Complications: A Surgeon's Notes on an Imperfect Science

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Dr. Gawande's essays are thoughtful and very well written, and it blows my mind that he was able to be such a prolific writer while doing a residency (let alone a surgical residency). I read these essays one at a time originally when they appeared in the New Yorker during my pre-med and med school days, and I enjoyed rereading them recently, now that I'm a resident myself. It is always refreshing to see honesty when it comes to the imperfections of the medical profession. His stories about dealing with his own children's medical problems are very compelling, struggling with when to relinquish control to other doctors and when to step in and advocate. I also currently find myself much more interested in the cognitive science of decision making, having to make potentially life-altering decisions in a split second, balancing multiple confounding variables along with personal styles, experiences and instincts. Another topic given well deserved scrutiny is the phenomenon of physician burnout and how the profession deals with, and often fails to deal with, "good doctors gone bad."

Dr. Gawande comes across as the type of person I wouldn't expect to enjoy working with the typical surgeon colleagues. In fact, I would love to see him address this topic in his future writings. It would take a writer of his skill to explore the stereotypical personalities and cultures of the different specialties. No one wants to over-generalize, but medical students from various schools will have very similar descriptions of the types of O.B. residents versus psychiatrists versus pediatricians versus orthopedists that they worked with. The broad, simplified version of this is along the lines seen on the TV show Scrubs, with surgeons being the jocks and internists being the geeks. That is too generalized but not entirely untrue. It's an interesting question, what perpetuates these sub-cultures, whether it is the type of person drawn to a specialty or whether people pick their careers based on who they want their colleagues to be.

In the end, even with all the discussions of mistakes, burnout, and imperfections, I found this book to be affirming about the medical profession. Affirming both as a physician and as a sometimes patient or family member of a patient. Medicine doesn't always work like it should, and doctors should not be placed on pedestals. There are real problems in the system, but there are also plenty of very dedicated, hard-working, medical professionals doing their best to overcome those problems, working to provide the best care possible to their patients, to make the best decisions possible given the limitations of our knowledge. In times of crisis, you just have to take a deep breath and then put your faith in the system.

This book is basically a collection of essays Gawande has published in the New Yorker, where he is a staff writer, along with a few from Slate. His writing style is similar to that of Malcolm Gladwell, Jerome Groopman, and other New Yorker authors of the David Remnick era - intelligent and clear.

Gawande is a surgical resident, so he is experienced enough to have insight into the medical profession and practices of surgeons, but still new enough in the field to bring a keen critical mind and the clarity of a relative outsider's perspective. Also, his compassion is one of his distinct qualities and shines through in the writing.

If you are a regular New Yorker reader, you probably have already read all of these essays. The brilliant essay about why doctors make mistakes is included, as well as memorable essays about when good doctors go bad, and how the practice of autopsy goes in and out of fashion. The only one that was new to me was the one about a surgeons' convention, which was entertaining but not crucial reading. It is nice to have them all in once place, but unless you are a completist or a rabid Gawande fan, I'd recommend getting it from the library or waiting for the paperback.

"Complications", by Dr. Atul Gawande is a very gutsy and honest discussion about medicine in general, and surgeons in particular. The book is also unique, for unlike others of its type it is written by a surgeon that is starting his career, and not looking back upon it. I would imagine that the book caused some consternation amongst his peers. The book does nothing to minimize the skills and accomplishments of the men and women who can reach in to the body and do some pretty spectacular work. The book does portray them as human beings that come with all the normal traits that any of us do. The pressure they must deal with is that when they make a mistake, it can irreparably harm or cause the death of the patient they are trying to help.

The vast majority of careers that people practice does not involve decisions that can cause the outcomes I mention above. And few occupations require of their practitioners near perfection, that if not delivered has a major legal industry prepared to hammer them with lawsuits. Incompetent or negligent doctors should be punished and removed from practice, but what about a human error, or a doctor that makes every single decision that is correct and appropriate for the patient he or she sees, and misses the 1 in 250,000 cases where doing everything correctly can cause a patient to die. The final chapter of this book deals with exactly those type of odds. Whether those odds are beaten often depends on the instincts of the physician. And these intuitive feelings they may or may not act upon are certainly helped by experience, but younger doctors without the years that familiarity brings can often make a decision largely because they are so new. Dr. Gawande makes clear that all the sophisticated technology available does not replace the one on one interaction with the patient.

If we ever need a surgeon we want a person we perceive as experienced, a person we are literally willing to risk our health and our lives with. The problem is that virtually no one wants to be part of a new surgeon learning his craft even with very experienced surgeons standing right at the table, watching and even directing the path the surgery takes. Dr. Gawande also shares his feelings when his children are ill and the contradictions he deals with as a parent, even as he is often on the other side with people judging him and his youth.

The statistics say that a surgeon will make a given mistake once every 200 times he or she performs a surgery that is described in the book, and that is also fairly common. If the mistake is made the results range from terrible to potentially terminal. The author does a great job of sharing what it feels like to be told that you will make the mistake, that doing the task 99.5% of the time without error can still cost a life.

A person who decides to become a general surgeon will study and practice until their mid 30's before they are able to operate on their own. That type of commitment is rare, and recent articles have said that less men and women are willing to devote that much of their lives before beginning their chosen career.

We want these people to be perfect when it is either we, or someone we care about that is to be operated on. They are not perfect, although those that are excellent can statistically come very near perfection. I would trust Dr. Gawande for he is a man that is clearly skilled, but is also acutely aware of how fine a line he walks every moment of his day.

I found Complications by Atul Gawande to be an exciting read from cover to cover. It is filled with a variety of topics centering around medicine's fallibility, mystery, and uncertainty, as perceived by Gawande who is himself a surgeon. Gawande's mastery of language makes each chapter come to life by developing the situation and revealing topics often ignored by the medical community. He also does a great job of leaving his own bias or opinions out of the chapters. This undirected, yet thought-provoking prose was ideal for our small-group discussion class which read his book. We found many topics to discuss and ethical issues to ponder. Although our time was limited as a class, I believe we could have spent much more time digging deeper into the issues Gawande addressed. Issues that we especially enjoyed pondering included the idea of "practicing" medicine on patients as part of the educational process, the robot feel of sub-specialty medicine vs. primary care medicine, and the stories of patients living with medical problems such as the "man who couldn't stop eating." Overall, I highly recommend this collection of short stories both because it is a delight to read, and because it raises some very interesting ideas that I hope to further investigate.

