Complications: A Surgeon's Notes on an Imperfect Science

by Atul Gawande

We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you’ve got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.

It is painful enough taking responsibility for one’s own failures.

Western medicine is dominated by a single imperative—the quest for machinelike perfection in the delivery of care.

When things go wrong, it is usually because a series of failures conspires to produce disaster.