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 ethical issues. He does not skirt controversial notions such as what happens to the soldiers who have been saved from grave injury on the battlefield and come home limbless and with horribly scared faces? Or why hospitals avoid publicizing the results of their effectiveness in treating certain conditions?

At the end of his book, he makes five suggestions about how doctors might make a worthy difference. All of these suggestions make sense for anyone wanting to make a difference. I'm only going to mention one that hits close to home: He says, "write something. . . it makes no difference if you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group. Just write."

Let me add, just read Gwande's "Better."

A fascinating and quick read, in each section there are plenty of inspiring stores about doctors making a difference. Dr. Atul Gawande, a general surgeon at Brigham and Women's Hospital and staff writer for the New Yorker has keen observation and insight to make single stories demonstrate not only the failings of our healthcare system but also the solutions to them because of individuals asking questions on how to do better. Ultimately, one of the questions he asks is how can doctors and hospitals be positive deviants? How does one become a positive deviant or an outlier that pushes beyond convention and advances patient care to new levels?

He gives examples of how over four million children need to be vaccinated in Northern/Southern India in three days to prevent a large polio outbreak. An immunization rate of less than 90 percent would be considered a failure.

Dr. Gawande talked about the evolution of obstetrics. After a damaging report in 1933, the specialty consequently committed itself to standardizing childbirth ensuring that with the new medical knowledge that it was applied consistently and routinely throughout the country. As a result maternal death in childbirth fell 90 percent from one in 150 in the 1930s to one in 2000 by 1950s. With continued innovations and the commitment to do better, the chance of a woman dying in childbirth is less than one in 10,000 today.

There are plenty of amazing examples that you don't have to be a doctor to relate on how truly inspirational these individuals are in times when the stakes could not be higher - life or death.

As a practicing family doctor, I believe that our healthcare system can do better in providing all of us the best care consistently and routinely across the country. Although his book is easily a classic and should be required reading for all future doctors, sadly I think true healthcare reform and improvement are years away. I wrote the book Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System specifically so everyone has the information they need to get the best care today. Until our healthcare system improves to its full potential as Dr. Gawande challenges us to do, unfortunately will always remain benefiting those who are insiders and harming those who are not. The real question is which one are you?

Like another Amazon reviewer, I found this book to be the best book written about the medical profession in some time. Dr. Gawande's style is lively and thought-provoking, particularly as he discusses practicing medicine in war-torn Iraq or how doctors struggle with ethical concerns relating to capital punishment.

I thought Atul Gawande's last book, Complications, was one of the best books written on the medical profession in a long while. In it, Gawande showed a deep respect and sympathy for patients while trying to be clear about what would help the medical establishment do a better job from a doctor's point of view. In this book, he covers some of the same ground but, as his title implies, here he is focused specifically on what it takes to do things better as a doctor. The chapters here are grouped under three big heading which Gawande feels are the categories of improvement: diligence, doing right, and ingenuity. Within that, he tells some fascinating stories.

Under diligence, he describes how simple persistence can improve performance significantly. For example, simple compliance with washing hands before and after each interaction with a patient would reduce unnecessary infections greatly and yet it is one of the poorest areas of performance in many medical establishment. My wife had a baby a couple weeks ago at a well-respected New York City hospital (that shall remain nameless) and, having read this book, I couldn't help but watch the hand washing. Though there was hand-washing going on, my anecdotal results were somewhat disappointing. It's scary. And yet, his stories of the effort to send polio the way of smallpox and the amazing success rates of medical teams in Iraq through no more than basic diligence with well-established methods give readers hope.

Under doing right, Gawande tells stories of the continuing debate over what constitutes right and wrong in medicine. What is the proper way to interact with someone who you have to examine naked? When is it fair to sue a doctor and how much is it worth? What should a doctor be paid for their services? Should a doctor participate in executions at prisons, considering the methods we use now are basically medical? When should a doctor continue treatment at all costs or let a patient die? These are questions with no easy answers and Gawande takes a balanced approach.