Jordan Wilson

Medical Student
UMD School of Medicine

"Complications" is a compendium of essays by surgeon Atul Gawande, with their overriding theme being the fallibility of medical science / the medical system.

This is a great book, first and foremost because it is an engrossing read. This is a work of nonfiction, but each essay has a plot that will keep the reader transfixed.

This book is also a careful and honest examination of many of the important issues with which modern medicine struggles. As a physician-in-training, I can empathize with "Education of a Knife," in which Gawande grapples with the fact that medical procedures are skills which require real-time practice... meaning that in order to have well-trained doctors, not-yet trained doctors have to practice risky procedures on real-life patients (one of whom might be you someday).

My favorite essay is one near the end in which Gawande reviews the case of a woman who had a slight possibility of having the dreaded necrotizing fasciitis (that's "flesh-eating bacteria" to you non-medheads). Had the decisions in her case been based on strict empirical medicine or decision analysis, rather than a vague clinical hunch, her outcome may have been much different. The essay ties together the themes of the book perfectly, underscoring the fact that that the "human factor," the cause of errors in so many cases, still cannot be discarded because our empirical methods and other diagnostic tools are still so primitive.

Although Gawande focuses more on questions than on answers, I think that this may well be a milestone book in medicine. Merely exploring the fallibility of medicine in such an honest, careful way is extremely valuable in that it teaches great humility -- something many doctors could use a little more of. Moreover, discussion of the limits of medicine is what will ultimately improve it. (Note that it is the recognition of the inevitability of human error that has led the field of anesthesia to develop failsafe systems which have so dramatically improved anesthesia safety over the past few decades.)

Awesome work -- thought provoking and actually fun to read. I can't believe that a surgical resident (with KIDS!!!) found the time to produce such great writing -- when does this guy sleep?

Medical schools should consider making some of these essays required reading.

Rarely do I think a book is so important and so good that it should be read by everyone. Atul Gawande has written such a book.

America has the best health care in the world and yet our health care system is a mess. High insurance rates and malpractice suits make for a situation where patients often cannot get the help they need and many doctors are afraid of taking risks because of the chance of being sued. With a willingness to realize certain things and make some changes, America could turn it's medical services into a true blessing for all of its citizens.

What is the most important realization? That doctors are human beings and even the best of them are going to make mistakes from time to time. This is probably the most important point Gawande makes in his book. It is a sad state of affairs when every single doctor in this nation expects to be the defendant in a major lawsuit at least once in their careers. How many possible brilliant doctors has this single fact driven from the profession? It is one thing when a doctor makes an error through maliciousness but a doctor who makes an honest mistake should not have to fear career destruction. If something could be done about all this litigation, it would likely be easier to drive truly bad doctors from the profession because doctors and hospitals would be more like to start admitting when things go haywire and actually make a concerted effort to try to make things better.

Though his insights into what it's like to be a doctor are incredibly valuable, I find his views on the psychology of being a patient interesting as well. His articles on the mystery of pain, the horrors of nausea & blushing (yes, blushing) and the results of a patient who has undergone gastric bypass surgery for obesity are eye-openers. He also has a very good chapter on the ethics of medical decision-making between a patient and doctor. Those people in the camp that all medical decision should be left up to the patient need to understand that, in many cases, the patient simply doesn't want to make that decision.

I had read much of the material that is in this book before as Gawande has published in various magazines. But I kept an eye out for this and I am glad to see it all gathered together in a single volume. It has been awhile since I've been so impressed by a book.

There is a lot to like in this self-portrait of a physician. OK, now here's a guy who has a long list of life's best ticket punches. He grew up as the privileged son of a double-doctor couple in a verdant, genteel Ohio college town. He went to Stanford, then Oxford, then Harvard. Now, he's in residency, training to be a surgeon, a more prestigious medical specialty than either of his parents had. He is a published author, both in the medical research literature and in the popular press. I know about him because I've read his articles in the New Yorker.

But the self-portrait that emerges is one of a humble, compassionate and well-rounded human being who just happens to have a first-class analytical mind and formidable skill with a pen. He admits to having no particular talent as a surgeon, just a dogged determination to master a complex set of skills. He makes mistakes, but he has some lucky breaks, too. He has a national reputation because of his New Yorker articles, but he wanders anonymously through his professional conference, acting like a first-year graduate student, feeling bemused and bewildered and lucky to be there. He finds time in his busy life to visit his patients at home because he wants to know if the surgery he performed on them did any good.

Dr. Gawande sounds like the kind of doctor I would like to have. In one beautiful sentence that soars off the page near the end of his book, he states his credo as a physician: to have that one "crystalline" moment in another person's life when his intervention alters its course for the better. I was awed and humbled by that sentence because I know that I can't state my professional goal so succintly or so poetically. Since the sentence was at the very end of the book, Dr. Gawande had deftly preceded it with the weight of evidence necessary for a merely rational person to figure out that the odds were stacked against him. As he says in many ways throughout the book, medical knowledge and clinical skill are always imperfect, so such moments are rare and fleeting.

But when I thought about Dr. Gawande's sentence more deeply, I found it disturbing. A generation ago, the ideal doctor was a Dr. Welby-like character, who delivered you and your sister and your mother and knew that all of you had a sweet tooth. Maybe managed care has damaged our health-care system so profoundly that all we get now is one moment with a doctor. If we're extremely lucky, that doctor may be a Harvard-educated surgeon like Dr. Gawande, who is not yet cynical about his job and is having a good day.

One of Dr. Gawande's own cases illustrates a big problem with his credo. A woman shows up in a surgeon's office after a mammogram revealed suspicious microcalcifications in her left breast. She was upset because the surgeon recommended a biopsy. This was the fourth time that her breast would be biopsied and it was already disfigured from the previous attempts. And all of those earlier biopsies had come back benign. "I'm not getting another goddamed biopsy," she said. Every time I come in here, you people find these specks and want to operate.

