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|  | Author: Atul Gawande
Publisher: Picador
List Price: $14.00
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Seller: airportplacebooks
Rating:  102 reviews
Sales Rank: 2969
Languages: English (Original Language), English (Unknown), English (Published)
Media: Paperback
Edition: 1st
Pages: 288
Number Of Items: 1
Shipping Weight (lbs): 0.6
Dimensions (in): 8.2 x 5.5 x 0.8
ISBN: 0312427654
Dewey Decimal Number: 616
EAN: 9780312427658
ASIN: 0312427654
Publication Date: January 22, 2008
Availability: Usually ships in 1-2 business days
Condition: Acceptable: book has underlining, highlighting, wear to cover or corners, notes in margins, writing inside front cover or crease to cover but is intact and does not have missing pages. Overall integrity of book is acceptable. Pages are yellowing due to age. (Airport Place Books does not ship on Saturdays and Sundays.)
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Showing reviews 91-95 of 102
 A physician & Surgeon reviewing a Surgeon's Notes May 12, 2007
Alan L. W. GUNSUL (Burien, WA USA)
3 out of 3 found this review helpful
I found the book exceedingly interested for it allowed investigation into the the doctor's philospy of medicine, that is "at first do no harm". He recognizes his limits and struggles to increase his skills in sad situations. I do wish there were more about his surgical cases tho. I highly recommend it to all medical and paramedical personnel as well to all young people thinking about careers in medicine. In my opinion anyone in medicine must have a similar philosopy to succeed. Well Done
One of the Top Books in 2007! May 7, 2007
Loyd E. Eskildson (Phoenix, AZ.)
7 out of 7 found this review helpful
Gawande opens by asking an important question: "What does it take to be good at something in which failure (the practice of medicine) is so easy, effortless?" The answer is grouped into three headings - diligence, doing right, and inquisitiveness. Gawande then uses examples to illustrate each topic.
Diligence: Hospital infection control efforts have long identified increased hand-washing as essential - yet, studies continually report alarmingly low rates of compliance. Examples demonstrate that making this easier, searching out best practices, and sustainment efforts are key to significant improvement. Polio eradication is the subject of Gawande's second example - the follow-up response to a case in India, involving vaccinating 4 of the target 4.2 million with 37,000 vaccinators in four days, and requiring effective ice, vaccine and personnel distribution, as well as follow-up. Then it's on to the U.S. Army's efforts to reduce Iraqi war death rates - data-analysis and follow-up (eg. WEAR those Kevlar vests, changes in treatment), placement of forward operating teams (operations limited to about 3 hours) backed up by four mobile hospitals (up to 3 days care) and level IV hospitals (up to 30 days care in Germany and Spain, backed up by Walter Reed - the average time from injury to the U.S. has dropped to less than four days (from 45 in Vietnam), and the death rate has dropped to 10% (24% in Vietnam).
Doing Right: Here Gawande summarizes the difficulty of health-care professionals "knowing when to quit" (do no more for a patient), the moral dilemma of assisting executions, and problems determining how much to pay physicians (paid about 7X that of the average U.S. worker, vs. 3X in the rest of the world).
Inquisitiveness: Gawande saves the best for last, beginning by citing problems in childbirth and the difficulty training new doctors in the art of forceps use (correct pressure, pulling strength, choice of forceps, placement). Then its on to cystic fibrosis. Here we learn of Dr. Berwick's efforts to improve quality (offers funds - IF recipient centers share their data and methods with others, AND discuss improvement plans with patients. Discussion with a resident afflicted with CF elicits the conclusion that better use of existing knowledge is more important at this time than more research (eg. genetics). Similarly, we learn how rural Indian doctors improvise - thus, basic tools and cleanliness are likelihood to offer greater improvement there than the latest U.S. technology.
Gawande's Recommendations for Physicians: 1)Don't complain, ask questions (include getting input from technicians, LPNs, etc.), quantify outcomes, write so others can learn, and look for opportunity to change to improved methods.
A riveting, thought-provoking search for excellence May 4, 2007
Lynn Harnett (Marathon, FL USA)
7 out of 7 found this review helpful
If, from the title, you're expecting a surgeon's personal reflections on pivotal moments in his own career, you are in for a treat. This riveting collection is a whole lot more than that.
Gawande, a surgeon, staff writer for "The New Yorker" and author of "Complications," travels the world in search of excellence and then explores how it's done. He delves into the medical and ethical dilemmas (which often walk hand-in-hand with excellence) and reflects on choices and decisions. His writing is engaging, clear and graceful, inviting the reader to participate.
