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Dr. Davis Book Recommendation: “Better” by Atul Gawande

This week we’re doing something a little different with a book recommendation from Dr. Davis:

Everyone has flaws, everyone faces challenges beyond their control but even though we’re only human, many people still strive to get as close as they can to perfection. This struggle for perfection is most prevalent in the medical field because health care practitioners are responsible for their patient’s lives. Atul Gawande’s “Better: A Surgeon’s Notes on Performance,” is a collection of essays about closing the gap between best intentions and best execution in the medical field. Atul Gawande MD, MPH, is a globally recognized surgeon, writer, and public health researcher. He is also the C.E.O. of Haven, which is a healthcare company created by JP Morgan, Berkshire Hathaway, and Amazon.

Better is divided into 12 mini-stories and three sections; Diligence, Doing Right, and Ingenuity. The book takes us to delivery rooms in Boston, battlefield surgical tents in Iraq, a cure for polio in India, malpractice lawsuits in American courtrooms, and the origins of the Apgar score. Gawande offers a sincere look into a field where failures are both inevitable and inconceivable. He provides a unique perspective on perfection and humanity. 

An example Gawande presents is bacterial infections, a dangerous but controllable contagion. One of the primary causes of bacterial infections spreading in hospitals is health care practitioners failing to properly wash their hands. This issue is mainly because the germs can travel between patients via health-care practitioners and this can turn into life-threatening situations, especially with the rising infection rates and antibiotic-resistant bacteria. Gawande explains that this is like taking your car in for a tune-up and having the engine fall out. Health care practitioners have known the importance of washing hands to prevent spreading germs for more than 140 years, but many still don’t make it a priority. 

Gawande states, “We always hope for the easy fix. But few things in life work this way. Instead, success requires making a hundred small steps go right — one after the other, no slip-ups, no goofs, everyone pitching in. We are used to thinking of doctoring as a solitary, intellectual task. But making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands.”

Gawande gives us an inside look at his own experiences as a practicing surgeon, where he offers an account of work in a field where mistakes are both unavoidable and unthinkable. His investigation into medical professionals and how they progress from good to great provides an insightful look into what defines success. In Better, we see a collection of committed medical professionals, throwing themselves into doing their best for their patients.

An example the author gives us is the Apgar test. In the 1950s, a time when one out of every thirty babies were dying during birth, Dr. Virginia Apgar came up with a framework to rate babies’ condition responsiveness on a scale from zero to ten. No one had ever done anything like this before and it added much-needed logic and competitiveness to the field. Doctors began pushing themselves to achieve better scores and healthier babies. Gawande quotes Apgar herself as saying, “Do what is right and do it now.” 

This book outlines various medical experiences and the wisdom he gained from them. The author provides examples of how doctors and facilities that are highly specialized typically have better outcomes. The stories include the experiences of doctors and their patients. The author concludes, “Nonetheless, what I saw was: better is possible. It does not take a genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” The key theme is that medical success is influenced more by drivers instead of skills, training, and availability of medical resources like equipment and drugs. The author also stresses the importance of “fighting and ingenuity” which he defines as diligence along with mundane and motivated persistence.

“The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight. Always look for what more you could do… But our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear.”

Better focuses on how medical professionals can continue to raise their standards, how good doctors become excellent doctors when they are competent and compassionate. Compassion is essential to excellent healthcare and it’s proven that doctors who have compassion have healthier patients. 

Stephen Trzeciak, MD, MPH is an American physician-scientist who researched over 1,000 research abstracts and 250 research papers published in medical journals. According to Trzeciak, compassion matters in meaningful and measurable ways, “Studies show that warm, supportive interactions from either doctors or nurses right before going in for surgery resulted in patients being more calm (with better achievement of adequate sedation) at the start of surgery and a decrease in the need for opiate medication following surgery. Patients also spent less time in the hospital.” 

Here at Mangrove Women’s Health; we listen, we take the time and we are compassionate. We strive to provide the care that our patients deserve with diligence and persistence. 

Posted in Diagnosis, Examinations, Overall Women's Health, Resources, Surgery Tagged with: , ,

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