Under ingenuity, he discusses some simple, clever ideas that have helped improve performance in various areas. His wonderful chapter on childbirth focuses on the Apgar score for newborns. As most know, this is a number ubiquitous now at the birth of a baby. It wasn't even developed by an OB/GYN. It was developed by an anaesthesiologist. It required no new medical techniques. It simply required doctors and nurses to do a directed assessment of a baby at birth. And yet, this simple, ingenious change, dropped child mortality rates significantly as babies previously thought to have no chance were given a chance and hospitals competed to "improve" their Apgar scores. In this section he also has a discussion on how true analysis of doctor and hospital performance is rare but, when used, greatly improves success as well as a discussion of the amazing cleverness of doctors in the poorest parts of the world to do procedures with limited equipment. It was incredibly eye-opening.

It is a fact of life that all of us will have to encounter the medical establishment from time to time. It can be incredibly frustrating. Still, it's nice to know that there are doctors like Gawande trying to understand things and make them better. In addition, he is a fine writer who has a wealth of interesting history and personal anecdotes that help make his ideas clear. Everyone should take some time and read his work.

I have to agree with Stephen Laniel that Gawande's Better is such a thought-provoking and insightful book that I couldn't help but keep reading till the end (however, I am such a slow reader, so I wasn't able to finish it in 4 hours. Though I managed to finish reading it on my road trip back to New York City from Maine this weekend. Of course, I was sitting comfortably in the passenger seat.

I do like "The Doctors of the Death Chambers" a lot. I think it was a tough call for the four physicians to make: whether to abide by the medical ethics codes or to "do it right" according to their conscience. Life is fully of these ethnical dilemmas that none of us can avoid. Normally we simply follow our gut feelings and if we are wrong likely it won't have any fatal consequence. But the dilemma these physicians encountered was particularly difficult as human lives were involved. They were being criticized by others as unethical and they could even jeopardize their jobs. Although medical professionals should be dedicated to preserve life, is it wrong to make it a less violent and more peaceful passing when the death is inevitable? Observing the rules blindly meant unnecessary and inhumane suffering during the execution, which is not something the medical society (or anyone of us) should encourage.

"The bell curve" is my favorite. I was particularly impressed by Dr. Warwick's ingenuity. Not only does he constantly push the quality of care he delivers to a higher level, he also pushes his patient to do better and try harder. I recalled a disappointing dialogue with my primary care physician when I told her I had been experiencing knee pain lately - mostly after running for over 40 minutes. She simply gave me a cold response, "You just have to stop running." I thought to myself that running is what gives me "bliss," so how can I just give up without even trying to fix the problem? If I were lucky enough to have Dr. Warwick as my physician, he would have come up with a more proper diagnosis and offers a workable treatment plan that allows me to run a half-marathon, if not a full marathon.

Definitely don't miss the Afterword. The suggestions for becoming a positive deviant are not limited to physicians only. They can be applied more broadly to every single individual. Everyone is given the opportunity to be a positive deviant in whatever aspect of life we desire (be it our professional endeavor, our interpersonal relationship, or our social responsibility, etc...). If you do miss the Afterword, here is the essence: As Atul suggested, "Find something new to try, something to change. Count how often you succeed and how often you fail. Write about it. Ask people what they think. See if you can keep the conversation going.

I enjoyed this book so much that I finished his other book titled "Complications" upon returning to NYC and continue to read through the articles posted on Dr. Gawande's website at http://www.gawande.com.

Coincidentally I recently came across an article titled "Where in the body is that sponge?" in the July 2008 issue of Health IT News (Yes, I am a geek in Health IT) which is related to Dr. Gawande's recent published findings in the Annals of Surgery about a computer-assisted method of counting surgical sponges (see http://www.gawande.com/documents/2008AnnSurg--BeyondCountingeditorial.pdf).

