Short summary: I loved this book. I’ve read it end-to-end twice, and dipped back into specific sections a few times since. While the book is written by a surgeon, and naturally focuses on medical situations, he does so in a style that is totally readable by everyone, and on topics that I think are important to everyone, not just other surgeons. To give you an flavor of the book, here’s two quick points that really resonated with me personally.
The opening chapter gives a great description of all his non-medical preparations for a specific surgery case of a patient of his; describing all his dealing with hospital administrators, the patient, nurses, other doctors in the hours required to plan the surgery, and the unforeseen circumstances which change those plans without warning. All this is before he finally gets to do what he trained to do – pick up a knife to start cutting.
This hit a chord with me, because I find it interesting how much it also applied to other fields. Software development is often portrayed as people sitting at desks typing source code, and thats it. Much like surgery is portrayed as a solitary surgeon with a knife. Or a live concert by U2 is portrayed as the four band members who get on stage. The amount of behind-the-scenes work in each of these fields is colossal, and coordinating all those people is a seriously complex task in itself. Throughout the book he outlines work that people are doing to improving existing complex large-group processes. People who were, literally, “making things better”. I found it all very inspirational.
Later in the book, he described a logistical situation in Karnataka, India, reacting to a confirmed case of Polio. To stop this one case becoming a Polio epidemic, the World Health Organization did a vaccination program in the area. Sounds boring and routine. Aid agencies have been doing vaccination programs for years, it should routine, right?The numbers quoted from Brian Wheeler, Chief Operations Officer for WHO’s polio program, just blew my mind.
They had to vaccinate every child under 5 years of age in an area of 50,000 square miles centered around that single Polio case. Anything less then 90% coverage of the target population – the percentage needed to shut down transmission enough to stop the spread – would be a failure. To do this, they needed to hiring and train 37,000 vaccinators, 4000 health care supervisors, rent 2000 vehicles, supply 18,000+ insulated vaccine carriers, get everyone to the actual location in rural India and have the workers go door to door to vaccinate 4.2 million children.
In three days.
And they didn’t have much advance notice either – from the first confirmed report of Polio to people on the ground, starting the Polio vaccination program was only 32 days.
How do you make all that more efficient for future outbreaks? Everything from rapid escalation processes, so WHO gets involved sooner,Â to dealing with cultural/social/educations issues. And they’re still figuring it out.
Try to read a few pages; I suspect you just wont be able to put it down. Thats what happened to me with both of his books so far. His previous book “Complications” was great, and this new book was as good, or maybe even… better?
One thought on “Better: A Surgeon’s Notes on Performance by Atul Gawande”
[…] This book, like his other book “Better“, is written as a series of short stories – each chapter covering a different topic with a different patient. This made the book easy to pickup, and stopping after a chapter is a great way to mull over some of the issues raised. But I find the book hard to put down, even after all these years, and all these re-reads. Atul has quite a skill, being able to describe all the nuances of a complicated field like medicine, and medical diagnosis, in a way that is readable, understandable, and totally fascinating, to someone who knows very little about medicine. […]
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