Doctors 1 'Better - A Surgeon's Notes on Performance' by Atul Gawande
When faced with the opportunity to read a book by someone who isn't by profession a writer, I always go for the doctor. It is the rare book by the businessman or entertainer or politician that I thoroughly enjoy; and lawyer-writers may be the worst of the lot. But doctors! Often, I love them. Arthur Conan Doyle was a marvel. Walker Percy was very good. Chekhov was phenomenal.
....
So why do these doctors write so well, and so much better ... than other non-writers? Perhaps there are elements of doctoring that lie in harmony with writing: peeling back the layers to get to the core of an issue; confronting the obvious but being willing to look beyond it; ... and, more than anything, recognizing that this object before you in one case a human body, in the other a manuscript is on a certain level a miraculous object with the power to astound, and on another level is a complex, dynamic system which can (and must be) reduced to a schematic, laid out on paper or x-ray film.
....
So why do these doctors write so well, and so much better ... than other non-writers? Perhaps there are elements of doctoring that lie in harmony with writing: peeling back the layers to get to the core of an issue; confronting the obvious but being willing to look beyond it; ... and, more than anything, recognizing that this object before you in one case a human body, in the other a manuscript is on a certain level a miraculous object with the power to astound, and on another level is a complex, dynamic system which can (and must be) reduced to a schematic, laid out on paper or x-ray film.
Stephen Dubner in Freakanomics blog.
A personal narrative first. Just to sort of bring in a context. And I promise not to bore you even though I am not a doctor.
I have had a complex relationship with doctors. My folks had wanted me to become a doctor. THE universal middle class parent aspiration for their kids. But becoming a doc implied you needed to take biology for your pre-degree. And that implied I would have to draw pictures of insects, cockroaches, spiders and plants. Naah, the teenaged I was adamant - the most complex picture I ever drew was that of a house -a rectangle for the body of the house, a trapezium for the thatched roof, and two small squares inside the rectangle for windows. Drawing a cockroach was a stretch from there.
Anyways, I was never interested in becoming one.
One of my cousins was enrolled in med school in my city and he used to come over sometime for a more 'peaceful' atmosphere to study than a college hostel. I used to have a glance at his text books and the close to obnoxious number of facts he had to know by heart for the exams. I guess the kid in me felt a visceral dislike for it then.
My doc readers, don't get offended, I am just saying that when I was a kid I had a visceral dislike for the 'fact by hearting' I saw. That does not mean that now I am not happy that you know all the different types of lung infections and their treatments by heart when I ask you for advice.
But over the years, I have made a few doctor friends and I have almost always been impressed by them. Okay, it is always bad advice to generalize about a group from a few random examples you know. But now I am going to - hey, this is my place in the end.
From what I have seen, they are perhaps the direct opposites of say a John Rawls like Phd in Philosophy who ponders 'what really is justice' in a five hundred page book. Maybe because they deal with the reality of human life in such a personal level every day which makes them die hard practicals about getting on with it, with attention to detail and a sort of compartmentalized detachment. One of my doc friends once admonished me in a memorable quote when I asked her how she could be so insensitive 'Oh pardon me for not being a bleeding heart. I'd probably have a nervous breakdown by now what with everything that I see'. That is maybe the reason why that when they write non-fiction, doctors can be the best writers to read.
I finished 'Better - A Surgeon's Notes on Performance' by Dr. Atul Gawande a few days ago. Malcolm Gladwell, Dr. Gawade's colleague in New Yorker calls it a 'Masterpiece'.
Actually, it is one.
I was mesmerized by it.
Dr. Gawande takes us to the heart of the problems that the flesh and blood human beings in medicine face. Their challenges, their dilemmas, their successes, their mistakes. He takes us inside battlefield tents in Iraq where almost inhuman amount of effort is called for from the so called Forward Surgical Teams who travel behind the troops in Humvees. We travel with him through the dusty by lanes of Bellary in Karnataka in the midst of a polio outbreak where seemingly insurmountable odds are fought against with diligence and then inside the medical malpractice courtrooms in America where one of the lawyers who sues the docs is actually an accomplished former doc who calls himself, 'The Law Doctor'.
There are no sacred cows. He examines why still so many people die around the world because Doctors and Nurses don't wash their hands. Yes, you read that right - 'don't wash their hands' and hence transmit infections from other patients. He takes us through the history of hand washing campaigns - one of them which caused a super gr8 results CEO of my former client Alcoa to throw up his presumably unwashed hands after trying to fix it.
He muses about the deep intimacy of a physical examination of another naked body by a human being, the questions it raises about trust, propriety and culture and how a lack of appreciation of this can go on to ruin a career.
He analyzes the bell curve of performance (which is true for almost all industries) - of how some doctors and institutions are super good and some plain suck while most are just mediocre - and how choosing one at the top can make all the difference. And why is it that so. One of them is so meticulous and tuned in that he extracts the actual story from a teenager who is loose with the facts and shows the wisdom to not get pissed off at her but to use her rebellion to make her take her drugs.
Then the biological miracle of the anatomy of human childbirth. (Err, too much detail there if you ask me. I really did not wanna know all THAT. Eeek.). He writes bout the history of using forceps to deliver a baby and why the use of this method is going down. And why more and more children around the world are being delivered by cesarean than by natural birth and why it is seemingly a trend which is irreversible.
He argues against the use of medical personnel for administering the death penalty. He interviews four who actually do it and talks about their motivations and circumstances.