I love his books because of his writing skills. Introduction with a story, then interlace it with evidence (usually historical), mix it with commentary, and end it with a conclusion to the story. Every chapter is like a reader's digest story or a very exciting magazine clipping...his writing is addictive. I went to his website www.gawande.com for more of his works. My husband, who is also a intern, provides little details about his work besides the "long hours" and "doctors are underpaid at $7 an hour, laugh," but I could never understand WHY until I read this book. A lot of outlying issues such as insurance, business practices, wartime physicians, and more are described in this book. It makes being a doctor seem like a journey through life itself. What a profession!

Better is a very good window on medical practice. There are a lot of books on this subject - and not many have the same cutting edge as this one. All the chapters are good, but the one about the bell curve is outstanding: why some places are much better than others when all should be about the same, using the same medical information that is avaiable for all.

Atul Gawande's second book is the first work I've read that falls under that bookstore subcategory of "Medical Literature." It's one of those books that can stimulate an interest for a subject in an initially less-than-curious reader. Firstly, Dr. Gawande's prose is very straightforward and approachable; his descriptions are nontechnical without sacrificing detail. Many chapters address issues to which the average person often has knee-jerk reactions to, such as medical malpractice. There are also quite enlightening passages: I for one have always been curious about how the current system for compensation for medical services came about.

Perhaps the strongest feature of Dr. Gawande's writing is the presentation of multiple perspectives, complete with interviews, example cases, and history. The author does not try to hammer his views across, but presents issues that the average reader might not have ever thought too deeply about. By providing a complete framework of an issue, the reader is then able to consider the subject from multiple angles.

The book is a fast read, a credit to the author's writing ability. The material really does keep you thinking long after you've put down the book, and I think that's why it deserves a 5th star in spite of the apparent short length. After all, there are so many books longer in length that, while enjoyable, do not lead to long moments of introspection during quiet times. "Better" is a book that first makes you think, and when you aren't satisfied with what you know so far, makes you go out to learn more on your own.

The title of this book is great. Gawande's notes on performance will provide a lot of information. He writes about malpractice headaches, insurance obstacles, medical resources in the war and how medical teams have helped so many soldiers. He also mentions a physicians role in the death penalty (that there shouldn't be one) and tells the reader a little about the history of executions. He also provides some history of childbirth and history of tools used. I found out about an inspirational woman named Virginia Apgar too by reading this book. The "fighting on" section did make me emotional and I'm so glad I wasn't somewhere public while reading it.

Every bit of the way Gawande provides nice advice for anyone, not just doctors, to do better.

Constantly bombarded by the latest headlines in advances of genomics research, new drugs, and ever sophisticated machinery to help save human lives, Atul Gawande's book offers an insightful suggestion: diligence, transparency, and focus on data-driven improvement, on the part of the doctor, may well be the next frontiers if we're looking to transform the healthcare industry.

Science helps, but ingenuity, and diligence of the doctor are often overlooked and underestimated. Having no affiliation to the healthcare industry, this book has definitely brought me to re-evaluate my relationship with my doctor, and gave me a much better understanding of what to look for in the future.

I enjoyed Gawande full view on the topics in medicine that he discussed. It gave me a great feel for the field and also left room for the reader to be critical and think of additional ways of how to make the problems within medicine better

Atul Gawande's second collection of essays from The New Yorker continues in the same style as his debut, Complications. While the book covers such diverse topics as hand-washing practices among hospital caregivers, vaccination efforts in third world countries, physician-patient relationships and etiquette in various international settings, medical personnel participating in state executions, and malpractice law, the overarching theme of the collection is Gawande's view of clinical medicine as both a science and an art.

Not discounting the central importance of scientific research and innovation, Gawande emphasizes that the most common of life-threatening mistakes occur not due to a lack of scientific understanding of a particular problem but rather a lack of diligence in adhering to practices and procedures that are elementary and thus easily forgotten. To the general public the words "modern medicine" are synonymous with expensive machinery and cutting-edge pharmaceutical therapies but the fact is that far more people in the US and around the world die because of iatrogenic drug-resistant pneumonias than high-grade gliomas (which is not a call-to-arms for gifted, savant doctors but a plea for diligence and discipline from every participant in the continuum of care). Of course the virulence of those infections has been increasing recently but that too can be linked to a lack of diligence in treatment -- excessive antibiotic prescription, inadequate antiseptic practices.

