which centers around
an anecdote--are followed by thorough review of the relevant scientific
literature, personal reflections, and excursions into the realms of politics,
ethics, and philosophy, Gawande remains both an unusually humble surgeon
and a lucid, likable storyteller. His first book is a refreshing attempt
at humanizing doctors and removing them from their often-unwarranted pedestal.
I suggest that you buy the book and spend a few good hours absorbing it--if
you have not already done so.
KM Tan, MD, is the Chief of Radiology, San Rafael KP, Northern California. He is a member of the Editorial Team for TPJ and has served in multiple state and national positions in CME, including the KP National CME Committee. E-mail: km.tan@kp.org.
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