He divides the book into three sections, "Diligence," "Doing Right," and "Ingenuity." Naturally the themes overlap and stimulate one another.
The subject of the opening essay, "On Washing Hands," will be familiar - and frightening - to many. Two million people acquire nasty infections while hospitalized and 90,000 die from them, according to the CDC (reading this, you will suspect it is a lot more). Gawande explores why medical professionals won't stop spreading disease, the programs designed to make them, and the one (!) ingenious, diligent program that worked. Up to publication time, anyway.
"Diligence" is also the key to the amazing survival rate of Iraq military casualties. Although news reports have outlined this phenomenon (10 percent mortality rate as opposed to 25 percent during WWII and Vietnam) most people would assume the reason is better technology. Not so. It's the innovation and diligence involved in getting people to, first, actually wear their Kevlar, and then stabilizing injuries in the field and transporting them quickly out.
Diligence - and money - is the key to the campaign to wipe out polio. But some ask whether the money wouldn't be better spent on nutrition programs, or malaria, or parasitic disease....
For "Doing Right" Gawande, explores this problem of money, the malpractice system, the unease inherent in the physical doctor/patient relationship, keeping patients alive and deciding when to let go, insurance and its effect on all of the above. He also visits doctors who have participated in prisoner executions.
"Ingenuity" visits a hospital with phenomenal success rates in cystic fibrosis patient health and finds an extremely diligent doctor, examines the Apgar score and its effect on infant mortality rates, and witnesses the incredible versatility of overwhelmed doctors in India. Each of these prompts hopeful thinking for wider improvements.
Gawande's focus is on the human component in medicine; how "positive deviance" from the norm - a willingness to change, to ask unscripted questions - can have a broader effect. Interestingly, while all the essays were equally absorbing, the grimmest were those dealing with the entrenched system - insurance, malpractice, time constraints.
In each of the others it seemed possible for individuals to stimulate improvement, as long as they engaged with colleagues and patients. Psychology plays a role in all innovation. Although a doctor in 1847 recognized physician culpability in childbirth death rates, his abrasive hectoring cost him his job. Yet 20 years later, Lister succeeded in transforming the field through persuasion and respectful explanation.
Thoughtful, enthusiastic and persuasive, Gawande deserves a wide readership among medical professionals as well as the rest of us.
 More, or Less, than Readily Meets the Eye May 2, 2007
Lee Karr (Venice, Fl. USA)
6 out of 8 found this review helpful
Dr Atul Gawande who is a surgeon, a staff writer for The New Yorker, and a 2006 MacArthur Fellow, offers his personal observations on the issue of hospital-acquired infections in the first chapter (On Washing Hands) of his book, Better: A Surgeon's Notes on Performance.
Early on he acknowledges "Our hospital's statistics show what studies everywhere else have shown --- that we doctors wash our hands one-third to one-half as often as we are supposed to . . . most of us do little more than wipe our hands on our white coats and move on --- to see the next patient . . . . " And he straightforwardly describes his own lapses in the area of combating hospital-acquired infections.
"I generally try to be as scrupulous about washing my hands when I am outside the operating room as I am inside. And I do pretty well, if I do say so myself. But then I blow it. IT HAPPENS ALMOST EVERY DAY (emphasis added). I walk into a patient's hospital room, and I'm thinking about what I have to tell him concerning his operation, or about his family, who might be standing there looking worried, or about the funny little joke a resident just told me, and I completely forget about getting a squirt of that gel on my palms, no matter how many laminated reminder signs have been hung on the walls. Sometimes I do remember, but before I can find the dispenser, the patient puts his hand out in greeting and I think it too strange not to go ahead and take it. On occasion I even think, Screw it --- I'm late, I have to get a move on, and what difference does it really make what I do this one time." --- ("Almost every day.") !!
That such lapses are not uncommon is attested to by the numbers of those who suffer these preventable infections (some 2,000,000 annually). They are reflected as well in the implications of an acknowledgement made by Dr. Pauline W. Chen, surgeon and author of Final Exam: A Surgeon's Reflections on Morality, who in reviewing Dr. Awande's book for the NYTimes wrote: "I even found myself reaching for the hand-washing alcohol gel more often." "More often."? ? How about invariably?
