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Better: A Surgeon's Notes on Performance
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Better: A Surgeon's Notes on Performance

4.14 of 5 stars 4.14  ·  rating details  ·  11,465 ratings  ·  1,216 reviews
The struggle to perform well is universal: each one of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives are on the line with every decision. In his new book, Atul Gawande explores how doctors strive to close the gap between best intentions and best performance ...more
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Published April 3rd 2007 by Macmillan Audio (first published 2007)
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Lightreads
I have had a lot of doctors in my life. The best one I ever had was the surgeon who failed. Before I went under, he told me it would take about 2 hours and had an 85% success rate. When I woke up, nearly five hours had passed, I was in far more pain than I had been led to expect, and he was waiting to tell me that I was in the 15%, that he hadn’t saved my eye, and that he would be ready to talk to me as soon as I was back on my feet.

When he retired several years later, I wrote him a thank you no
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David Singerman
Not nearly as good as his first, in a number of ways.

What made Complications so exhilarating was that we were learning about being a doctor just as Gawande was learning about being a doctor. Literally: he wrote most of those essays while still a resident. The humility this brought to Gawande's essays makes all the difference. We were forced to consider the ethical implications of a healthcare system that has to deploy inexperienced doctors so that they can be trained and become better doctors.
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Robert
"Better" collects surgeon Atul Gawande's recent essays on medicine in three categories--Diligence, Doing Right, and Ingenuity. Each essay, on topics as diverse as washing hands to minimize infections in hospitals and doctors participating in executions, is a marvel of case study and comparative assessment, shifting back and forth between the particular and the general.

The simplicity and directness of Gawande's prose mirrors his mode of thought: always looking for the basic truth, the underlying
...more
Gail
If I had to pick just one of Gawande's books to read, it would be Complications. But this is still a great collection of stories on fascinating fields of and issues related to medicine.

What I admire so much about Gawande is his ability to wrap his analytical mind so effortlessly around storytelling. His writing is conversational, straightforward and thoughtful. Medicine isn't a topic that would necessarily appeal to me, but with Gawande at the helm, it's fascinating.

In this book, his stories inc
...more
Patricia
Atul Gwande's Better: A Surgeon's Notes on Performance is a collection of essays that probe skillfully and poignantly into the depths of medical ethics and the performance of doctors. He is a fine researcher and an astute observer who carefully delineates many facets of each issue that he explores, be it washing hands, malpractice concerns, or the Apgar score.

As a non-fiction writer, I was acutely aware of how adept Gawande is at using narrative to illustrate and discuss complex moral and ethica
...more
Cassie
Oct 12, 2007 Cassie rated it 3 of 5 stars  ·  review of another edition
Recommends it for: doctors, patients, politicians
I really like Gawande's writing style, and for the most part feel like he gives a very rational, nuanced look at medical care in the US. The only exception to this is the essay "The Score." Although his main point in this essay, that a concrete, replicable measurement of baby health led to great improvements in infant mortality in the US, is well-taken, his description of the history of obstetric care and the near inevitability of an increasing c-section rate in the US is shockingly uninformed. ...more
Rebecca
Aug 07, 2008 Rebecca rated it 5 of 5 stars  ·  review of another edition
Recommends it for: anyone interested in the medical profession, people who like the New Yorker
Shelves: essays, non-fiction
This is a great book. From it's title, I thought it was about how doctors figure out how to make their patients better. But instead, it is about how the medical profession makes itself and its performance better. Gawande classifies the methods he sees in several ways. First, there is diligence, doing right, and ingenuity. He explores these ideals while discussing the campaign to get doctors and nurses to wash their hands in hospitals, improving the field of obstetrics, saving the lives of more a ...more
Michael
Takes the reader comfortably into the world of medicine's challenges under the theme of how efforts to improve performance can save a lot of lives. Like the good chef he proved to be in his earlier set of essays on his experience as a surgical resident, , "Complications", he again makes tasty and nutritious dishes out of a wide variety of ingredients. How has public health gotten so close to eradicating smallpox? How has the casualty death rate for American military medicine gone from about 20% ...more
Ahmed
Although I enjoyed "Complications" more, because it reached out to me on a personal level, "Better" isn't any less of a masterpiece. In dire times-during my final year of med school, when the need to do better is of paramount importance, I found this book very useful and extremely inspiring. The tales in this book were thought provoking and motivating to say the least. Even though I think it is aimed more at bettering the healthcare system and is addressed to practicing physicians, I found it fu ...more
Kara Larson
I thoroughly enjoyed this book on performance in the medical field. Dr Gawande writes in 3 sections: Diligence, Doing Right, and Ingenuity, covering performance improvements and their history all the way from irradiation of Polio in India to war-time strategies for combat medicine in Afghanistan to CF clinics in the USA. In each chapter he looks at the history of medicine and how the process and the people improve. Dr. Gawande writes, "Arriving at meaningful solutions is an inevitably slow and d ...more
Peter
Oh, I wanted this to be great! Alas, only part of it is. To wit: Gawande’s umbrella themes dominate the book, but they are a distraction from his best conclusions, which are tucked quietly in the afterword.

