Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition (2003) (PDF) by Atul Gawande

Description

Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one’s own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is — complicated, perplexing, and profoundly human.

Atul Gawande offers an unflinching view from the scalpel’s edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won’t go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.

At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.

User’s Reviews

Review “Complications is a book about medicine that reads like a thriller.”–Malcolm Gladwell, author of The Tipping Point”Complications is a uniquely soulful book about the science of mending bodies.”–Adam Gopnik, author of From Paris to the Moon Amazon.com Review Gently dismantling the myth of medical infallibility, Dr. Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science is essential reading for anyone involved in medicine–on either end of the stethoscope. Medical professionals make mistakes, learn on the job, and improvise much of their technique and self-confidence. Gawande’s tales are humane and passionate reminders that doctors are people, too. His prose is thoughtful and deeply engaging, shifting from sometimes painful stories of suffering patients (including his own child) to intriguing suggestions for improving medicine with the same care he expresses in the surgical theater. Some of his ideas will make health care providers nervous or even angry, but his disarming style, confessional tone, and thoughtful arguments should win over most readers. Complications is a book with heart and an excellent bedside manner, celebrating rather than berating doctors for being merely human. –Rob Lightner –This text refers to an alternate kindle_edition edition. Review Gawande is a writer with a scalpel pen and an X-ray eye…. Diagnosis: riveting.”–Time magazine Praise for Complications:”Gawande is arguably the best nonfiction doctor-writer around.”–Salon.com “Remarkable…A new and different voice, bringing to modern high-tech medicine the same clinical watchfulness that writers such as Williams and Sacks have brought to bear on the lives and emotions of often fragile patients.” –Sherwin B. Nuland, The New York Review of Books –This text refers to an alternate kindle_edition edition.

Reviews from Amazon users, collected at the time the book is getting published. It can be related to shiping or paper quality instead of the book content:

⭐ The author wrote 14 medical-related articles. He grouped these articles into 3 general categories. I’ve very briefly described the articles (and categories) below since your interest in this book may depend upon your interest in the topics the author has chosen to include in this book. Each article typically includes a specific patient’s case, which very nicely carries some of the general discussion over to real-world impact. Well written. Interesting. Easy for a layman to understand. But fairly general (i.e., no real surprises and not much new information).FALLIBILITY (I.e., doctors make mistakes) —-EDUCATION OF A KNIFE: New surgeons learning their craft by operating on real patients.COMPUTER & THE HERNIA FACTORY: Using computers and ultra-specialization to reduce medical errors.WHEN DOCTORS MAKE MISTAKES: Most doctors make mistakes. How can they be reduced?NINE THOUSAND SURGEONS: What it’s like at going to a surgeon’s convention.WHEN GOOD DOCTORS GO BAD: When an experienced doctor’s performance markedly declines.MYSTERY (I.e., not everything about medicine is known) —-FULL MOON FRIDAY THE 13th: Does the emergency room really get unusually busy on these superstitious evenings?THE PAIN PERPLEX: What causes pain? What drives the intensity of pain?A QUEASY FEELING: Nausea. Like pain, sometimes hard to determine its cause or alleviate its discomfort.CRIMSON TIDE: Nope, it’s not about periods – it’s about blushing.THE MAN WHO COULDN’T STOP EATING: Hunger and the gastric-bypass operation.UNCERTAINTY (I.e., what’s really the right thing for the doctor to do?) —-FINAL CUT: AutopsyTHE DEAD BABY MYSTERY: SIDS (Sudden Infant Death Syndrome)WHOSE BODY IS IT, ANYWAY?: Letting patient’s make their own informed decisions about their medical care.THE CASE OF THE RED LEG: Diagnostic uncertainty, doctor’s gut instinct and flesh-eating bacteria.

⭐ I was referred to this book by a friend of mine who knew I liked the books of Malcolm Gladwell. I first read it near about when it came out, around 2002, and just got around to re-reading it. I had only remembered two of the stories from the book, so it was very similar to reading it again for the first time.The theme of this book is reflected in its three parts: Fallibility, Mystery and Uncertainty. Each part talks about a particular aspect of Gawande’s career as a surgeon that deals with the less-certain side of being a doctor. Each concept is accompanied by one or more anecdotal references to his own real-life cases that illustrate his point brilliantly.And that point is that doctors know a lot – but they don’t know everything. Their education and practical experience can help prepare them with knowledge, but skill comes from years of learned real-world practice. I could really sympathize with him and the stressors he has to deal with. I’ve been guilty as well of feeling my doctor must and should know everything that is right for me to do. The truth is a lot more complicated than that.This book doesn’t even take into consideration the patient frustrations with healthcare – cost, attention, etc. It really does focus on pulling the screen back and giving you a glimpse into the vast uncertainty that accompanies this sometimes wondrous profession.This is NOT a book that says, “I’m a surgeon. Here’s all the supercool things I’ve done and this is why I’m awesome and don’t you wish you could get me as your doctor?” This book shows the doctor, warts and all, and makes them much more human.

