Book Review - "The Modern Realities of Health Care"

By Eva Bosco
May 8, 2010

Gawande, Atul. Complications: A Surgeonís Notes on an Imperfect Science. New York: Henry Holt and Company, 2002. 269 pp., paper, $24.00. ISBN 0-312-42170-2

This book is well-written and passionately effective in its detailing the modern realities of halth care from all sides of the aisle. The chioces that we all make, doctor, insurers (in his online essays), patients, family members are reviewed in an anecdotal way that's clea, concise, and well structured.

Complications undertakes the challenge of examining the imperfection of doctors, the uncertainties of medicine and other unknowns in human situations with enough emotion, and offers unusual incidents to keep the reader involved. Dr Gawande comes across as the kind of person I wouldn't expect enjoys working with more typical colleagues. In dramatic and revealing stories of patients and doctors, Gawande explores how deadly mistakes occur and why good doctors can go bad too.

Dr Gawande begins by showing how imperfect a science medicine must be. The book begins with a tour through an ethical minefield as Gawande considers why mistakes happen in medicine and how we should balance the quest for the best possible care with the need to train the next generation of doctors. He also showed us what happens when the medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea taht won't go away and is starving her to death during her pregnancy; a television newscaster whose blushing is so sever she can't do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes in caring for human lives.

Gawande challenges our tidy visions of what medicine is about: we imagine good versus incompetent doctors, right or wrong decisions. He presents carefully considered way of reducing errors and improving care. His arguments and illustrations are touching vignettes from the fallen super-doctor who endangers patients. One of the most striking features of the book is the unsparing detail of what happens during operations. The book shows the difficulties of split second acts and decisions and the limits -- often not suspected by patients -- of medical science. We learn of the surgeon who left a large metal instrument in a patient's abdomen where it tore through the bowl and the bladde wall, the doctor who bipsied the wrong section of a woman's reast, delays in diagnoses, wrong diagnoses, Many mistakes are solved or by surprisingly low tech solutions, such as markig the patient's leg with a strip to ensure that the correct limb is operated on. Others take a law to insist that machines delivering anesthesia are made to a certain universal standard.

I found this book nonetheless to be affirming both for physicians and patients. Doctors should not be placed on pedestals or demonized. There are real problems in the way health care is delivered in this country, but Gawande affirms the norm is doctors doing their best. Gawande's Complications should be essential reading for anyone involved in medicine. He is making the professional look at the profession openly, candidly; for patients we see doctors are people too. His prose style is engaging, shifting from painful stories of suffering patients (including his own children) to explanations and history of techniques to suggestions for improving an area of medical care. Some of his ideas may make health care providers angry or nervous, but his disarming style, confessional mode and thoughtful arguments should win over ethical people.


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