He writes about Virginia Apgar, a path breaker for women in medicine who was told to take up less prestigious anesthesia over surgery which she had trained for as a female surgeon of the time had little chance of attracting patients. Apgar went on to device a supersimple method which forced people to look at the health of newborn babies health more objectively and hence drastically reduced infant mortality all over the world dramatically. Her method? well, she made people look at the baby and put down a number as to how healthy it is over five factors - skin color, heart rate, irritability, movement and breathing. Yeah hardly nuclear physics stuff but newborn survival rate before and after are drastically different because it turned something abstract like the condition of a baby into a number which could measure, compare and try to improve.
He deals with the fact that now applying consistently what is known has become a far bigger challenge to modern medicine than finding new cures and treatments.
And he signs off with some super great advice. On how to become what he calls 'a Positive deviant'.
Buy and read this book. It is super cool.
Three of the essays are available from the NewYorker archive.
The Score - How Childbirth went Industrial
Piecework - Medicine's money problem
The Bell Curve - What happens when patients find out how good their doctors actually are?
I have had a complex relationship with doctors. My folks had wanted me to become a doctor. THE universal middle class parent aspiration for their kids. But becoming a doc implied you needed to take biology for your pre-degree. And that implied I would have to draw pictures of insects, cockroaches, spiders and plants. Naah, the teenaged I was adamant - the most complex picture I ever drew was that of a house -a rectangle for the body of the house, a trapezium for the thatched roof, and two small squares inside the rectangle for windows. Drawing a cockroach was a stretch from there.
Anyways, I was never interested in becoming one.
One of my cousins was enrolled in med school in my city and he used to come over sometime for a more 'peaceful' atmosphere to study than a college hostel. I used to have a glance at his text books and the close to obnoxious number of facts he had to know by heart for the exams. I guess the kid in me felt a visceral dislike for it then.
My doc readers, don't get offended, I am just saying that when I was a kid I had a visceral dislike for the 'fact by hearting' I saw. That does not mean that now I am not happy that you know all the different types of lung infections and their treatments by heart when I ask you for advice.
But over the years, I have made a few doctor friends and I have almost always been impressed by them. Okay, it is always bad advice to generalize about a group from a few random examples you know. But now I am going to - hey, this is my place in the end.
From what I have seen, they are perhaps the direct opposites of say a John Rawls like Phd in Philosophy who ponders 'what really is justice' in a five hundred page book. Maybe because they deal with the reality of human life in such a personal level every day which makes them die hard practicals about getting on with it, with attention to detail and a sort of compartmentalized detachment. One of my doc friends once admonished me in a memorable quote when I asked her how she could be so insensitive 'Oh pardon me for not being a bleeding heart. I'd probably have a nervous breakdown by now what with everything that I see'. That is maybe the reason why that when they write non-fiction, doctors can be the best writers to read.
I finished 'Better - A Surgeon's Notes on Performance' by Dr. Atul Gawande a few days ago. Malcolm Gladwell, Dr. Gawade's colleague in New Yorker calls it a 'Masterpiece'.
Actually, it is one.
I was mesmerized by it.
Dr. Gawande takes us to the heart of the problems that the flesh and blood human beings in medicine face. Their challenges, their dilemmas, their successes, their mistakes. He takes us inside battlefield tents in Iraq where almost inhuman amount of effort is called for from the so called Forward Surgical Teams who travel behind the troops in Humvees. We travel with him through the dusty by lanes of Bellary in Karnataka in the midst of a polio outbreak where seemingly insurmountable odds are fought against with diligence and then inside the medical malpractice courtrooms in America where one of the lawyers who sues the docs is actually an accomplished former doc who calls himself, 'The Law Doctor'.
There are no sacred cows. He examines why still so many people die around the world because Doctors and Nurses don't wash their hands. Yes, you read that right - 'don't wash their hands' and hence transmit infections from other patients. He takes us through the history of hand washing campaigns - one of them which caused a super gr8 results CEO of my former client Alcoa to throw up his presumably unwashed hands after trying to fix it.
He muses about the deep intimacy of a physical examination of another naked body by a human being, the questions it raises about trust, propriety and culture and how a lack of appreciation of this can go on to ruin a career.
He analyzes the bell curve of performance (which is true for almost all industries) - of how some doctors and institutions are super good and some plain suck while most are just mediocre - and how choosing one at the top can make all the difference. And why is it that so. One of them is so meticulous and tuned in that he extracts the actual story from a teenager who is loose with the facts and shows the wisdom to not get pissed off at her but to use her rebellion to make her take her drugs.
Then the biological miracle of the anatomy of human childbirth. (Err, too much detail there if you ask me. I really did not wanna know all THAT. Eeek.). He writes bout the history of using forceps to deliver a baby and why the use of this method is going down. And why more and more children around the world are being delivered by cesarean than by natural birth and why it is seemingly a trend which is irreversible.
He argues against the use of medical personnel for administering the death penalty. He interviews four who actually do it and talks about their motivations and circumstances.
He writes about Virginia Apgar, a path breaker for women in medicine who was told to take up less prestigious anesthesia over surgery which she had trained for as a female surgeon of the time had little chance of attracting patients. Apgar went on to device a supersimple method which forced people to look at the health of newborn babies health more objectively and hence drastically reduced infant mortality all over the world dramatically. Her method? well, she made people look at the baby and put down a number as to how healthy it is over five factors - skin color, heart rate, irritability, movement and breathing. Yeah hardly nuclear physics stuff but newborn survival rate before and after are drastically different because it turned something abstract like the condition of a baby into a number which could measure, compare and try to improve.
He deals with the fact that now applying consistently what is known has become a far bigger challenge to modern medicine than finding new cures and treatments.
And he signs off with some super great advice. On how to become what he calls 'a Positive deviant'.
Buy and read this book. It is super cool.
Three of the essays are available from the NewYorker archive.
The Score - How Childbirth went Industrial
Piecework - Medicine's money problem
The Bell Curve - What happens when patients find out how good their doctors actually are?