Dr. Gawande's response was to try to persuade the patient to change her mind because the abnormal mammogram could be an early symptom of cancer. But rather than discus with her the large body of literature that shows that the history of breast cancer surgery is a history of overtreatment, that there are many biases built into the culture of medicine and surgery that predispose to overtreatment, and that patient pressure has forced doctors to scale back their mutilating therapies, Dr. Gawande offers a cheap rhetorical trick. A good doctor, he says, will let the woman get dressed and invite her into his office, where they will sit side by side in comfortable chairs. He will say: Every time you come in here, we find something. And every time we do a biopsy, it's benign. As Dr. Gawande writes, these sentences show empathy because they convey to the patient that she's been heard. But the only thing the doctor actually did was repeat what she said.

So maybe that crystalline moment isn't enough time for a genuine conversation. If Dr. Gawande can't pull it off, with his obvious communication and people skills, then who can?

There are other writing doctors around, but there's nobody like Atul Gawande. I'd first got to know his voice, his distinctive approach -- immense vivid medical detail combined with an almost philosophical interest in the systemic or ethical dimensions of the problems he explores--in the pages of The New Yorker. But there's a lot here that never appeared in that magazine, and, besides, the whole really is greater than the sum of its part. His arguments -- about the fallibility of medicine, about judgment under conditions of uncertainty, etc. -- run through the chapters like sinews. "Complications" is a genuine page turner, but you come away not only entertained, but enlightened, too. I've recommended it to a lot of my friends, and nobody's been disappointed yet.

People often take medical care for granted, but anyone who lives through an injury or illness (their own or a loved one's) experiences the complex set of issues discussed in Atul Gawande's fascinating book.

"Complications" is presented in three sections, abstractly named Infallibility, Mystery, and Uncertainty.

INFALLIBILITY

We've all read other books about medical education and training, but Gawande states the realities chillingly: "Like the tennis player and the oboist and the guy who fixes hard drives, we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon."

From the inexperience of the intern to the ubiquitous medical error to the burned-out doctor gone careless, medical care is saddled with the variability of all human endeavors. In the second chapter of this section Gawande outlines two examples of reducing that variability -- what he calls "the quest for machinelike perfection in the delivery of care."

A Swedish study, led by an expert in artificial intelligence, fed EKGs and the multitude of factors involved in their interpretation into a computer and trained it to do 20 percent better than a cardiologist in determining whether a patient had had a heart attack.

The second example involves a medical center outside Toronto -- the Shouldice Hospital -- where hernia repair is the only operation performed. Due to "routinization and repetition," variations are ironed out of the process and near perfection is attained.

A particularly interesting chapter details how patient safety was deliberately engineered into the delivery of anesthesia, dropping the death rate to 20 percent of what it had been in only a decade.

MYSTERY

The second section of "Complications" explores several conditions that are particularly fraught with intangibles: chronic pain, nausea and vomiting, blushing, and obesity. These conditions and their possible treatments (gastric stapling and bypass, in the case of obesity) are explored with humility and respect.

UNCERTAINTY

The several issues covered in the final section highlight the frequent difficulty of knowing the best thing to do. Gawande explores the modern concept of patient autonomy in decision-making, a welcome turnaround from the paternalism of earlier times. These chapters detail cases where the best decision is by no means clear, even with a second and third opinion. Decision theory, he points out, is a good predictor in the aggregate, but of little use in the individual case.

Gawande's essays (some of which were previously published) are loosely linked in theme, but together they give a fascinating look at the realities of medical care and decision making. Though some treatments and statistics may have changed in the six years since "Complications" was published, the underlying realities are enduring.

The most telling metaphor in Gawande's book is that of the hurricane and the ice cube: science, he says, can give a good statistical prediction of what a hurricane will do. But it can state with 100% certainty that an ice cube thrown into a fire will melt. Medicine, he shows us, is more the hurricane than the ice cube.

Linda Bulger, 2008

I read this book while convalescing from surgery,therefore with recent 'experience" from both sides of the blade. I was amazed at the impressive insight and expressiveness of this surgical resident who only starting his medical career. His descriptions of various controversial medical themes and dilemas evoked many of my own experiences,emotions and my own impressions of how it is that we solve our daily medical mysteries that rarely conform to the textbooks. I've recommended this book to my son who is contemplating a career in medicine, I think he'll understand better what he might be getting himself into. I am anxious to follow any subsequent writings of this writer to see what I think will be an interesting evolution as he becomes first an attending physician and then deals with many more challenging experiences that will leave him even more perplexed,doubting,dispirited,uncertain but at the same time elated by his many clinical triumphs.

Yes, this is a book by a surgeon, and there are certain, um, "graphic" descriptions in this book. But it's well worth your while to read them, even if they make you feel goosy, in order to learn from this incredibly talented writer, surgeon, and ethicist.

Some ethical questions:
- Should a doctor act on hunches?
- What if the action might be risky?
- Should a teaching hospital let a junior doctor operate on YOU?
- Will the hospital even tell you if this happens?

A big one:
- Is it ever right to ignore a patient's plea to "Please don't put me on a machine"?

You may think you know the answer to the last one, but after you read his description of an actual patient who said this, you'll be much less sure.

And what about when a doctor is sure of his diagnosis - is the doctor right? How often? Well, it happens that there _is_ a way to find out, and it was commonly used 50 years ago. We just don't like to use it much, anymore. It's called an autopsy. But in the few cases where it is still used, there are surprises.

What an incredibly informative book. Read it. Get past the blood, you'll be glad you did. You'll see your doctor, and medicine, and your own body, in a whole new light.

This book has gotten rave reviews but I was not so impressed. Dr. Gawande describes his training in a large academic medical center where every test, scan and specialist is available at the snap of ones fingers. Mobs of specialists descend on complicated patients like swarms of locust. Dr. Gawande describes one anxiety filled period time when he has to wait a full 20 minutes for one such specialist to appear. This is not how most medicine is practiced. I think Dr. Gawande should do a shift in a rural emergency room to learn what real uncertainty is all about.

