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38 of 40 people found the following review helpful
4.0 out of 5 stars Thought-provoking and rivetting
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...
Published on 29 Jun. 2004 by James Bury

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2.0 out of 5 stars Not exactly what I expected
An interesting start to the book, not a bad middle then..... not what I expected. That's all I can say about it, it went nowhere
Published 18 days ago by Kindle Customer


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38 of 40 people found the following review helpful
4.0 out of 5 stars Thought-provoking and rivetting, 29 Jun. 2004
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James Bury (Gloucestershire, UK) - See all my reviews
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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.
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14 of 15 people found the following review helpful
4.0 out of 5 stars Detailed, honest, and fascinating, 10 May 2004
By 
Michael Canty (Oxford, UK) - See all my reviews
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This is a superb book. Gawande describes the trials, tribulations, and rewards of his surgical residency beautifully, with a collection of essays, comprising anecdote and musing, on various aspects of medicine. Yet despite the fragmented nature of the structure, the book flows well and gels nicely into a whole. Particularly fascinating are his thoughts on the intractability of pain, what makes a good doctor go "bad", and the perceived invulnerability of modern medicine, which he strips away with the same skill you can imagine him stripping away layers of tissue. Never failing to surprise, educate, and emote, this is a marvellous read, definitely in the "un-putdownable" category. The only reason it doesn't receive a fifth star from me is that it isn't in my top ten greatest books ever - but that is a personal quirk, nothing more. Highly, highly recommended.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Daily dilemmas of a junior surgeon, 18 Dec. 2014
By 
Brian R. Martin (London, UK) - See all my reviews
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This review is from: Complications: A Surgeon's Notes on an Imperfect Science (Paperback)
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.
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2 of 2 people found the following review helpful
5.0 out of 5 stars Complications, 11 Sept. 2013
By 
Damaskcat (UK) - See all my reviews
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This fascinating book provides insights into the world of medicine. It is about the author's triumphs and failures and about his mistakes and his almost miraculous intuitions. I enjoy his writing style and he must be an interesting person to know in real life. There are strange and puzzling cases and even more strange and puzzling people - both as patients and in the medical profession. The author talks about marvellous recoveries and tragedies and about cases where medicine intervenes too much rather than letting the human body work things out for itself.

I think the one thing which comes over to me from all the medical books I read is that however much medical science advances there is just so much about the human body which remains undiscovered. Doctors are never going to get it right all the time however well trained they are and however much experience they have. I was interested to see how much of an inexact science diagnosis is and the autopsy figures quoted by the author show that the cause of death may turn out to be incorrect as many as a third of cases. The figures haven't changed in the US since the 1930s in spite of the huge increase in modern technology and ways of seeing inside the human body.

It is all too easy to assume that modern medicine has all the answers and this book will swiftly disabuse the reader of this idea. I found the chapter about patients being given all the risks and options fascinating. Do we want doctors to make decisions for us or do we want to be given enough information to make our own decisions? What should a doctor do if he/she believes a patient is making the wrong decision? This author's books are a must read for anyone who has had any dealing with modern medicine if only because it helps to remind us all that doctors are people too
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4 of 4 people found the following review helpful
5.0 out of 5 stars All doctors and most patients should read this, 8 Jan. 2010
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This review is from: Complications: A Surgeon's Notes on an Imperfect Science (Paperback)
This should be mandatory reading for all doctors, medical students and much of the health service-using public too. Atul Gawande has great clarity of thought and this very readable book crystallises many of the problems of providing and receiving health care. It is also a very enjoyable read---his humility and his clear fascination for his subject make this so enjoyable as well as informative.
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10 of 11 people found the following review helpful
5.0 out of 5 stars Absolutely superb, 19 Sept. 2007
By 
Rob Sawyer (Hampshire UK) - See all my reviews
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I have worked in medical devices (implants for orthopaedics (hips and kness) and general surgery (bums and tums)) for over 20 years so know a little about surgery, and saw this book on a browsing trip on Amazon, and impulsively thought I might enjoy it.

If you have the remotest interest in surgery then you must read it. It's written in a very readable style (slight irritation of US spellings!!) and with the use of case studies, I found it almost un-put-downable!

I think Gawande leaves the best till last (I won't spoil it for you) and this case was particularly relevant as one of the products I have worked with has been used successfully in a similar case.

I learned a lot about surgery, medicine, surgeons and the difficulties that exist that I suspect most of us wouldn't consider.

An excellent thought provoking book - loved it!
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8 of 9 people found the following review helpful
5.0 out of 5 stars A thoroughly recommended, fascinating book, 19 Jan. 2003
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.
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1 of 1 people found the following review helpful
4.0 out of 5 stars Human Complications, 31 July 2011
This review is from: Complications: A Surgeon's Notes on an Imperfect Science (Paperback)
Gawande is basically a machine. One of those perfect being that I find hard to relate with. Surgeon, researcher, writer. Excellent at everything. I admire him, but we don't have anything in common, the excellence factor especially. But Gawande is a smart fellow outside of the OR too. He knows he isn't a random person and that people will obviously look at him with some degree of suspicion. So he does a good job at portraying himself as a common anyone featuring details of his internship period. Whether true or not, all those little struggles that get mentioned make you like him a bit more. Almost to the point that would make you think `we kind of are similar in a way'. Wrong, and yet, that's ok.

The first essay is the most engaging and personal, with anecdotes from the life of an intern--reading about being afraid and all the tries before you finally are successful at making a central line might be one of my favorite passages--but also the appearance of Gawande as a father dealing with the sickness of one of his kids made the opening essay something special. None of the other essays has the same intensity, particularly those in the middle section of the collection are weak. An entire essay that indirectly implies that there may be some curse going on on Friday the 13th? No Atul! You can do better than that. The final section deals with the most unexpected and intriguing cases and those make an enjoyable reading.
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13 of 15 people found the following review helpful
5.0 out of 5 stars Confident With Him as My Surgeon, 26 Feb. 2003
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taking a rest - See all my reviews
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"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.
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2 of 2 people found the following review helpful
4.0 out of 5 stars thought provoking and an honest account of a resident's training years, 17 July 2014
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Being a surgical trainee myself, I found Atul's experience both helpful and insightful into the everyday life of a resident's decision-making challenges.

At times I found the narrative too detailed when providing an argument to his point. I would not fuss about it though.

Reading it made me realise that a practicing clinician needs both medical knowledge and loads of common sense. This book tries to help us improve on the second aspect.
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Complications: A Surgeon's Notes on an Imperfect Science
Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande (Paperback - 27 Mar. 2008)
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