⭐ As a former Navy Corpsman (Medic) attached to the USMC infantry, I have always had an interest in medicine, and science in general, and this book was a great insight into the medical and surgery field.As a young Corpsman with the Marines, I was thrust into medicine, and learned very quickly what did and did not work. “Watch one, do one, teach one” is how we were instructed to learn medical practices. From diagnosing (even though we couldn’t “diagnose” as Line Corpsmen…we still did essentially) cellulitis, learning to place sutures, to removing infected toenails, I made mistakes, but generally our medical skills quickly flourished, and we were able to practice outstanding medicine for the grunts.Atul writes about this, and the decisions he had to make, which affect him to this day. As a surgeon and author, he actually cares about his patients, which is a great thing to have as a medical professional. While he doesn’t touch on this very much in his book, his caring about the patients and following up is the mark of a true caregiver. For it is those doctors, medics, corpsmen, nurses, and other medical professionals that actually care and are empathic with their patients, yet know how to distance themselves when needed, that operate the best and can change medicine for the better.A truly great read, I would recommend this book to anyone interested in the healthcare system, surgery, medicine, and anyone who has ever worked in the medical field!

⭐ The author writes from the viewpoint of a resident and young surgeon covering such topics as When Doctors Make Mistakes, When Good Doctors Go Bad, Pain, Nausea, Obesity and the Ethics involved in end-of-life decisions. His excellent writing makes the hospital setting and the O.R. come very much alive. Doctors are portrayed as human beings with a high fallibility factor and surgeons are portrayed with very high confidence levels. Yet the doubts, the anxiety and the frustrations of the medical profession are also expressed very eloquently. His insight into the medical world is almost profound and his empathy with the patient is palpable. Gawande has written other medical books for the popular market that have gotten good reviews. I hope to read them soon.

⭐ I found this book to be very entertaining, well written, and disturbing at times. It certainly made me aware of how fragile life truly is and that we should take advantage of every minute of good health that we are given in this life. It also makes me realize that doctors are just like you and I, they might have more education, but when it comes to the nonordinary, they are just like the lesser educated in that they must make their best educated guess. We all put our pants on the same way but physicians through shear hard work get to live briefly in their patients world, and make profound decisions that will effect the outcome of their patient’s lives forever. What a purposeful joyful burden they share with their patients. What a great payoff for all their hard work and studying: To change for the better and sometimes save lives every time you go to work!

⭐ book:we did not get this straight from an amazon seller, rather a third party; the book has been used, as stated, but was in very good condition. i bought this for my daughter’s high school bio summer assignment. she thinks that it was a very interesting book, considering that becoming a surgeon is one of her possible career paths. she noted that the book was highly interesting and gave many descriptions on how the field works and looks. it’s very engaging and she learned a lot from it. for anyone willing to read about the stories of surgeries, this book will open up your mind to that field and area.

⭐ Having been in a “complication” myself through surgery, I read this with an eager eye, and now have a better understanding of what it means to be a doctor, to make decisions “on the hoof” and bear the consequences of those decisions. My doctor actually recommended it to me because I have more surgery to come and was backing up faster than a mouse from a cat! Those knives the specialists wield are not meant to cut and thrust any deeper than can be helped, and the hands that hold them are attached to a human being trying to do his upmost for you. So dig into this book and see another side other than your own. Yes, you get pain from those knives, but you also get information, healing, and another bash at a good life. Please read it.

⭐ I have read all 4 of this author/doctors books. What a wonderful writer he is, as well as a doctor who seeks the truth! Love it, love him and more. I am anxious for him to write another, although it seems he has already covered everything! My friend, a nurse, said this was too frightening for the common reader, I didn’t think so, as I want to know! Such interesting material he choses, and how he researches it all! Just fantastic!