Gawande is bothered by the idea that medicine can be such a theater for technological prowess while simultaneously facing a breakdown in logistics that causes a consistent percentage of patients to receive the wrong medication every day. Here he calls for new systems of internal study and review so that performance can one day match our capabilities. If you enjoy Oliver Sacks and other clinical writing, you will appreciate this book.

Better" is as good as Gawande's first book. Gawande is interested in the improvement of medical practice, and he combines personal experiences and observations with a study of best practices by others. He is obviously comfortable in interviewing both patients and doctors, as well as being brilliant and an entertaining writer.

As it happens, only because his daughter urged him, he got a second opinion on her psoriasis, and it was cleared up with a common antibiotic. I am sure Gawande had researched her problem, so this illustrates the point he makes later that there is a need for more informal write-ups of things which seem to work. My daughter had a similar experience with a different problem. I was surprised to learn that he expects 2% of his surgeries to go wrong: either there will be life threatening bleeding, or collateral damage like harm to a critical nerve, or a wrong diagnosis.

I enjoyed some chapters more than others, but I have no confidence my rankings will correspond to those of other readers. Anyway, I liked most the chapters on the problems in implementing better hand washing; how treatment of Iraq war wounds was dramatically improved; medical malpractice; medical care in India; and, my favorite, the chapter on the bell curve as illustrated by treatment for cystic fibrosis. I think Gawande really has something in suggesting that the U.S. handle inadvertent harm by doctors as it does harm from vaccines. However, like with unemployment insurance, doctors and hospitals should have to pay more into the fund if their history has been bad.

Atul is not only a great doctor, but a very gifted story-teller. His stories are interesting, quirky, surprising and filled with feeling.

From my perspective the selection of essays in this second volume feels a little uneven compared to Atul's first book, "Complications". Some of the essays in this second volume are a tad dry.

Still I'd have to say that Atul's books are very accessible and absorbing and will help you gain useful insights on the complexity and pressures faced by the world of medicine and medical professionals.

Good book with good advice. Dr. Gawande is an engaging, entertaining, candid writer. Better is nice for a general crowd, but Complications, his earlier book, is excellent for people interested in the medical sciences, especially surgery. I'd recommend both, but if I had to choose just one, Complications gets my vote.

I didn't like the book "Complications" by this same author..so I won't bother reading this book. I advise finding some other memoir (and there are excellent ones out there :) and spend your time reading something excellent rather than wasting your time reading something awful!

Atul Gawende's "Better" should be mandatory reading for anyone engaged in providing, regulating, or legislating health services. Gawende, a general surgeon who specializes in endocrine surgery at Boston's Brigham and Women's Hospital, has written a provocative and insightful book on how we can improve healthcare today. He is quick to admit that true success in medicine is not easy. It requires will, attention to detail, and creativity.

"Better" shows, however, that it is possible anywhere and by anyone. The author illustrates this with case studies showing how diligence, doing it right, and ingenuity can make a big difference.

Gawende argues that once we've made a science of "performance" - as he shows with simple examples of hand washing, a polio "mop-up,"wounded soldiers, child delivery - thousands of lives can be saved. Today, the scientific effort to improve performance gets only a miniscule portion of scientific budgets. Yet it can arguably save more lives in the next decade than bench science, more lives than research on the genome, stem cell therapy, cancer vaccines, and all the other laboratory work we see in the press. The stakes are high.

Gawende is arguable the best nonfiction doctor-writer around today.

Dr Gawande may have written this book specifically about improved practice in medicine, but many of the points he makes are valid in other fields of human endeavour. Dr Atul has provided eleven essays around the themes of Diligence, Doing Right and Ingenuity. The question posed in the introduction, and explored throughout the book, is ` ..having accepted the responsibility, how one does such work well.'

The topics of the essays are:

Under the heading of `Diligence', Dr Gawande writes about the importance of handwashing, attempting to eradicate poliomyelitis, and the treatment of casualties of war.

