Complications: A Surgeon's Notes on an Imperfect Science

This volume was originally published in 2002, when the author was a junior doctor undergoing surgical training in an America hospital. It was the first of a subsequent series of books that, together with giving the 2014 BBC Reith Lectures, have established him as a household name. It consists of a series of essays based on cases he worked on. They vary very widely, but all are linked by highlighting important question about the role of the doctor in medical treatment and the doctor-patient relationship, particularly in a hospital setting where decisions often have to be taken quickly against a background of imprecise information or knowledge. A perfect example of this, although extreme, is the final case he discusses of an otherwise healthy young woman who presents with an inflamed red leg. Is this a severe case of cellulitis (probability approaching 100%) or is the leg infected with the bacteria necrotizing fasciitis (probability vanishingly small, but with potentially devastating consequences)? The author honestly admits that hunches, gut feelings and other unscientific considerations inevitably play a role in decisions about what actions to take, however much he wishes that they didn't. He is just as frank about other aspects of medical practice, such as the need for surgeons to hone their technique on real patients, with the inevitable consequences that the less advantaged in society become the `guinea pigs' and some operations will not be done well. But when his own child becomes dangerously ill he honestly confesses that he does not want an operation to be done by an inexperienced junior surgeon, as would any parent wanting the best for their child. How do we resolve this dilemma? There are many other dilemmas of medical practice discussed in the book, such as: how should poorly performing surgeons be disciplined in a way that does not make the profession in general too conservative and hence hinder surgical progress; to what extent is a surgeon entitled to `steer' a patient into a course of action that they, the doctor, thinks is the right choice, even though the risks may be high; and should a doctor attempt to prolong life, even when the treatment will not prevent the inevitable outcome and may even produce more suffering? This well-written book brings home to the reader not just the technical difficulties of being a surgeon, but also the ethical responsibilities it entails and the stark problems that surgeons have to face daily. It can usefully be read by both medical students and professionals, as well as by anyone who is liable to be a patient at some time, and that means all of us.

I think that I am looking at this book from a different perspective to most of its previous other reviewers. I am a lecturer in health in particular perioperative practice. I first came across Atul in a discovery channel programme called 'When Surgical Instruments go Missing' from this point Atul's name has cropped up a number of times mainly associated with the research that underpinned the development of the World Health Organisations' Surgical Safety Check List which evidence would suggest has contributed to a reduction in adverse surgical events such as leaving a swab in a patient. This is though his first book and it sits under popular science genre, it is though well written and there are sources identified for each of the chapters, I have accessed a number of these for further reading and resources for teaching. I think the book is insightful; it gives a brief look into the life of what was then a junior surgeon, albeit one who was destined for greater things! It covers a lot of topics, which given that the book was published in the UK in 2002 are still relevant today, these topics include, 'obesity and bariatric surgery,' the 'justification of research using humans' and 'blushing' to name but a few. I have used the following quote on a number of occasions 'Medicine in, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology and physics, lay them unconscious and open their bodies to the world. We do in the abiding confidence in our know how as a profession.' Thought provoking or what? I am about to read his next book 'Better; A surgeon's notes on performance' and will report in due course! Better: A Surgeon's Notes on Performance

He is great. His dad was my doctor. This book is honest and scary at the same time. I grew up with doctors and hospitals and healthcare professional friends and family members.

Complications is a book for everyone and anyone; in theory we know many of the points Gawande raises - but in reality we don't know what it means to be a surgeon or medical practitioner. There has always been such mystique about the practice of medicine, even for those who practice it, that it's inevitable that few people know let alone understand of the doubts and responsibilities associated with this profession. And how many of us want to be operated on by a trainee? We all want the best surgeon. Yet how can the trainee student doctors ever learn to be surgeons and physicians if they are never given any responsibilities other than with those who have no money to pay for procedures? How many ssurgeons can excel at every possible type of surgery? How can they keep up with all the changes and advances in medicine and surgery? It's just not possible. Thought provoking and highly recommended.

You must read this book if you have any interest in Surgery or medicine! I have learnt so much from reading this. Atul's style manages to grip you so that you cannot put the book down. I did not realise that this is actually a collection of stories he wrote at different times and has been put together in a book. So some of the stories do not seem to follow on very well from the previous chapters. However this book has taught me to question Doctors and to ask them for second opinions. Doctors are not infallable and they do not know all the answers. A lot depends on how much time the Doctor has to diagnose you and on his/her "hunch" being right! In a way medicine becomes more of an art than a science at times! Hard to understand unless you read the book. Buy this book. You will not regret it!

