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This book wss filled with about 25 anecdotes flimsily tied together by Gawande s less than inspiring reflections 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 pg 217Next to this paragraph I had written NO SHIT The book is full of these minor, pseudo epiphianic moments that come off as weak aphorisms 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 And so we ve decided that the patients should be the ultimate arbiter 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 A s the field grows evercomplex and technological, the real task isn t to banish paternalism the real task is to preserve kindness pg 223 4This simply makes sense, nothing new here.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 The possibilities and probabilities are all we have to work on within medicineWhat we are drawn to in this imperfect science, what we in fact covet in our way, is the alterable moment the fragile but crystalline opportunity for one s know how, ability, or just gut instinct to change the course of another s life for the better In the actual situations that present themselves, however, we can never be sure whether we have such a moment or not 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 pg 251 2In a way, the whole thesis of this book which I think is summed up in the sentence in bold above is pretty remarkable There is so much talk about the fallibility and humanity in medicine right now fallibility is so hot right now However, as is apparent in this book, the medical community is only at the stage of recognizing this fallibility Gawande doesn t do what I thought he would suggest what we should do given the increase visibility of the fallibility of the practice of medicine He really doesn t have any good ideas 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 Maybe it is just me being tired of reading anecdotal medical non fiction, but it just seems like a lame format don t hold these words against me because I really don t know what I am looking for, or what type of book I would write He treats them like data points I believe that the book could be reduced by about 80% for someone like you or I who are as far in the medical field as we are However, I believe there to be value within this book I am really really happy that millions of people future patients are reading books like this and Groopman s How doctor s think as it really does educate them to get real about what medical care is all about 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 lotfrom 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. (((FREE DOWNLOAD))) ↠ Complications: A Surgeon's Notes on an Imperfect Science ⇺ In Gripping Accounts Of True Cases, Surgeon Atul Gawande Explores The Power And The Limits Of Medicine, Offering An Unflinching View From The Scalpel S Edge Complications Lays Bare A Science Not In Its Idealized Form But As It Actually Is Uncertain, Perplexing, And Profoundly Human Complications Is ANational Book Award Finalist For Nonfiction Complications is a book of anecdotes about a surgical resident s experiences and impressions of the current health care environment Gawande divides his stories into three sections fallibility, mystery, and uncertainty The fallibility section demonstrates that doctors can make mistakes Some fallibility arises from there being a learning curve For example, it is hard to do a central line correctly the first time But for a doctor to learn how to do a central line, he must have a first patient to try it on The concern then arises as to which patients receive care from the inexperienced versus the experienced Yet fallibility occurs in even the most experienced doctors Gawande reports on one doctor who became so careless that he was no longer allowed to practice The frightening part of that story is how long his colleagues let him continue when they had concerns The Doctor also brings up this issue It is understandable that doctors are reluctant to come down too hard on their colleagues They need each other as a support system and thus need to maintain trusting relationships Further, medicine is uncertain, and it can take a long time to see a pattern of truly irresponsible behavior as opposed to just havingcomplicated cases Gawande makes the point that discipline of doctors works best when it done by a group outside the doctors peer group or employer because it isobjective Then this outside group can propose a plan of action which the employer can implement Unfortunately, this model has been too expensive to be much of a viable option The mystery section details stories of conditions that cannot be explained by current medical science, like blushing, pain, and nausea In each of these cases, the doctors could not explain why the patient had the condition Much of the time, the patient just wanted the doctors to believe them even though there did not seem to be a physiological source of the problem It is interesting that the patient iswilling to accept that there is no medical explanation than the doctors Yet the doctors are the ones with the training and have probably seen manycircumstances when they cannot make a diagnosis The uncertainty section deals with how to make the right diagnosis or judgment There are several points in this section that have come up in the other literature reviewed for this independent study First is the declining use of the autopsy The autopsy is how doctors can determine what was actually wrong with the patient It is the final way to get rid of uncertainty Its purpose is to help the doctors recognize such conditions in the future Yet autopsies are done less and less Although many times the family is opposed to the autopsy and will not allow it Another recurring point is the decision making power of the patient Patients have becomepro active in their desire for decision making ability, but they are muchambivalent about actually exercising it Especially in situations where there is uncertainty, patients do not feel comfortable or emotionally able to make the decision Some do not think they can handle the responsibility if it turns out to be the wrong decision Gawande notes that doctors also prefer to make the decision One of the things he had to learn as a resident is how to persuade patients to the decision he thinks is best As health care becomesconsumer driven, the debate over the level of physician agency is likely