Better by Atul Gawande: Intro and Chapter 1

To begin our discussion of Better, by author and surgeon Atul Gawande, I want to begin with Gawande's bio and a review of his article on health care reform


  1. Also, for those who want an audio primer on the subject, Gawande gave an interview with Scientific American in which he discussed the major themes of his book and some really good examples which appear in the first few chapters.

    From reading his education bio you realize how smart the guy is:

    "He received his B.A.S. from Stanford University, M.A. (in politics, philosophy, and economics) from Oxford University, M.D. from Harvard Medical School, and M.P.H. from the Harvard School of Public Health."

    The breakdown of his accomplishments as a surgeon is as follows:

    "In 2003, he completed his surgical residency at Brigham and Women's Hospital, Boston, and joined the faculty as a general and endocrine surgeon.

    He is also Associate Professor of Surgery at Harvard Medical School, Associate Professor in the Department of Health Policy and Management at the Harvard School of Public Health, and Research Director for the BWH Center for Surgery and Public Health. He has published research studies in areas ranging from surgical technique, to US military care for the wounded, to error and performance in medicine. He is the director of the World Health Organization's Global Challenge for Safer Surgical Care."

    To quote Scientific American's Steve Mursky from his preface of Gawande's interview - "he is probably going to be our Surgeon General someday."

  2. That's just Gawande's bio. The intro to his book Better revolves around a story of his residency in which he treats a patient with pneumonia. He goes through the motions with this patient, but the senior doctor on the case goes above and beyond, monitors the patient personally, and is able to give the patient a swift and easy recovery as a result.

    The lesson that Gawande draws from this experience is this:

    "When I was a student and then a resident, my deepest concern was to become competent. But what that senior resident had displayed that day was more than competence - he grasped ... how to catch and fight [pneumonia] in that specific patient, in that specific moment, with the specific resources and people he had at hand."

    He goes on to describe the lessons he expands upon in Better:

    "The sections of this book examine three core requirements for success in medicine - or in any endeavor that involves risk and responsibility. The first is diligence, the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles.
    "The second challenge is to do right. Medicine is a fundamentally human profession. It is therefore forever troubled by human failings, failings like avarice, arrogance, insecurity, misunderstanding.
    "The third requirement for success is ingenuity - thinking anew. Ingenuity is often misunderstood. It is not a matter of superior intellect but of character. ... It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions."

    He concludes with a story about how he perservered in trying to get a patient an operating room, and how he was able to do so because of the goodness of several nurses who pulled overtime because they recognized the backlog of patients who needed attention.

    My own take was that I appreciated the universal appeal of his lessons. All of these topics come from his experiences in medicine, but I see immediate parallels to my own experience in business and in general day-to-day living. Did you feel the same?

  3. Admit it - you're as gay for Gawande as Simmons' is for Durant.

    I'm about half way through the book, and there are some great stories and stats, but I want Gawande to not come off as hoighty toighty as he does. I just don't feel it's genuine when he says I screwed up. I get the feeling he felt it necessary to put it in there to not sound hoighty toighty, but it doesn't always work for me.

  4. No first of all SCREW that, I had a man crush on Kevin Durant before Simmons wrote about it. I remember watching Durant play for Texas and seeing him do things on the court I hadn't seen another player do - for example, the spin move into instant dunk off his inside foot at the start of these highlights against Oklahoma St - and developing a serious affection for the next big NBA star at that point. So don't discount my Durant man-affection, okay?

    Now back to Gawande. I do agree with you about his tone bordering on pretentious at times. That said it didn't really distract me the way it seems to distract you. I'm only through chapter 2 because I'm intentionally slowing my progress in order to extract more thoughts on it.

    Do you want to discuss the specific examples from the book? Or would you prefer to do a book review in broader movements?

    For example, how did you feel about the first chapter, revolving around hand washing?

  5. I am not reading the book, but I wonder if his hand-washing discussion talks about the evolution of anti-bacterial hand soaps weakening the immune systems of the majority of children across the board. Children are less likely to get a small illness, such as a cold or infection, but increases the risk of their body not being able to fight a more dangerous illness such as a staph infection.

    A friend told me about her kid's pediatrician saying that by two years old, a child should have developed a strong enough immune system to eat dog poop and not get sick. The pediatrician encouraged kids playing in the dirt.

  6. Go dog-poop eating!

    I usually read a decent clip, so I'll probably end up commenting on the book as a whole with a few specifics.

    Specifically on hand-washing, nothing jumped out at me other than the fact that doctor's don't wash their hands that much - sure as hell doesn't get portrayed like that on television.

  7. Do they not wash their hands because they are wearing latex gloves any time they touch a patient?

  8. Aaron, that's not really the direction he takes the discussion, no. But that is interesting info and certainly the resistance of our immune system is a big factor in all this.

    Scott, what about the approach that some hospitals have taken to improve the hand washing and germ control? I will dig out the passages that relate.

    The kind of "internal systems" approach they took to delegating responsibility for improvement really stood out to me.

  9. Royce, in the Management post you refer to this post and casually drop in that hospital employees chose the location of hand washing stations...can you expand on this?

  10. Yes, there are several long passages about it, I will try to condense and paraphrase... also chapter 2 + 3 discussion...

    But don't be having me read and summarize the book for you. I strongly encourage you to read it.