Atul Gawande mostra com exemplos e com linguagem simples um mundo que é vivenciado por médicos e por vezes incompreendido pelos pacientes. Mostra ainda a arte que cerca essa ciência imperfeita que é a Medicina. Recomendo tanto para médicos quanto para pacientes.

I thoroughly enjoyed reading this book. The author takes you on a journey through just a few issues within their industry, dabbling on personal experience, hardships, and backs it up with factual research. In addition, I found the grammar to be nearly perfect, which I personally find makes for an easier read.

Un libro molto interessante da leggere se masticate l'inglese. Drammatico e comico allo stesso momento. Lo scrittore ha avuto un grandissimo successo con vari libri basati sulla sua esperienza da neurochirurgo che ho immediatamente ordinato poco dopo. A me è piaciuto molto e l'ho finito in meno di due settimane.

This book was a fascinating look into the modern doctors world. It is a job more defined by statistics than in the past, but personality and experience still play a great part. I really enjoyed reading this doctor/author's book book on Checklists and their usage in medicine so I was not disappointed with his more random thoughts on doctoring in general. Some of it is quite unsettling as in the case of surgery and interns learning. You hate to be a learning experience when your life is at stake, but how else do interns learn? Still...most doctors insist that their loved ones, are not part of this experience. Doesn't seem really fair; does it? Doctors like everyone else do better with practice, and this is well demonstrated with these specialized practices that only do Hernia operations. It also makes it possible for robots and computers to be quite effective at simple procedures. However that gives me pause. Here the blue screen of death might have greater implications than a reboot. I liked the fact where he dealt with some of his mistakes and diagnoses of patients and how there was a struggle of procedure and how to approach things. One person was nearly harmed by a minor oversight and another person was saved with a hunch. Given that both of these areas (oversights and hunches) are in the gray areas of human cognition it shows how much luck plays a factor, or a sixth sense, that doctors with experience start to develop. A quick synopsis of what this book includes: INTRODUCTION FALLABILITY *Education of a knife: How interns are trained in surgery. Odds are, you are their training. *The computer and the hernia factory: Repetition = perfection and efficiency *When doctors make mistakes: How mistakes happen. Like all of us they are human, but unlike all of us the ramifications are greater. *Nine Thousand Surgeons: Conferences provide an opportunity to compare notes and keep up to date. *When Good doctors go Bad: Peer review is necessary but whistle blowing on a colleague is rare. Not surprising there are remediation schools, but few and far between. Important note, if some doctors push you away from others...take note. MYSTERY Full Moon/Friday the 13th: Is there any truth to this. Statistically no, but the jury is still out. The pain perplex: Pain stumps most doctors as how and why it exists is not clear cut.There is no test for pain. A queasy feeling: Nausea is not one symptom, nor does it have a single cause and can be very difficult to treat. Crimson tide: Blushing, for some it undermines their confidence, but is it only cosmetic? The man who couldn't stop eating: Overeating is a life altering issue and surgery to address this is gaining ground as in the case of the morbidly obese, it works. UNCERTAINTY *Final Cut: Autopsy is not done as much any more unless there is a mystery surrounding the death. However, it helps educate doctors as to the accuracy of their diagnoses. Unfortunately to many it is a violation of the dead, who will gain nothing in return. *The dead baby mystery: Sometimes the answers are obvious *Whose body is is anyway: Doctors these days advise, not dictate and patients struggle to make the right choices. *Doctors have to let patients make bad choices despite their objections. *The case of the red leg: Gut feeling are sometimes all you have and often they are dead on. In the absence of this all that is left is statistics. SUMMARY This book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea. Others associated with medical errors, bad doctors, cases that were swayed by errors and hunches. If you have any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific.

It is so refreshing to read what a doctor really thinks, with honesty about the mistakes they might make (as any of us can in our own professional lives) rather than the old model where the doctor always knew best, even when they made a mistake. It made me want to have a different relationship with my health professionals, to acknowledge that they are human, and have them also acknowledge, as any of us should, that they might not have all of the answers. Gawande writes, as he speaks (I discovered him giving the BBC Reith lectures in 2014) in such an open, easy, and eloquent way: I just enjoyed every story, and his humanity shining through. His compassion is life affirming. And his respect for his parents' experiences in India, and in the US just shine through the pages. He puts all health professionals in their appropriate places: as card carrying ordinary human beings, and I'm recommending reading him to all the health professionals I've had to deal with lately!