Under `Doing Right', Dr Gawande addresses the use of chaperones during medical examinations, medical malpractice, income earned by doctors, the roles of doctors in capital punishment, and issues around aggressive medical treatment.

Under `Ingenuity', Dr Gawande covers medical intervention in the process of birth, excellence in treatment for cystic fibrosis, and medical care in India.

Finally, Dr Gawande offers suggestions to medical students (and others) about making a difference by becoming `positive deviants'.

In summary, the answer to the question posed by Dr Gawande could well be the following `Do what is right and do it now' (Dr Virginia Apgar, as quoted on Page 186).

This is well written book which, while it draws on examples in the field of medicine, contains lessons for each of us who strive to make a difference. Technology provides many solutions and enables advances in areas previously thought impossible. But it is human ingenuity that underpins technological advance, and sometimes it is simple human practices that have the biggest impact.

I recommend this book to those who are interested in striving for excellence more generally.

Jennifer Cameron-Smith

Atul Gawande, in "Better: A Surgeon's Notes on Performance," asks, "What does it take to be good at something in which failure is so easy?" When someone's well-being is at stake, is mere competence enough? The author maintains that a great deal more is needed "to enable every human being to lead a life as long and free of frailty as science will allow." With so much on the line, knowledge is not enough. To do their best, doctors should be conscientious, technically proficient, morally scrupulous, resourceful, and compassionate. The author examines "three core requirements for success in medicine": diligence (attention to detail and avoidance of errors), "to do right," and ingenuity ("thinking anew"). Is a doctor willing to look at a difficult situation in a new light? Can she confront her failures, learn from them, and change? Dr. Gawande presents specific examples of medical professionals meeting a variety of challenges and, in the process, transforming medical care and saving lives.

In this elegantly written book, the author makes the abstract real. He does not merely focus on dramatic events; he also demonstrates how the seemingly mundane can be crucial. One example centers on infection control. Deborah Yokoe, an infectious disease specialist and Susan Marino, a microbiologist, have done their utmost to reduce the spread of infection in their Boston-based hospital. Two million Americans acquire infections every year during their hospital stays and thousands die as a result. One way to cut down on infection in hospitals is for clinicians to carefully and consistently wash their hands. Yokoe and Marino have tried everything to get doctors and nurses to wash. They have posted warning signs, installed new sinks in convenient locations, given rewards to the units with the best rates of compliance, and even issued hygiene report cards. Nothing has worked. Doctors and nurses simply do not take the time to wash their hands as much as they should. As a result, the rates of infection in the hospital remain higher than they should be.

Two other individuals in Pennsylvania, however, came up with innovations that actually made a difference. Peter Perreiah, an industrial engineer, devised an ingenious system that made each hospital room function like a mini-operating room. Jon Lloyd, a surgeon and colleague of Perreiah, promoted the idea of "positive deviance--the idea of building on capabilities people already had rather than telling them how they had to change." By inviting the staff to come up with their own solutions rather than imposing rules from above, "the norms began to shift." One year into the experiment, infection rates dropped precipitously.

Gawande demonstrates time and again that when people rack their brains to come up with answers, they can solve seemingly intractable medical problems. The author's account of the Herculean efforts expended to eradicate polio in India and to save the lives of wounded soldiers in Iraq are fascinating and impressive. Equally engrossing are the sections dealing with best practices in obstetrics and effective treatments for cystic fibrosis. Dr. Gawande's remarks concerning how far physicians should go to keep their patients alive raise intriguing questions without offering facile answers. "In the face of uncertainty, wisdom is to err on the side of pushing, to not give up. But you have to be ready to recognize when pushing is only ego....You have to be ready to recognize when the pushing can turn to harm." The author believes that medical decisions should always be based on the best interests of the patient, and fruitless suffering should be avoided. This is a tough call and wise doctors will not hesitate to consult with their colleagues to get other opinions. My one quibble is that Gawande's segments focusing on doctors' income, malpractice, and the ethics of physician-assisted executions do not fit comfortably in a work about enhancing medical performance.