Atul Gawande's book, Complications: A Surgeon's Notes on an Imperfect Science, is a great read for anyone involved in the world of medicine: patients, nurses, medical students, or even physicians. I feel just about anyone can take something away from this account of medicine's triumphs, fallbacks and mystery.
In the book, Gawande analyzes medicine as seen through his own medical training and professional career. The reader discovers throughout the collection of true stories that medicine is not the highly tuned and infallible body of knowledge and procedure that it seems to be, but a system riddled with uncertainty, error and complications; an imperfect science applied by fallible hands... the hands of human physicians.
But with this unsettling presentation of the drawbacks of medicine, Gawande also gives some indications of the virtues of the practice: its empathy for the people it serves, its genuine drive to help, and its struggle for perfection.
Again, to read this collection of short stories, the reader will surely come away with not so much a sense of skepticism of the practice of medicine, but rather a finer appreciation for its art and humanity.

When I entered medical school, friends and relatives sent numerous articles about medicine from a wide variety of sources. While many were interesting, Atul Gawande's "Final Cut" from The New Yorker caught my attention. His writing style invited me into the world of autopsies, historically and currently, with all of the underlying questions that they entail. While autopsies are not generally considered standard dinner conversation material, I found myself discussing the article with friends both in and outside of the medical community.

Needless to say, having the chance to read Gawande's Complications, which includes "Final Cut", as part of my medical training was wonderful. Gawande addresses many issues of medicine from an informed perspective, and gives us a window into a world most of us will never see. Yet, the issues affect us all as patients.

In particular, his essay "Education of a Knife", exploring the unspoken and often unknowing consent patients give to have physicians in training `practice' on them, generated a lot of conversations between my classmates, as we saw bits of his descriptions within our own experiences with patients. Other chapters took on less specific topics, using illustrative case histories to illuminate chronic pain, the limitations of our scientific/medical knowledge and abilities, the culture of medical professionals, and even the important issue of when things go wrong. All of these essays stand well on their own, but together they make for a powerful collection.

While Gawande offers no specific answers or even strong opinions on the topics, his thorough descriptions invite the reader to ponder the issue for themselves, and linger long after the final page has turned. Gawande, as a surgeon, has seen a great deal of the system, and has found a way to share that with the rest of us. This fact, perhaps, makes this collection of essays one of the best parts of my medical education, and I guarantee it is worth reading and thinking about for anyone.

The medical profession, for much of its lifetime, has been shrouded in mystery. For many, the words and judgements of a doctor seem infallible, which is why there is often such incredulity associated with mistakes. It's only been in the past few decades that this has changed and people are learning that doctors are humans too. In Atul Gawunde's book, we get a behind the scenes look at his life as a resident in Internal Medicine and some of the truths that people must accept take place when they enter a hospital. What amazes me most about Gawunde's writing is his use of anecdotes to perpetuate his arguments and ideas. His experiences have been so rich and varied that he is able to draw upon so many fascinating cases to highlight some of the great and some of the not so great aspects of medicine and of learning to be a physician. Anyone who would like to be a doctor - and especially those who want to go into any surgical field - will benefit from this open and honest account of what it truly means to be a doctor. I was thoroughly engaged and even scared to learn about what often goes on in the mind of the person wielding the scalpel blade.

Gawande is an outstanding writer who gets right to the heart of some of the most difficult, painful, and controversial issues in modern medicine. Is there any way train new doctors without giving them the chance to work on real, live people (and thus make potentially fatal erros)? Why do even experienced doctors make serious mistakes, and why do we expect them to be infallable? Who should make critical medical decisions: the patient or the patient's doctor?

Both my mom and my former wife were register nurses (RNs), so I tend to have a somewhat skeptical view of doctors. Gawande did much to give me greater sympathy for the medical profession and the challenges it faces, without understating or rationalizing away the critical issues within the profession. Read it. ..bruce..

Even in a wonderfully literate magazine such as The New Yorker, Dr. Atul Gawande's articles have always stood out. Dr. Gawande is a staff writer for the magazine and he writes about issues he can deeply relate to-the science and complexities of medicine. Complications: A Surgeon's Notes On An Imperfect Science is a compilation of many of Gawande's essays, a few of which have appeared before in the New Yorker. Many of the essays, however, are new.

It is immediately apparent upon reading the book what an extremely humble person Dr. Gawande is. Even as a resident surgeon in a prestigious hospital in Boston, he retains a special capacity to see the human side of the person laid out on the operating table. Dr. Gawande is able to distance himself from his profession and analyze its faults and shortcomings (including his own).

Complications, nominated for the National Book Award this year, is divided into three categories. In the first, Dr. Gawande focuses on the fallibility of surgeons. In one of the most honest statements in the book (and there are many!) he says, "Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however-close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes-is how messy, uncertain, and also how surprising medicine turns out to be." Surgeons, it turns out, are only human, and they do make mistakes on the job. All have to learn on the operating floor. It is a fine line between learning and the betterment of all patients with no harm caused.

The second part of Complications deals with the mysteries surrounding some of the most common of physical ailments-pain, blushing, obesity, morning sickness to name a few. It is in these pages that I was struck by how keen Dr. Gawande is to keep track of his patients. He continues to be in their lives long after the surgery has been done.

Dr. Gawande addresses the uncertainties that plague medical decisions in the last part of his book. How much rights do patients have when the doctor knows "what is good for them". The book features a brilliant discussion of patient autonomy. "The new orthodoxy about patient autonomy has a hard time acknowledging an awkward truth: patients frequently don't want the freedom that we've given them. That is, they're glad to have their autonomy respected, but the exercise of that autonomy means being able to relinquish it." In one of many personal examples in the book, the author himself admits to letting his doctors decide how to care for his premature baby when she was gasping for breath. Sometimes laying the entire decision burden of patient care on the patient can be too emotionally exhausting.

Apart from Dr. Gawande's precise writing (the book reads like a thriller!), I was struck by his strong feelings for the socio-economic underprivileged. He does not neglect to make the case that in a medical setting where learning needs to be done it is often at the expense of the underprivileged or the uninformed. The doctor's child gets special treatment, but the truck driver's child doesn't.