to continue. I finished this book about a week ago and the next day my mom fell and f % broke her hip So, this is NOT the type of book to read or even think about when you have someone in the hospital.Most doctors, especially surgeons, are viewed as infallible but in reality they are just like us They have bad days, they make mistakes and some of them should really change careers.The author writes eloquently, with compassion and a clear love for surgery, which made this a fascinating book to delve into Most of the stories felt anecdotal rather than a deep dive into the details which for a layman like me was perfect.The author also poses a lot of ethical questions about the profession and how much patient autonomy should be allowed when making health decisions.If you have any interest in medical memoirs you should try this author at least once. Although I am interested in the medical profession, motivation to learnabout it often elludes me Gawande was able to keep my attention and present points that I could understand in spite of my limited medical knowledge.Admittedly, some of his information scared me After reading some points about surgery, I wondered how I ever allowed anyone to cut into me and place a plate and seven screws in my leg Also, some of his writing made me squeemish I had to pause or skip places that became too graphic for my weak stomach Some of his writing discouraged me Why am I trying to lose weight if no one is able to succesfully lose weight and keep it off unless they are dangerous and intensive surgery I also felt discouraged over the problems he presented that really have no attainable answers.In spite of my difficulty with his unanswerable questions, I appreciated Gawande s straightforward honesty about the medical profession and its weakness Ironically, his admission of the fallibility of doctors and medicine, makes mewilling to approach a doctor It makes it easier for me to ask questions if I don t expect the doctor to have all the right answers especially if that doctor is willing to admit such a possibility. Not quite a 4 star read, but close enough It s fairly short does make his major points fairly well They boil down to medicine isn t perfect.Doctors are humans, so need to learn will make mistakes, even with the best intentions Do I want a doctor to learn on me or mine Hell no Gawande admits that he doesn t either he makes sure they don t, BUT we won t get any new ones if they don t start somewhere So what s the solution There isn t a good one Deal with it.Patients are humans, so they re complicated They do things that are bad for them all demand the highest level of care Since the mid 80 s, they ve been gettingsay in what their treatment is often they re not well equipped to do so either due to ignorance or just feeling like crap Balance between what the doctor recommends what the patient wants is tough.Medicine has come a LONG way in a short time, but they still don t know a lot As it becomescomplicated, it s tougher for doctors to stay on top of even their specialty Unspoken, but obvious in the subtext, is that it takespeople to do the job a lot depends on every one thing s availability doing their job properly Facilities are often stretched.Overall, it was an interesting tour inside the field from a young surgeon s point of view I think this was his first book it suffered a bit from that It s also a bit dated in some respects having been written 15 years ago or so Still, it s well worth reading. Read these sentences and tell me that this writer isn t an unbearable idiotIf choice of one s surgeon cannot go to everyone, maybe it is better when it is not allowed at all Taking time to bond with patients is fine, but every X ray must be tracked down and every drug dose must be exactly right Hospital lawyers warn doctors that, although they must, of course, tell patients about injuries that occur, they are never to intimate that they were at fault, lest the confession wind up in court as damning evidence in a black and white morality tale This was not guilt guilt is what you feel when you have done something wrong What I felt was shame I was what was wrong And yet I also knew that a surgeon can take such feelings too far One surgeon with a national reputation told me about an abdominal operation in which he had lost control of bleeding while he was removing what turned out to be a benign tumor and the patient had died The case affected his performance for months In its way, the MM is an impressively sophisticated and human institution Unlike the courts or the media, it recognizes that human error is generally not something that can be deterred by punishment So sophisticated that it doesn t include compensation for negligently injured patients Or consequences for negligent doctors besides shame in the conference roomThere are all sorts of reasons that it would be wrong to take my license away or to take me to court Those reasons do not absolve me Whatever the limits of the MM, its fierce ethic of personal responsibility for errors is a formidable virtue Personal responsibility so long as it s a fifteen minute shaming directed at your mentor And note that he doesn t discuss why it would be wrong to take his license away wow, what a great look at the complexities of the situation rmeBut the problem of bad doctors isn t the problem of frightening aberrations like James Burt, a notorious Ohio gynecologist who subjected hundreds of women, often they had been anesthetized for other procedures, to a bizarre, disfiguring operation involving clitoral circumcision and vaginal reshaping which he called the Surgery of Love It is the problem of what you might call everyday bad doctors the illustrious cardiologist who has slowly gone senile and won t retire Ahahaha, trying to treat James Burt as an isolated freak when other doctors knew what he was doing, said nothing and later refused to testify against him Years wherein they said and did nothing about this man who was not licensed as a surgeon and was bragging about mutilating women while they were unconscious James Burt is an illustration of the extent to which the medical community are willing to look the other way If doctors will ignore the James Burts of the world, then how can we expect them to turn in the hypothetical illustrious but senile cardiologist It is the same problem Nice try though, GawandeWas money part of the problem Gawande tries to portray a