The bottom line is that "arriving at meaningful solutions is an inevitably slow and difficult process." Common to all successful initiatives is the willingness to face challenges with a determination to do whatever it takes to find remedies. Atul Gawande is a thoughtful and intelligent writer; his graceful prose makes "Better" an absolute pleasure to read. We can only hope that Dr. Gawande's colleagues will pick up on his admirable enthusiasm for behaving more responsibly, creatively, and diligently.

Gawande's essays contain honest observations of the conflicting roles that the medical profession play in the life and death of individuals and populations. He also asks seemingly obvious questions about why things are done in medicine and public health despite clear evidence that there are simple changes that can radically improve patients' health outcomes. There are no clear answers naturally, but the narratives provoke much thought.

What is really striking is the humility in his advice about being a positive deviance through simple principles of diligence, doing right, and ingenuity. His suggestions to fellow doctors and medical students to ask an unexpected questions, not complaining, measure and write about one's experience, and adopting best practices continually are underpinned by the recognition of medicine more as art than science. That there is always uncertainty in how human beings respond to the best of care in the medical setting. That much is unknown, and even more is unknown about what the profession does not yet know. Perhaps a healthy dose of scepticisim, coupled with a dash of irreverence for sacred cows, and continually asking "Why not?" in medicine, may be what is needed to "do right".

In Better, the anecdotes show just how unpredictable and irrational human behaviour can be despite the best of intentions. How surgeons who are obsessively sterile in the confines of an operating field ironically seem to blatantly disregard their own obsession once they are out of the OT. Stories about communities who reject the life-saving (and tragedy-preventing) public health measures to ring-fence polio outbreaks with vaccinations.

A fascinating (and fast) read.

Atul Gawande's collection of essays reflect on medicine in an amazingly even-handed way, considering the author is a surgeon. Rather than a defense of medical care, the author explores several controversial issues affecting health care and manages to not only see the various aspects of each issue, but to examine them in such a way the reader's mind is opened.
Divided into 3 main sections, each a virtue that contributes to the development of modern medicine: diligence, doing right, and ingenuity.
I was grabbed immediately by the first chapter regarding hand washing. Yes, hand washing! As an obsessive hand washer myself, I found the statistics regarding health care professionals and hand washing to be astonishing! And in the face of overwhelming evidence favoring hand washing, its pretty amazing that everyone is not donning exam gloves for everyday tasks. On the contrary, the cavalier attitude demonstrated by doctors and nurses towards hand washing would make a great psychology study. But luckily for us, there are people out there that not only appreciate the value of frequent washing, but took the extra step to figure out how to make it happen.
I must apologize for not making this sound more interesting, because it truly is.
While I found every chapter fascinating, I was particularly intrigued by the study of cystic fibrosis centers, and the description of medical care in India. In each chapter, we meet people who use their knowledge and skills to BE better.
I especially appreciate Gawande's advice on becoming better, a 5 step program for improvement, or how to be a positive deviant. 1. Ask an unscripted question. 2. Don't complain. 3. Count something. 4. Write something. 5. Change.
When are our efforts enough? Why do we always have to be better? Because we have not eradicated disease. We have not eliminated mistakes. We have not erased social inequities. Read about the people who are dedicating their lives to making things better. It will make you want to be better as well.
Highly recommended to health care professionals and patients alike.

In any human endeavor, variations of performance create a bell curve and most participants are average or below average. Dr. Atul Gawande explores the challenge of practicing medicine and striving to be a "positive deviant" on that curve. Better: A Surgeon's Notes on Performance explores the pursuit of perfection in several areas of medical practice. Athletes, he writes, teach us a lot about "the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line." (p. 4)

Several chapters of this book appeared first as articles in periodicals. Though the book follows a fascinating theme, do not expect it to be as well-integrated as Complications: A Surgeon's Notes on an Imperfect Science. The overall message is the dialectic between strict adherence to practices known to work (hand-washing) and an inspired ingenuity. How to achieve both?