Complications is the kind of wonderful book that makes me feel better prepared the next time I or one of my own is lined up on the operating table. I have been given a view into how the system works. I know I can keep myself informed and hope for the best. If I am lucky, my surgeon will be like Dr. Atul Gawande, capable, sincere, and a person who knows how to "preserve kindness."

This book reveals surgeons as human beings who learn and practice surgery, with the emphasis on the words human beings. Dr. Gawande exposes the myth of doctor perfection and replaces it with a compassionate look at the humanity of surgeons. Of course this comes at the price of a loss of confidence in surgeons or at least a heightened sense of concern when someone you know goes into the hospital.

Do surgeons make mistakes? They learn and practice on people and as part of that process they make mistakes. So should you use only experienced surgeons? What if they are not up to date on a newer and safer technique? They still have to learn and practice them. Where will our next generation of experienced surgeons come from if no one would use the less experienced ones?
These are tough questions that must be answered. It is easy to say that surgeons need to practice on people and should be encouraged to while under the supervision of a more experienced surgeon, but what if it is your child being operated on? Gawande even shares his experiences as he had to deal with this situation.

A thought-provoking and revealing book it will educate and entertain. For people who want to see the human side of the surgeon's profession it is a recommended read.

Being in the medical field, I found myself pretty engrossed in Atul Gawande's COMPLICATIONS. But even if you're not in medicine, there's no reason you shouldn't pick up the book. Focusing on both sides of the scalpel (those that get cut as well as those that do the cutting), the vignettes sketched out here are hit upon with compassion, thoughtfulness, and razor-sharp telling ("We have taken [medicine] to be both more perfect than it is and less extraordinary than it can be.")

Gawande holds back nothing in his narrative. One chapter will discuss the evolution of a surgeon and how perilous and dangerous it can be ("Everyone wants a surgeon with experience, but how does a new surgeon become the veteran?"), while the next will look at how effective specialized medicine is (a hospital that does ONLY hernia operations and how incredibly successful those surgeons are).

The most frightening portion of the book -- for me -- was the discussion on dangerous doctors (chapter 5: When Good Doctors Go Bad). When MD's get older and can't function as well, or get burned out, or simply can't keep up with new medical technology, there's no system in place to remove them. The AMA, local affiliate groups, none have the sole power to remove a doctor until it is often too late for the patients (Gawande's examples are horrifying, showing us an orthopedist who had more law suits pending against him than patients in his practice, and still he practiced and operated).

The big flaw with this "novel" is that it isn't novel at all. It is a compilation of short stories without a core. Whipping back and forth between medical superstitions in one chapter to the study of subjective pain the next, there's no rhyme or reason to the placement of chapters within the book. This isn't all bad, though, just something the reader should be aware of before digging in.

Regardless, it is an eye-opener to those in the medical profession and those who are patients within it. Gawande is as sharp with his pen as he is with his scalpel. And he spares no one; from the physicians within his own cadre, to the misconceptions patients hold for their care givers.

Complications should be required reading by all physicians, past, present and, especially, future simply because it is brutally honest and keeps its perspective tightly woven toward patient care.

my husband is starting his general surgery residency this summer. i read this book a few years ago at his recommendation. it's opened my eyes to his world. i'm able to understand what he does so much better. the book is superbly written! my husband met Atul Gawande at one of his interviews and is in awe of him and his accomplishments. a must read for all of us who live this life of the surgeon.

We're inundated with medical information every day. Much of it is hype, or half-digested research work proposing cures for every known disease or ailment, "and all you have to do is ...."

Gawande is a brilliant writer, but his main gig is as a resident surgeon. He explores many medical issues and ethical dilemmas in this book, illustrated throughout with real-life examples and case studies. You are certain to learn something from reading his collected essays, even if he sometimes raises more doubts in your mind about medical practice than you might care to enjoy.

All of these essays have appeared elsewhere, but that doesn't detract from their power as a carefully sequenced collection. Highly recommended.

I find this book which has gotten such rave reviews disappointing. Dr. Gawande addresses a number of issues which are pertinent to surgical practice. However,I found the book to be superficial and lacking of "heart".

I will elicudate. Dr. Gawande states frequently that surgeons slash their way into a patient.I suspect that this is for dramatic effect.There are other examples of this such as the description of an autopsy.He tones it down later.He treds lightly on the fact that doctors don't want to own their mistakes which is why there is no improvement in medical care over 20 years ago despite huge advances in both technology and costs.

The only Surgeon I have ever known who "slashed" his way into a patient ended up losing his privileges...thank God but it took many years and a yeoman's effort and those who spoke up were alienated and shunned. It was not as simple as is portrayed in this book.I do laud him for bringing up the "good doctors going bad" issue. It is a huge problem and bad doctors are often covered for years and years while patients are repetitively injured. It is also very harmful to the doctor who is creating the problem. The cost of this problem to patients, hospitals and society is staggering.

I looked up the reference that computers were better than doctors at diagnosis. It is not about medical diagnosis, it was about psychologists' diagnosis. The second article was from 1954...A bit dated. before the computer era.

I laud him for the courage in mentioning his screwed up tracheostomy attempt. There are numerous methods for both intubation and percutanous guided tracheostomy techniques that have been available for 20 years. I have to wonder why he was unaware of these. The technique that he describes for subclavian vein cathethers is also not as safe as other methods which use a small guage finding needle. I have to wonder why 20-30 years after these problems were identified that this young doctor was not being instructed in these techniques.

His chapter on bariatric surgery is notable for his mentioning of the commercialization of medicine an increasingly dangerous trend is appropriate. At this point bariatric surgery has been shown to be helpful for a large number of patients, but without question medicine has been commercialized.

His section on uncertainty is the best part of this book. He saved the best for last.

Nonetheless, I find his "laissez-faire" attitude to these problems even more worrisome.I find little actual feeling that he cared about his patients in this book. This is not surprising as it pervades medicine today.