⭐ This book was a fascinating look into the modern doctors world. It is a job more defined by statistics than in the past, but personality and experience still play a great part. I really enjoyed reading this doctor/author’s book book on Checklists and their usage in medicine so I was not disappointed with his more random thoughts on doctoring in general.Some of it is quite unsettling as in the case of surgery and interns learning. You hate to be a learning experience when your life is at stake, but how else do interns learn? Still…most doctors insist that their loved ones, are not part of this experience. Doesn’t seem really fair; does it?Doctors like everyone else do better with practice, and this is well demonstrated with these specialized practices that only do Hernia operations. It also makes it possible for robots and computers to be quite effective at simple procedures. However that gives me pause. Here the blue screen of death might have greater implications than a reboot.I liked the fact where he dealt with some of his mistakes and diagnoses of patients and how there was a struggle of procedure and how to approach things. One person was nearly harmed by a minor oversight and another person was saved with a hunch. Given that both of these areas (oversights and hunches) are in the gray areas of human cognition it shows how much luck plays a factor, or a sixth sense, that doctors with experience start to develop.A quick synopsis of what this book includes:INTRODUCTIONFALLABILITY*Education of a knife: How interns are trained in surgery. Odds are, you are their training.*The computer and the hernia factory: Repetition = perfection and efficiency*When doctors make mistakes: How mistakes happen. Like all of us they are human, but unlike all of us the ramifications are greater.*Nine Thousand Surgeons: Conferences provide an opportunity to compare notes and keep up to date.*When Good doctors go Bad: Peer review is necessary but whistle blowing on a colleague is rare. Not surprising there are remediation schools, but few and far between. Important note, if some doctors push you away from others…take note.MYSTERYFull Moon/Friday the 13th: Is there any truth to this. Statistically no, but the jury is still out.The pain perplex: Pain stumps most doctors as how and why it exists is not clear cut.There is no test for pain.A queasy feeling: Nausea is not one symptom, nor does it have a single cause and can be very difficult to treat.Crimson tide: Blushing, for some it undermines their confidence, but is it only cosmetic?The man who couldn’t stop eating: Overeating is a life altering issue and surgery to address this is gaining ground as in the case of the morbidly obese, it works.UNCERTAINTY*Final Cut: Autopsy is not done as much any more unless there is a mystery surrounding the death. However, it helps educate doctors as to the accuracy of their diagnoses. Unfortunately to many it is a violation of the dead, who will gain nothing in return.*The dead baby mystery: Sometimes the answers are obvious*Whose body is is anyway: Doctors these days advise, not dictate and patients struggle to make the right choices. *Doctors have to let patients make bad choices despite their objections.*The case of the red leg: Gut feeling are sometimes all you have and often they are dead on. In the absence of this all that is left is statistics.SUMMARYThis book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea. Others associated with medical errors, bad doctors, cases that were swayed by errors and hunches. If you have any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific.

⭐ Having worked as an analyst in the healthcare industry, Atul Gawande’s name is no stranger to me. His high profile work as an advisor in healthcare reform and authoritative figure in the world of medicine prompted me to pick up his most popular book, Complications. To my surprise, this book turned out to be quite different from what I expected. I began reading with the impression that it would be more in tune with the healthcare reform-directed rhetoric ubiquitously heard in the media and other public debates these days. Instead, I found Complications to be an intriguing narrative on a wide range of lesser known issues in the medical practice.Complications explores a hodgepodge of topics through each chapter. Through captivating anecdotes, situations explored include areas such as the systemic problems resulting from the way healthcare is practiced, philosophical thoughts relating to limitations in understanding the human body, and the vital role that a physician’s intuition still plays in decision making despite the improvements in technology and evidence based studies. Some of the systemic issues addressed include: the ethical dilemma in training new doctors by allowing inexperienced hands to operate on patients, how a good physician can go “bad” because of a the perverse incentives of our reimbursement system, and how performing autopsies can help improve the delivery of care. I was particularly fascinated by the medical mystery chapters of the book, which presented some common but poorly understood areas of medicine such as pain, nausea, and eating disorders. I think an underlying theme is the uncertainty of medicine – that doctors are human and the complexity of their work requires intuition based decisions, even if at times such decisions may lead to unforeseen error.Although the memoirs make some very suspenseful reading and provide an eye-opening perspective on certain problems facing healthcare, I feel that Atul steers clear of the potentially politically charged ideals. While the reading is informative, it isn’t very opinionated. I think this makes the book more enjoyable to read and leaves the reader with a greater sense of awe from the narrative. I feel like it was written not with the intention of advocating an ideology, but to tell a good story. If you are looking for a specific commentary on the social issues of healthcare familiar to public debate, you won’t find it here. However, you will find interesting views on a number of other intriguing areas in medicine, from the eyes of a surgeon. Even though Complications turned out different than I anticipated, I found it to be a very entertaining and worthwhile read.

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