There is much interesting material here: the WHO campaign to eliminate polio, the history of Cesarian sections in obstetrics, the ethics of assisting in the death chamber, the story behind longer life span for cystic fibrosis patients. These and other chapters are tied together by the quest for improvement of outcomes.

The afterword encapsulates Dr. Gawande's advice to medical students on making a difference in people's lives, and it alone is worth the price of the book. "It often seems safest to do what everyone else is doing ..." he writes in closing. "But a doctor must not let that happen--nor should anyone who takes on risk and responsibility in society."

Altogether this is an informative and thought-provoking book with lessons that go beyond the specifics of medical practice.

Linda Bulger, 2008

Sorry, unable to comment. This book was purchased for distribution to my Hospital Board of Directors. Thank you

I'd read the cystic fibrosis and c-section articles, and while the first was interesting, the second was an appalling disappointment for me, as I, like just about everyone else, really enjoyed _Complications_. While Gawande still has interesting things to say, his conclusions have become simplistic and seem at odds with the stories he tells in the course of each discussion. This was particularly apparent, as another reviewer has already noted, in the essay on the death penalty.

In general, I got the sense he is papering over some very, very serious concerns with medicine as he is accustomed to practicing it. He gives slight recognition to the possibility of _not_ deploying every piece of technology available and describes glowingly, for example, the treatment of very low birth weight babies and inaccurately characterizes the value of the current system of treatment (never mentioning the greater success of kangaroo care elsewhere) both in terms of immediate preservation of life and in terms of long term quality of life.

If cheerleading makes you feel good, this might work for you. But look elsewhere for a thoughtful, balanced assessment of our medical system and how it might be improved.

Better is an entertaining compilation of writings about different facets of medicine, I picked up this book and finished it during one travel day.

Atul Gawande, a surgeon at Brigham's Hospital in Boston, weaves individual patient's stories with his thoughts about larger issues facing society. The stories remind us that medicine, given all of its dimensions, may be the most "human" of all endeavors.

I am not related to any doctors, I don't have any friends in the medical field, and I see my own doctor as infrequently as possible. Meanwhile, 15% of our economy is based on medicine and health care. This book was a peek into that world for me, showing how engulfing it is, occupied by deeply dedicated professionals who are barraged by emotional, intellectual and physical challenges as part of their commitment to others' health.

Gawande maps out his book in the Introduction. He says that there are three core requirements for success in medicine, around which he organizes his book: diligence, doing right and ingenuity.

In the section on diligence Gawande talks about the effort to encourage doctors and nurses to wash their hands to stop the spread of superbugs, the diligence of doctors on the battlefield in Iraq (many soldiers' lives are saved that would have been lost before,) and lastly, the effort to rid polio from the earth, how complicated and human that effort is in its problems and issues.

In the chapters on doing right Gawande talks about doctors' pay, medical lawsuits, doctors who assist in prisoner executions (when they have sworn to "do no harm") and how to know when to "pull the plug" on a dying patient (hint: you can't know.)

In the chapters on ingenuity Gawande talks about how medical centers can implement systems which improve survival. He describes in detail how a couple medical centers (and, arguably, due to the influence of a couple people in particular) are responsible for the life expectancy of cystic fybrosis patients now being up to age 45+, when in the 1960's the average patient could expect to live to age 3.

For me, reading this book was like meeting a captivating guest at a dinner party who offered me a glance into a deep, engaging, world. I came away thankful for the author and others in medicine for their commitment to a tough field in which they make meaningful differences in people's lives and well-being (and, therefore, happiness.) I know that people in medicine are as human as everyone else, and that there are people in medicine who abuse power, are greedy, etc, just as in every other field. But I think, for the most part, people enter and stay in medicine for noble reasons. This book is about those people, whom I can only admire and appreciate.

This is an easy read, but asks some profound questions about the status of medical practice in the U.S. today. Definitely worth reading.

Atul Gawande is a fantastic writer and this book is no exception. This is a quick read that sheds a bit of light on to the ways the field of medicine has progressed. I really enjoyed Complications more, but I recommend this book as well.

