Complications: A Surgeon's Notes on an Imperfect Science [Kindle Edition]

What I particularly like about the book is that it goes beyond giving a slightly morbid peek into the medical world, and really involves you by raising all sorts of dilemmas and social issues that affect us all.

Do I want a novice surgeon operating on my child - certainly not. Do I want expert surgeons to be around when my daughter grows up - certainly do! So, who do I want them to learn on - someone elses child, the elderly or homeless??

What about medical negligence issues - if we keep punishing doctors for errors, how does that affect the treatments they're prepared to carry out or indeed the careers they're prepared to follow? Trial and error is an unavoidable part of developing new techniques. So if we want to reduce the number of errors, we have to be prepared to reduce ther level of progress in medecine. Where does that leave us when we're in dire need and only ground-breaking techniques can help?

This is a fascinating and sometimes disturbing book that should be compulsory reading for society as a whole, not just the medically curious.

"Complications", by Dr. Atul Gawande is a very gutsy and honest discussion about medicine in general, and surgeons in particular. The book is also unique, for unlike others of its type it is written by a surgeon that is starting his career, and not looking back upon it. I would imagine that the book caused some consternation amongst his peers. The book does nothing to minimize the skills and accomplishments of the men and women who can reach in to the body and do some pretty spectacular work. The book does portray them as human beings that come with all the normal traits that any of us do. The pressure they must deal with is that when they make a mistake, it can irreparably harm or cause the death of the patient they are trying to help.

The vast majority of careers that people practice do not involve decisions that can cause the outcomes I mention above. And few occupations require of their practitioners near perfection, that if not delivered has a major legal industry prepared to hammer them with lawsuits. Incompetent or negligent doctors should be punished and removed from practice, but what about a human error, or a doctor that makes every single decision that is correct and appropriate for the patient he or she sees, and misses the 1 in 250,000 cases where doing everything correctly can cause a patient to die. The final chapter of this book deals with exactly those type of odds. Whether those odds are beaten often depends on the instincts of the physician. And these intuitive feelings they may or may not act upon are certainly helped by experience, but younger doctors without the years that familiarity brings can often make a decision largely because they are so new. Dr. Gawande makes clear that all the sophisticated technology available does not replace the one on one interaction with the patient.

If we ever need a surgeon we want a person we perceive as experienced, a person we are literally willing to risk our health and our lives with. The problem is that virtually no one wants to be part of a new surgeon learning his craft even with very experienced surgeons standing right at the table, watching and even directing the path the surgery takes. Dr. Gawande also shares his feelings when his children are ill and the contradictions he deals with as a parent, even as he is often on the other side with people judging him and his youth.

The statistics say that a surgeon will make a given mistake once every 200 times he or she performs a surgery that is described in the book, and that is also fairly common. If the mistake is made the results range from terrible to potentially terminal. The author does a great job of sharing what it feels like to be told that you will make the mistake, that doing the task 99.5% of the time without error can still cost a life.

A person who decides to become a general surgeon will study and practice until their mid 30's before they are able to operate on their own. That type of commitment is rare, and recent articles have said that less men and women are willing to devote that much of their lives before beginning their chosen career.

We want these people to be perfect when it is either we, or someone we care about that is to be operated on. They are not perfect, although those that are excellent can statistically come very near perfection. I would trust Dr. Gawande for he is a man that is clearly skilled, but is also acutely aware of how fine a line he walks every moment of his day.

Dr Gawande has produced in 'Complications' an intriguing and absorbing text. This exploration of medicine reveals to the reader a world of scientific guesswork and intuition, all going on behind the facade of clear-cut clinical practice. As a surgical Resident, Dr Gawande provides the Physicians view - the control that people are willing to give to the doctor, allowing them to inject them with chemicals, perform procedures that could cause more harm if done incorrectly, and in the extreme to assume control of their vital functions. He also as a father conveys the mixed emotions elicited by surrendering ones children to those most capable of saving them.
However, 'complications' goes beyond this, with discussion of the motivation of the medical profession, its attitudes towards conditions that cannot be treated, and the 'gut feelings' rather than hard evidence underlying many diagnoses. Similarly, the attitudes towards medical teaching (wherein doctors learn by doing) are considered from the viewpoints of both doctor and patient, along with how and why doctors make mistakes.
This book must be recommended to anyone with even a slight interest in medicine, particularly those considering entering the medical profession.