I haven't found this book to be a thriller.It lacks depth of character. If he had connected with us and his patients emotionally I believe that it would have been a much more powerful work.

I cannot recommend this book too highly for anyone interested in medical practice as a clinician, future clinician, present or future patient, or friend or loved one of a patient. In other words, just about everyone. I am using it in my Medical Ethics (philosophy) course because each of the essays raises important bioethical questions. We are also using it for an educational session in the Pediatric Ethics Committee of a major teaching hospital.

My only regret in assigning Gawande's essays in a university course is that all of the other readings, even the best written, may seem a bit dull by comparison. Gawande is a master story-teller, and most of the essays tell compelling stories. More than anything I've read, they give the reader a feel for the drama of medical decision-making. But they do more than that because Gawande uses each narrative as a springboard for raising larger issues and, in many cases, offering insightful and compassionate suggestions for how to address them.

Gawande's essays are, in spite of the ultra-serious subject, a joy to read. They are models of clarity and among the best-written essays I've ever read (and I've been teaching over 30 years).

Gawande presents the medical profession realistically without sugar-coating. Medical errors and plain negligence are not ignored. But in the end one gains a realistic appreciation of the medical profession, of the frequent need to make life-and-death choices without the comfort of definite evidence, and of the extent and limits of patient autonomy.

This book is plain EXCELLENT!

A friend of mine suggested it, and wow, I found I had to force myself to stop reading and go back to work!

Dr AG somehow has been able to combine extremely interesting and compelling medical cases with deep considerations about the field, about being a doctor, about the limitations of medicine and how we cope with them.

Even more amazing is the humility and simplicity of the author's writing. No bragging, no self-praise, just an extremely intimate conversation on the experiences he had as a doctor, the lessons he learned and the meaning he saw through them.

The feel of the book is that of an incredibly fascinating conversation with a close friend in a warm café.

thank you Dr.!

I received this book as a gift from my residency director at the conclusion of my Emergency Medicine residency. Residency is a difficult time of self-doubt, self-effacacy and self-discovery. I found Dr. Gawande's insight and frank discussion quite refreshing. It reminded me of the humanity in this very human endeavor. I encourage all my patients, present and future to read this book and realize that the physician is human, fallable and trying to do the right thing. Dr. Gawande shows how it is the "Art of Medicine" rather than the "Science of Medicine." Must-read reading for both physicians and patients alike.

I just picked this book up by chance, didn't know much abt it, never heard of the writer but the subject matter sounded interesting. I finished the book in 2 days! What a great book abt humanity. I really like Dr Gawande - he always seemed so objective but compassionate at the same time. The stories and observations are from his point of view but he never makes it sound like it's all abt him. Dr Gawande explained the technical bits so simply and effectively - now I understand what the drama was all abt in "ER". There's so many interesting things, I had to stop reading and keep telling my husband abt them. Thank you thank you for such an eye opening book. Now I have more appreciation for doctors and the medical process. I've always been a bit confused abt how to approach doctors but Dr Gawande has at least given me the confidence to be more engaging and assert my rights as a patient. I realise now that it is a two way process - neither doctor or patient should have the upper hand. It's like what Donald Trump said - surround yourself with experts, hear what they have to say, consider what they have said, and use that to make the best decision you can. Because in the end, it is your life.

Complications explores the humanity of doctors and society's unrealistic expectations of them in interesting ways. The author's observations on how patients want perfect doctors--but don't want doctors learning/practicing on THEM--were particularly striking. (When my husband needed a bone marrow biopsy, it was done by a UW student who had only done 10 in the past--we were not too happy, but we trusted him, and the young dr. did a good job.)

The book is divided into three sections--the first and third are best, because in them, the author is relating his own experiences. The second section, while very interesting, seemed like a synthesis of others' studies. The discussions of nausea, chronic pain, and appetite are interesting--Gawande makes the latest research accessible to the layman.

Each chapter is stand-alone; the book itself has some chapters that were originally published in magazines. This makes Complications an excellent book to read on a plane or at a patient's bedside--you can leave it for days, then pick up where you left off.

As the wife of a cancer survivor, I found this book refreshingly honest--it made me even more grateful to the doctors whom God used to save my husband's life. I truly believe that it is worth searching the country to find a doctor with whom you fit--a doctor like Gawande.

I was totally taken aback by how incredibly involving and fascinating this book was. Dr. Gawande writes of the grand successes and the human imperfections of the science of medicine, and shows us how both doctors and patients are involved in the quest for improving health and saving lives. Would you consider a chapter discussing nausea and vomiting to be of interest? Dr. Gawande makes even this unappealing topic unbelievably informative and riveting. Indeed, every page is a revelation. Five stars is a poor rating for such an invaluable source of awe-inspiring essays. Required reading for everyone.

I am a great fan of Dr Gawande.
Since the first time I read his essay in the New England journal of medicine, I have expected more from him.I have read most of his pieces from the New yorker.
I think he is amazingly talented and that he will only turn out more and better books.
As a layman, I would give this a 5 stars: for once Dr Gawande has been able to describe in a medical person's perspective that would register with a layman.without the glamour and jazz.
Our fears,doubts and tribulations.
For medical personnel: this would be a 3 stars: not because it is subpar, but because he tends to simplify this a little more than I would like him too. He lost me through 3/5 ths of the book when he hit the Bariatric surgery part. I had to struggle to get back in again.
I would have liked him to tackle the other part of patient care that we, being PC, tend to avoid: difficult patients, people who live of the system, a lazy and inefficient system which chews residents and fellows and makes a mockery of ideal medicine.Of a profit driven insurance system and a medicare/ medicaid system which promotes mediocrity.
But maybe that is another book.
a must read for pre meds and parents of pre meds.

This is the sobering message of Atul Gawande's excellent book. A writer for the "New Yorker" as well as a practicing surgeon (how does he do it?), Gawande reflects on his profession as it really is--human beings trying to help other human beings.