This book is a collection of previously published and some original essays. The core idea that connects these essays is the idea of better performance in medical practice. To explain this idea, author focuses upon the social and organization aspect, not on technical medical tools and techniques. The book focuses on processes and people to describe various ways of overcoming seemingly un-breakable barriers doctors face when doing their job. From the resource constrained polio eradication project to ethically difficult choices execution assisting doctors faces to plethora of mal-practice suites to compliance issues facing simple practitioner behaviors, it explores problems and quandaries doctors face in their "normal" day to day activities. The suite of essays is full of anecdotes, thought lines and candid self-reflections. These are well written and engaging essays.

On the cover of "Better" by Atul Gawande, the thoughtful Malcolm Gladwell exclaims, "Better is a masterpiece...". To be sure "Better" gets high marks for exploring territory that the medical profession might sooner forget, even Gawande admits to his discomfort level but to suggest that the bell curve tells us "...something unforgettable about the world outside" is to know very little about the world outside. However, I don't want this to be about Gladwell. Gawande is a good writer. He captures the medical world, a world alien to most of us, through the eyes of a surgeon in a way that makes those who heal, those we trust and respect more than any others in society, almost human. They are just like us. As the father of a daughter who was brought into this world with a mere 23.3 weeks gestation and a zero Apgar score, who just turned 10 years old this month, I considered these healers and decided they were superhuman. They were sheltered from a world of stress, financial worry, problems with relationships, and the like. I knew I was kidding myself but I chose to believe. I knew the doctors and nurses caring for my daughter in the NICU for 87 days were on top of their game. Gawande pierces the veil and I applaud the effort to capture his thoughts. To take the time from his busy schedule to think and to consider the meaning in what he does, to improve, to get better. He has a simplistic five-step method; Ask an unscripted question, don't complain, count something, write something, and change. Simple enough, and the beauty of his formula is that it will work, and it can be applied to all aspects of life - so do as Gawande asked, heath professional or not, improve what you are and what you do. However the real message, the journey Gawande takes us on to reach his formula, is the better part of "Better". And since we all get sick and need the medical profession, we should all stand in the shoes of a medical professional. Gawande let's us stand in those shoes, if just for a brief moment, to glimpse a world where life and death decisions hang in the balance. Followed shortly by a life and death decision in the next examination room. Most of us will never know this kind of life. So here is my formula, first go wash your hands. Second go read this book. It will not change your life, but it will change your perspective on your next visit to the doctor's office and how you perceive the hidden world of medicine.

My father was a surgeon, so when my wife checked "Better: A Surgeon's Notes on Performance," by Atul Gawande, out of the library, I decided to open it and see if it was worth a read.

Happily, it was absorbing reading! In spite of the title, it was not a collection of stories of successful heroic surgeries, but a series of essays on widely varying medical topics dealing with decision-making in the absence of complete data, morality, ethics, doctor-patient interaction, etc. Dr. Gawande deals with real-life issues that possibly could confront any member of the healing professions--supervising lethal injections of convicts, for example--in spare, straightforward prose packed with well-researched statistics, extensive interviews with doctors and nurses, and exposure to all sides of the issues. Although I paced myself, reading one chapter a day, I could have finished the book in a few hours, as it was interesting and written in down-to-earth terms.

Perhaps the greatest value of this book is the emphasis on performance measurement--"benchmarking," if you like. Dr. Gawande's research into treatment of diseases like cystic fibrosis, for example, revealed that the most successful treatment centers (1) kept detailed records of treatments, (2) were eager to try any seemingly logical approach, and (3) learned quickly from their successes and failures.

I'm going to recommend this book to all of my physicians--all of whom I regard as exceptional caregivers, but I heartily recommend it to anyone concerned with the state of health care in America.

A follow up to Gawande's earlier "Complications." This is a good, quick read, but it lacks some of the depth that the earlier parts of "Complications" had. Still, a worthwhile book.

That's How the Light Gets In: Memoir of a Psychiatrist by Susan Rako, M.D. The title comes from a song by Leonard Cohen: "There is a crack, a crack in everything. That's how the light gets in." This is a great read. The writing just flows.