Katie's Reviews > Better: A Surgeon's Notes on Performance

Better by Atul Gawande
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's review
Mar 11, 2011

really liked it
Read in March, 2011

Another fascinating read from this doctor-slash-author. This book focused on ways to improve medical performance, using concepts such as keeping and sharing statistics on performance data, and better ways of evaluating tricky topics like how hard to try to save someone's life (even if they are severely suffering). He mentioned something which seems so simple today--the Apgar test, of newborn's health--which you can't believe somebody didn't come up with earlier, but they didn't. Such a simple rating scale, yet it apparently revolutionized (and greatly improved) obstetrics. Of course things aren't always that simple... he also mentions how Apgar has also increased the prevalence of C-sections, which is good-yet-bad.

There was a lot of discussion on ethics, particularly regarding doctors assisting at executions, where I'm not sure I ultimately agreed with or completely understood his reasoning. Yet, he's such a good writer that it interested me throughout.

Also, he brings up an excellent point, which is that although medicine might be greatly improved in leaps and bounds by greater risk-taking, we probably don't really want greater risk-taking. Not on ourselves, at least! Let somebody else take the risk and then I'll benefit from the outcomes--that, in a nutshell, is the problem, and is part of why medical innovation cannot happen faster.

In fact, my favorite part of the book illustrated this very topic--he spent some time doctoring in India and described what it was like there. It was both better and worse than here. Worse because it's a poor country and patients are overcrowded and often have to bring their own medical supplies (!), yet better because doctors' hands are not tied like they are here, with all our regulations, malpractice fears, long waits for FDA approval on new drugs, etc. There, they are more free to innovate, and often this leads to bigger leaps and bounds in medical advances. Of course, would I rather be treated here or there? Here--but it was inspiring to read that at least somewhere in the world, medicine is occurring in a more research-and-development, maverick-type atmosphere... which may (who knows) ultimately lead to new discoveries which might benefit us all in the long run.

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