Book Review "Better: A Surgeon's Notes on Performance" by Atul Gawande

Better A Surgeon's Notes on Performance by Doctor Atul Gawande is an absolutely fascinating book on almost every level. This is Gawande's second book, his first was Complications which was written during his residency. Better takes place after he takes a position as a general surgeon at a Boston hospital. Gawande has a way with words. They are infused with knowledge, insight and humility. Additionally he covers an incredibly broad range of experience within two-hundred and fifty seven pages. The book starts off with the importance of washing one's hands and how most doctors do not do this on a regular basis but that if they did the number of cases of infections in hospitals would drop dramatically.

He then moves on to his experience working with the World Health Organization ("WHO") to eradicate polio just like small pox was eradicated decades ago. Gawande goes along with a mop-op in India where the goal is to get all children under the age of five vaccinated in a three day period. This is done with extremely limited resources a host of volunteers and in all reality no real power. WHO organizes the mop op but they have no real control over any of the players and yet they achieved a success rate of over 90% and were able to contain the spread of the disease. If WHO keeps doing this the reality is that it is 100% possible that polio will be eradicated within our lifetime.

The next section of the book deals with what surgeons are currently doing on the battlefields in Iraq and Afghanistan and how these decisions have lowed death rates to less then ten percent even in injuries that should be life threatening including loss of limbs and traumatic brain injuries coupled with bomb blast injuries. Gawande explains how looking at the injuries that small changes have had big impacts two of the changes that have been made is mandated that all service personnel wear their Kevlar vests. This is no longer an option it is a requirement and the Generals are mandating this and holding their commanders accountable. Another change was in the look of eye protection. Services members did not want to wear that old glasses because they looked like they belonged on seniors in Florida. The Army gave into the sense of fashion and redesigned the eye wear. It is being worn and eye and facial injuries have dropped drastically.

Gawande also covers the treatment and follow up of cystic fibrosis - 20 years ago the average life span was just over eighteen today many many patients are living into their fifties with some having life spans of sixty years. All by opening up the process and focusing on working with the patients and not being stuck abiding my standards.

As you read the book you will also learn about HMOS, medical care in third world countries with a focus on a shift in treatments in India and other countries. Gawande also touches on medical malpractice, doctors working in prisons and examining and treating prisoners on death row including participating in executions. You will also get brief insights into stand labor and delivery practice and at the end be challenged to be the best you can in whatever field you practice and also live.

I cannot recommend this book highly enough. It should be read by anyone who wants to be better and/or great at their job and their lives.

Peace