In his introduction, Gawande asks, “What does it take to be good at something in which failure can be so easy, so effortless?”—and even though he says, “This is a book about performance in medicine,” the question applies not just to medical practitioners. All of us can ask the same question ab
...more
Sanjay
With 'Complications', Boston-based surgeon and New Yorker writer Atul Gawande joined the ranks of Doctors Who Can Write. (Speaking of which, whatever happened to Abraham Verghese?)

In his next work, 'Better', Gawande continues his Montaigne-like ruminations on his profession. The essays here are centred on the theme of improving medical performance, and the book is structured around the three ways to do this: diligence, doing right and ingenuity.

In prose that’s limpid and affecting, Gawande walks
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Jan
If Atul Gawande were a cobbler, he'd be writing for the New Yorker about how to make a better shoe. That's because Gawande is a storyteller and a craftsman. His essays appear deceptively simple and ingenuous, but it takes a great deal of art and craft to make them that way. No matter how earnest and idealistic a physician he may seem, he is actually a writer's writer.

That said, as a physician who left the profession, I am buoyed and reassured by Gawande's insights and exhortations. He gives me h
...more
Abdulaziz  Albabtain
If I had any say in the matter, I'd add this book to every single medical school curriculum in the world.
There is no book with a title that truly reflects it's content like "Better". If answers some very simple yet fundamental questions every physician needs to ask himself.
How can I be the best physician I can become? What are the best ways to get the best out of everybody in a healthcare team? How to turn my patient into an ally fighting on the same enemy instead of simply being someone I am t
...more
Petra X
The first chapter of this book was on the effect that hand-washing has on infection rates of MRSA and VRE in hospitals. It was fascinating! I never thought I would find twenty pages on hand-washing so engrossing - I have high hopes for this book!

The book got better and better. Proper review will be forthcoming, definitely. But when?
Harriet
A thoughtful, unshowy, effective look at some of the conundrums at the heart of modern medicine, from a surgeon's point of view. Gawande uses stories to highlight some of the issues he considers, and leaves the reader to make up her or his own mind. I love Gawande's clear, simple writing, which belies a powerful voice at work.
Bill
One of my favorite granddaughters (I have 7, all favorites) gave me this book on Kindle for Christmas. I would never have chosen it for myself for several reasons, but thoroughly enjoyed reading it and couldn't wait to start the other one. Yes, Zoe gave me two, both by Atul Gawande (the name was one thing that might have discouraged me from selecting this book - not a good thing to admit). Dr. Gawande is to be the speaker at her graduation from UNC Nursing School in May. We will definitely be th ...more
Stefan Kanev
This book was great!

It's hard to pinpoint what exactly Gawande is writing about. He is telling stories in medicine, he is exploring ways to improve performance and he is tackling hairy issues like malpractice lawsuits, doctors participating in executions, the state of care in idea and various other things. It was insightful to compare his view of the contemporary world of medicine and my view of the contemporary world of software development. There are some interesting similarities and many inte
...more
Dave
Not quite as good as "Complications", as chapters on insurance and the death penalty go nowhere, but still very much worth the read beyond that as Gawande does an excellent job reviewing the absolute necessity of frequent hand-washing, the enormous task of attempting to finally eliminate polio, the evolution of birth and how it is now orders of magnitude safer than just a century ago, and most powerfully a chapter on cystic fibrosis. A genetic disease that strikes ~1000 American children per yea ...more
Giancarlo Buonomo
I had previously read Atul Gawandes first book, "Complications", and I must say that "Better" was at least its equal, if not superior. The two books have slightly different focuses. Complications is more about the "gray" areas of medicine, fields and procedures where things sometimes go mysteriously wrong and doctors are forced to improvise. "Better" feels like an obvious sequel, because Gawande seems intent on making some of the errors he talked about in his first book nonexistent.Many of the c ...more
Emily
Dr. Gawande is not afraid to take a hard look at his profession, its strengths, its weaknesses, and how to improve. In Better he addresses three general topics that he calls the “core requirements for success in medicine—or in any endeavor that involves risk and responsibility,” including diligence, “doing right” and ingenuity. Along the way, he explores medicine in some exotic locales from the battlefields of Iraq and Afghanistan to polio eradication efforts India, as well as potent ethical imp ...more
Ensiform
The author, a general surgeon, discusses some challenges and discoveries of the medical field, and what qualities it takes to improve performance. Drawing on the history of medicine and his own experiences, he investigates not only what makes improvement, but how it is implemented. For example, the simple act of hand-washing nearly removed the risk of “childbed fever,” an infection which killed newborns; but the successful implementation of hand-washing in an institution comes not by diktat but ...more
Susan Connell Biggs
A colleague recommended this book last spring, and it has sat in my "to read" pile ever since. I finally picked it up after reading an article about its author, Atul Gawande, in Harvard Magazine. I loved it! It's one thing to read a book that teaches you something, but even more impressive to me are the books that get you to think smarter, to ask questions you might not have come up with on your own. I love that kind of intellectual nudging. That's the kind of book Better was for me. And I love ...more
Shauna
A good presentation of humans in the art of medicine. There are things that medicine must change and only through sharing these stories will society as a whole help us answer them. Favorite quotes:


“To do right: I puzzle over how we know when we should keep fighting for a sick patient and when we should stop.”



"But if mortality is low, the human cost remains high. The airman lost one leg above the knee, the other at the hip, his right hand, and part of his face. How he and others like him will be
...more
David
The author of this book is a surgeon who gives some wonderful insights into that very specialized occupation, from the perspective of how processes can be improved in sometimes dramatic and unexpected ways. The lessons apply in many areas beyond medical care, and that's the potential of this book - to help us consider how to do better at everything we do.

The book has three sections: Diligence, Doing Right, and Ingenuity - which the author considers the essential components for success in endeavo
...more
Alexandra
I really enjoyed reading a surgeon's perspective on the three attributes necessary to be highly successful in the medical profession (and other professions, too, particularly where lives are at stake). They are: diligence (doing the small things like hand washing etc), doing right (being open to criticism and honest about your own shortcomings, in additon to a medical ethics discussion), and ingenuity, which here refers to a sort of relentless pursuit of innovating to make people well rather tha ...more
Raghu
This book by Dr.Atul Gawande is about ' performance' - about what it takes to grow from 'good' to better or great. Being a surgeon, the incidents relate to the practice of medicine. It is a fascinating and compassionate book and takes a very balanced view as he discusses diverse issues such as the ethics of doctors in administering lethal injections on people in death row, on the question of doctors being sued for making mistakes in doing a proper diagnosis on a patient which lead to life long n ...more
Jennifer
Nov 15, 2013 Jennifer rated it 4 of 5 stars  ·  review of another edition
Recommends it for: anybody who thinks about the work that they do
Recommended to Jennifer by: Adena Staben
This was an engaging look at how the medical profession tries to do "better." Atul Gawande explores topics as diverse as improving hand washing rates in hospitals to surgical innovations in military field hospitals to the medicalization of labor/delivery. Into these discussions, he also weaves stories of his own experiences as a medical student and a surgeon. The result makes you rethink what you know about the field of medicine but also raises questions that are not easily answered. The final c ...more
Christy
I read a couple intriguing reviews of this book, and then I realized that I have been reading Gawande's pieces in The New Yorker for some time, which made me more intrigued. What finally tipped the scales was that one of our favorite bookstores was having a going-out-of-business sale and they had this book in stock. (I'll miss you, Liberty Books!)

Gawande is very skilled at writing for the layperson and putting an interesting face on medicine. In another person's hands, most of these topics could
...more
Amy
Complications by Atul Gawande made my top ten list last year, and I've had my eye on this book for awhile now. Since it is still only available in hardback I'd resigned myself to waiting until the paperback version came out, but I found it at the public library right before I left for the break and thought it might make a good airplane read.

I think Complications is still my favorite of the two, but I still thought Better was very interesting. It is a little like a collection of essays, although
...more
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Atul Gawande is author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. His latest book is Being Mortal: Medicine and What Matters in the End.

He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard
...more
More about Atul Gawande...
Complications: A Surgeon's Notes on an Imperfect Science The Checklist Manifesto: How to Get Things Right Being Mortal: Medicine and What Matters in the End The Best American Science Writing 2006 Scoot Over, Skinny: The Fat Nonfiction Anthology

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“Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” 81 likes
“We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in.” 51 likes
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