Gawande makes a persuasive case, on the one hand, for the routinization of medicine. He cites the amazing record of a hospital in Toronto which does only hernia operations. The goal is not a high success rate, but perfection, and the doctors there do hundreds of hernia repairs in a year--more than a general surgeon does in a lifetime. But Gawande also points out that fallibility is the price humans pay for being instinctive, for having that sixth sense that all of us often ignore at our peril. It was this sense that saved the life of a young patient who appeared to have a simple bacterial infection--having seen a far more deadly form of it recently, Gawande urged a biopsy, and against all odds he was right. An over-conscientious resident? Was he overdiagnosing? Performing an unnecessary, costly test? That's what we'd say if he had been wrong.

Gawande writes with a humility and sensitivity that the stereotype of the typical surgeon doesn't have. We owe it to ourselves to be well-informed as consumers of medical services--but that needn't be burdensome or boring. I highly recommend "Complications."

I am considering a career change to medicine and have recently undergone several surgeries myself. This was an eye-opening book that says what you know deep down, but that doctors usually will not admit: They may try their best, but they do not have all the answers and they do make mistakes. It's thoughtfully written, and full of compassion for his patients. It made me wish Dr. Gawande was my doctor. Every doctor should read to not lose sight of the patient perspective, and every patient should read to understand why they cannot expect perfection from medicine.

This is a very good book. I've enjoyed it and have shared it with many other friends and family.

+++++

This book by surgical resident and medical & science writer Dr. Atul Gawande is about surgical medicine and how it is an "imperfect science." Gawande elaborates:

"As pervasive as medicine has become in modern life, it remains mostly hidden and often misunderstood. We have taken it to be more perfect than it is and less extraordinary than it can be."

This easy to read book is divided into three sections:

(1) Fallibility of Surgeons.

It asks, among other things, how mistakes happen, how a novice learns to cut into a living human, what a good doctor is, and how it is that a good one could go bad.

(2) Mysteries and Unknowns of Medicine.

It struggles as to precisely what to do about them. Included in this part is a story about a young women whose awful nausea won't go away and a T.V. newscaster whose blushing became so severe that she could no longer function in her job.

(3) Uncertainty in Medicine. Gawande explains:

"What seems most vital and interesting is not how much we in medicine know but how much we don't-and how we might grapple with that ignorance more wisely."

There are two main things I liked about this book:

(1) Real-Life Surgical Stories. I felt I was alongside Gawande when he was doing an operation. Knowing some basic anatomy would be helpful in understanding the full impact of these stories.

(2) Gawande's Honesty. Personally, I was expecting defensiveness but to my surprise there was complete honesty throughout the book which I found refreshing. For example, here is a quotation from the excellent introduction:

"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 [are] on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing."

Here are five more examples:

(1) "Do we ever tell patients that because we [meaning surgical residents] are still new at something, their risks will inevitably be higher, and that they'd likely do better with others who are more experienced?...[W]ho in their right mind would agree to be practiced upon?"
(2) "[A]ll doctors make terrible mistakes." Several chapters later he says, "Equally troubling, people seem happy to let us off the hook [for our mistakes]."
(3) "Most surgeons are sued at least once in the course of their careers."
(4) "Mistakes are an inevitable part of medicine."
(5) "Medicine's ground state is uncertainty. And wisdom-for both patients and doctors-is defined by how one copes with it."

Who is this book for? I would say for all people since we all have the potential of landing on a surgeon's table. People who idolize doctors and surgeons (for example, those with the annoying habit of calling doctors "docs") will probably raise their eyebrows when reading some sections of this book. Personally, I wonder how Gawande was perceived by his fellow colleagues after this book was published.

Finally, to get more insight into medicine and the people who practice it, I recommend these two books:

"Confessions of a Medical Heretic" by Robert Mendelsohn, M.D. and "The Medical Mafia" by Guylaine Lanctot, M.D.

In conclusion, this honest book contains a surgeon's notes on an imperfect science. I guarantee that after you read it, you will never look at a surgeon the same way again!!

(first published 2002; author's note; introduction; 3 parts or 14 chapters; main narrative 250 pages; notes; acknowledgements)

+++++

If you have ever been a surgical patient, or expect you might become one in the future, I highly recommend that you read Dr. Atul Gawande's "Complications: A Surgeon's Notes on an Imperfect Science". If you are a medical student, I highly recommend that you read the book twice - once for you and then again for your patients.

Gawande, as a seventh year Harvard surgical resident, offers reflective insight regarding his observations and experience as a surgeon. From failed attempts to insert a central line as a new resident, to his pride of attending his first medical conference with more senior house personnel, readers easily share in his frustrations, delights, and challenges.

This book will encourage you to appreciate the ethical dilemmas surgeons face as they evaluate new procedures and self-police their own performance and that of their peers. Gawande reveals that even surgeons are mystified by the amazing human body and sometimes cannot explain how or why our bodies react the way they do to surgery.

This book should not be mistaken for a gruesome account of risky surgical procedures performed late at night by sleepy-eyed residents. Gawande's descriptions of his patients and their surgical cases are detailed, but he provides them as intellectual case-in-points rather than the yellow journalism of blood and guts shown on TV and in the movies.

This book will make you think...sometimes harder than you want to...it may even make you realize that surgery is not perfect and neither are even the best surgeons.

A real page turner and a fast read. Don't cheat yourself by skipping over this one!

This book describes the imperfect science that is medicine. From the training of up and coming doctors to the burnout that befalls those on top of their game, Atul Gawande deftly explains the power and fallibility that comes with wearing a white coat. His stories talk about some of the wonders and mysteries of medicine. Gawande also explores the delicate process of how doctors balance their need to train with respecting their patients' rights to quality health care. This author also raises some interesting questions that are part of everyday medicine and presents the challenges of being in a demanding profession. His stories are delivered in an unbiased manner that is both provocative and entertaining. I enjoyed the style of this book and the issues that were addressed. This book also made for good small group discussion and I would recommend it to students who are pursuing careers in medicine.