Being able to schedule sufficient time to honor the professional obligation of safeguarding their patients is understandably difficult for physicians functioning in the pressurized environment in which many of them choose to function. Multi-tasking, thinking about one thing while trying to accomplish another, is admittedly hard to do under those circumstances. The conditions of urgency and chaos commonly experienced in many hospital settings are conditions that many physicians have come to accept as normal. These conditions needn't be commonplace. An important outcome of modifying the conditions that generate the routine experience of urgency would be to make life less stressful for many physicians --- and to make life longer for many patients.
Further, Dr. Gawande doesn't comment about the typical lack of any practical consequences for those physicians who make these tragic errors all the time. But Dr. Gawande's book is, after all, a book about medical problems --- written by a physician. And doctors for reasons concerning which many doctors themselves may or may not be aware, are infrequently averse to cutting each other a bit of slack --- or a lot. That doctors are reluctant to criticize other doctors, I think, is not at issue. Otherwise ethically impeccable physicians ignoring or rationalizing the faults of other physicians is one of the unfortunate secrets of the medical culture that produces so many hospital-acquired infections as well as other tragic problems.
It is nevertheless very easy --- too easy perhaps --- to empathize with Drs. Gawande and Chen and the pressures that they have accepted, because they are pressures that are routinely encountered in medicine --- and have been for too long. It is easy to empathize with doctors who have to deal with too much, much of the time --- unless you first empathize with one of the literally many millions who have suffered painful, debilitating or life-threatening infections because of commonplace circumstances such as those so ably and honestly described by Dr. Gawande. It is easy to empathize with the doctors unless you empathize first with the survivors of someone who didn't make it through a demonstrably avoidable infection.
If you empathize with the victims you may understand that not washing one's hands is not simply an Oooooooops moment; it is a very serious matter (as Drs. Gawande and Chen would be among the first to acknowledge.) It is often a matter of life or death. And signs, laminated or otherwise, no matter their number, contribute little to solving this tragic and ubiquitous medical problem.
Later in the chapter, Dr. Gawande comments on an effort at solving the problem of needless infections. He notes that after two years and some encouraging results, when Peter Perreiah, an industrial engineer in charge of the project left the effort for another project, "performance on (the original) unit began to slide . . . " When that happened, "Paul O'Neill, the former Secretary of the Treasury, and CEO of the aluminum giant Alcoa, who had agreed to take over as head of the regional healthcare initiative," and who had put Perreiah in charge of the project, "quit the project in frustration. Nothing fundamental' (after two years of high-powered intervention) Dr. Gawande acknowledged, `had changed."
Dr. Gawande however concluded the chapter on a high (if tentative) note. He described how John Lloyd, a surgeon, in association with Peter Perreiah, the industrial engineer just referred to, developed a program with the Veterans Administration in Pittsburgh. Through the application of town meeting-like democratic principles, and through rewarding each small victory by recognizing it, they managed to reduce MRSÅ wound infection to zero!
"The Robert Wood Johnson Foundation and the Jewish Healthcare Foundation' wrote Dr. Gawande, `recently launched a multimillion-dollar initiative to implement this approach in ten more hospitals across the country. Lloyd cautions that is remains to be seen whether the Pittsburgh results will last. It also remains to be seen if the success can be duplicated nationally. But nothing else has worked, and this is the most fascinating idea anyone has had to solve the problem in a century." Like many physicians who are dismayed by the unnecessary deaths that occur in hospitals, Dr. Gawande seemingly quite reasonably seeks answers within the existing structure. This approach however has not yet proven fruitful, nor is it likely to, despite this most recent initiative.
This problem has for a century or more eluded efforts to solve it. Ways of resolving the issue of hospital-acquired infections requires sophisticated examination of the functional roots and origins of this problem. Traditional and current efforts have skipped this step.
Atul Gawande is a national treasure April 30, 2007
Joe Minnock (Utah)
8 out of 8 found this review helpful
What impresses me most about Atul Gawande is his ability to maintain an open mind on most issues. For instance, in this work, he examines the medical malpractice issue and rather than accepting one view or another on this controversial issue, he examines the topic from a unique angle--physicians who have themselves had to sue other physicians for malpractice. He takes the same view to a broad range of topics, from the varying success rates for cystic fibrosis treatment to physician's role in state mandated execution to treatment of wounded in Iraq. He takes each issue and approaches from a thought provoking angle.
This work also should be read as a management book because he suggests that in medicine as in any other walk of life, some acheive success using what is believed to be the same methods as others, but in reality the success is due to "positive deviation," small improvements which result in greater results.
I loved his first work, Complications, and this is certainly its equal.
Showing reviews 91-95 of 102
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