surgeon who admits to booking farpatients than he could handle and rushing through their care in order to makeandmoney despite making 400k as a poor little rich boy Sorry, no The question is, was greed part of the problem and the answer is yesThere are both honorable and dishonorable reasons for doctors finding themselves unable to do anything decisive about bad doctors The honorable reason, and probably the main reason, is that no one really has the heart for it When a skilled, decent, ordinarily conscientious colleague, whom you ve known and worked with for years, starts popping Percodans, or becomes preoccupied with personal problems, and neglects the proper care of patients, you want to help, not destroy the doctor s career I love that his first concern isn t the patients or even the doctor, but the doctor s career I also love that the example bad doctor he discusses didn t end up getting the sack for ruining a 28 year old woman s life but because he didn t go to MM conferences Injure all the patients you like, but don t you dare thumb your nose at our rituals wherein we discuss these injuries And then he cries about how this poor disgraced doctor only succeeded in getting malpractice insurance after a year Oh gosh, a whole year How terrible for himPeople actually prefer the world of don t ask, don t tell Just ask yourself, could you abide by a system that rehabilitated drug addicted anesthesiologists, cardiac surgeons with manic psychosis, or a pediatrician with a thing for little girls if it meant catchingof them one of these things is not like the others and that isn t your only option and rn, there are plenty of doctors who have been disciplined for egregiously terrible stuff and should never be allowed to practice again and yet somehow, are so what would be the differenceCould it have been a mistaken, then, even to have told him about the surgical option People are rightly suspicious of those claiming to know better than they do what s best for them But a good physician cannot simply stand aside when patients make bad or self defeating decisions decisions that go against their deepest goals goes into an anecdote about how a doctor convinced a woman to start her physical therapy and it was all for the best Yeah, because not giving a patient the full range of their surgical options is the same as encouraging a patient to do rehabilitative therapy Definitely Has this man done zero law in the zillion years it must have taken him to get a MPH and become a surgeon Ok, I ve parsed enough I will say that his musings on patient autonomy are truly disgusting though he thinks we should replace the autonomy principle with a concept of kindness because paternalism is not the enemy, what the everlasting fuck and show that he doesn t understand the concept of patient autonomy or the emergency exception doctrine I only know about it through canadian law but I m sure Americans must have the same thing.This was probably the most hateful thing I ve read in years Wow. 4.5 starsI had a great time reading this with Heidi from My Reading Life The book is broken up into three sections named for ideas that vex doctors Fallibility, Mystery, and Uncertainty He looks at the way surgeons are educated, advancements in medicine, hard to pin down diagnoses, andwith a liberal sprinkling of fascinating cases.The pacing is perfect, there are edge of your seat moments to see if a patient makes it, and he brings up ethical issues that appear in his later books, such as medical error and treatment decisions at the end of life Those in the know will recognize that medicine has changed over the years since publication, but even so it holds up incredibly well.I kinda wish I hadto say but it s one of those books that s so good you don t need to say all that much in the first place If you have any little interest in medical nonfiction you ll want to pick up Complications, as well as Gawande s other books, post haste. Practice is funny that way For days and days, you make out only the fragments of what to do And then one day you ve got the thing whole Conscious learning becomes unconscious knowledge, and you cannot say precisely howI have always been intrigued by medicine I know it s a scary thought, but inevitably, illness will impact each of us in one way or another Either we will get sick or somebody we love will get sick Which is why learning about medicine and healthcare is so important However, a lot of books about medicine and healthcare can be pretty dry, which is where Dr Gawande comes to the rescue His clear prose makes even the most difficult medical concepts easy to understand In this book, Gawande is just starting out his medical career Like most new graduates, Gawande is excited yet nervous about the new challenges that await him in the workplace But he soon realizes that medical school only teaches you a tiny smudge of what being a doctor is actually about Medicine is so muchthan just a science it is a messy and imperfect art A lot of what doctors do is intuitive they piece together symptoms to formulate a treatment plan However, uncertainty feels grander in medicine because human lives are at risk And as a doctor, you not only need book smarts, but the ability to navigate unforeseen challenges with integrity and fortitude A lot of this book comprises of fascinating case studies a victim who was shot in the buttock leaves the hospital virtually unharmed, a pregnant woman with nausea so debilitating that she has to leave work, a neurosurgeon who copes with severe blushing, and a young woman whose inconspicuous leg pain turns out to be a deadly infection If you like suspense, then this book is for you The sayingeverything can change in an instantis ever so applicable to medicine Although I enjoyed this book, I thought it was a bit dull at times I think it could have been improved if it contained a tad bit of humor But overall, I did enjoy it I would recommendComplicationsto medical professionals or anybody who is interested in learning about the healthcare field. Atul Gawande writes for The New Yorker, and I always read his articles as soon as I spot the by line I read Better last year and think it is even, yes, better But both books have rare qualities Gawande is a physician who can step back from his ego and write with compassion and insight about the relationship between vulnerable sick people and those whose skill and judgment they are compelled to trust.