Atul Gawande writes with great ease and honesty about some of the most interesting and pressing issues in medicine today. In a typical chapter he first defines an issue by introducing an anecdotal account (either his own, or someone he has met). As soon as the main issues of the story become clear through his "novel-like" style he pulls the reader away for a minute to analyze these issues with statistics and a world of scientific data that he handily interprets for the non-physician. Without bias, he educates the reader on the many angles different people have looked at the issue from, then he returns to the unfinished story to let you know what decisions were finally made and why, and, often, what could be done the same or differently. He bravely and openly critiques certain aspects of medicine and defends others, and even addresses alternative methods of delivering health care that might seem somewhat odd in today's society, such as the account of a team of Canadian doctors who do nothing but hernia repairs. Such "assembly line" medicine has been debated, but he presents a fair, evidence based interpretation of their results. Gawande is a surgical resident who has obviously taken great efforts to understand the world of medicine in which he is immersed, including not only issues of training, and practice, but also of ethics and humanism in a money-conscious society. This book will benefit the health care worker as well as the non-health care worker, since it touches on many issues that people will sooner or later deal with in their own lives. I highly recommend this book - it will make you think about the world in which we live.

Gawande does a superb job of showing how modern medicine isn't the exact cut and dry science that we wish it to be. By taking various surgical cases and placing them into a new light, he creates short stories that are both antedotal and a exciting to read. From chronic pain to supersitions, Gawande gives wonderful insight into broad topics.

I always find myself starting novels, but never finishing them--that's what's nice about the short story approach--each chapter is a separate case or story which makes it almost impossible to get lost.

Finally, I enjoyed Gawande's perspective on medicine. It is truly amazing how observant he is. Everyone would like to believe that his/her doctor is perfect, that the advice or diagnosis or surgery is always correct, however we know that behind the white coat lies a fallible human. Gawande's advice for the doctor: "No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it."

Complications: A Surgeon's Notes on an Imperfect Science, by Atul Gawande, caught me off guard. I had been reading The Best American Science Writing, 2006, and I was encouraged to drop that one and pick up a copy of Complications. In this I failed, since I was attempting to get others to drop their reading of Complications and to instead read The Best American Science Writing (full of intriguing articles on a broad range of topics). So, I started reading Complications. Then I noticed that not only had Dr. Gawande written articles in the past volumes of The Best American Science Writing (at least for 2004 and 2005), but he had been the editor of this volume in 2006!

I guess I should be paying closer attention to these things. The style of his writing is reflected in the choices he made as an editor for The Best American Science Writing, 2006.

Gawande's format reminds me of the writings of Lewis Thomas (Lives of a Cell: Notes of a Biology Watcher): focused on the interface of biology, medicine, and human behavior. Whereas Thomas' writings do sound "old" today, Gawande, obviously, discusses the cutting edge concerns and issues affecting medicine.

He begins by stating that "Western medicine is dominated by a single imperative - the quest for machinelike perfection in the delivery of care" (p. 37). He then outlines numerous examples from his own experiences where he agonizes over his decisions (perhaps "agonizes" is too strong a word... no, it isn't).

People (the clients of providers of medical services) want the best. Doctors sometimes give it to them. Mixed in this menu of selections is patient consent, professional decision-making, mental illness, the search in humans for patterns, physical versus mental conundrums, detective processes, compassion, error evaluation, and the cutting edge of modern medicine.

In all probability, most readers of Complications will, at some time in their life (and death), have to deal with issues raised by Gawande. When you do, ask your physician if they have read Complications. Choose the physicians who have... they are the ones who strive to see the "bigger picture." And to be fair, the physicians should ask their patients if they have read this same book! Alas, the vast majority will not have even heard of it, and they will ask for the perfection that Gawande, sadly, cannot deliver.

Atul Gawande's book "Complications" is a rewarding read on many levels. The reader is drawn in smoothly along a thread of entertaining medical vignettes. These anecdotes serve as the framework for a set of well reasoned essays that explore the inner life of the surgeon. Gawande's primary purpose is to convey the various challenges, surprises, and contradictions that he has encountered as a surgical resident. His scrupulous honesty in describing the motivations, limitations, exhilarations, foibles, and challenges of the surgical profession is refreshing.

I was disappointed by two omissions. Firstly, Gawande does not deal in this book with the issue of tort reform and malpractice insurance. Perhaps this will become a more significant issue for him as he moves into independent practice. Secondly, thoughout the book I kept wondering why he did not apply decision analysis to his difficult medical decisions. When in the last chapter Gewande describes an unsuccessful attempt to apply decision analysis, it is clear that the analysis methods had not been correctly taught to him. Maybe these are issues that he can address in a future book - a book which I look forward to reading.

As the title of the book, Complications: a Surgeon's Notes on an Imperfect Science suggests, the book is about Dr. Gawande's experiences working as a surgical resident. The book talks about the mishaps that happened to patients due to doctors' bad decisions and lack of experience and also the miracles and eccentric cases that nobody can explain. The events are thoroughly researched and written in detail, while refraining from the use of jargon, so that people with no knowledge of technical, surgical terms are able to understand it. The patients and their conditions described in the book are truthful and are easily related to. This book will open its reader's eyes and provide them with cruel insights of the medical world. This is an interesting read; I highly recommend it to everybody.

I highly recommend this book to any medical student, pre-med or even resident, especially the first year who struggles with the many life altering decisions one makes in the OR. Not only will medical professionals relate to this book, but lay people - future patients - will have an understanding of the importance of learning about their diseases. Fallibility exists in all humans, even physicians, but Dr. Gawande presents a great light to the world of medicine that leaves the reader with both a foundation of medicine's past and a hope for the medical future.

A fair amount of the stories in this book have only tangential ties to surgery. I was expecting the vast majority of the book to be straight from the operating room. Instead, there are several stories outside the surgical setting, as exemplified by passages on life-threatening vomiting during pregnancy and surgical conventions. Nevertheless, I was captivated while reading every page of this book. The author comes across as a very caring clinician, and this helped rope me into the reading. Also, there is enough humor to balance the necessary descriptions of the grosser side of our internal functions. I certainly didn't buy the book to learn about vomiting, but I now have a deep respect for the act. If any one of my three sons finds himself in a high school rock band, I'll recommend "retrograde giant contraction" (page 131) as a band name, and possibly suggest "prodromal phase of emesis" (page 130) as the name for the band's first CD. Don't let me mislead you, the author whips out precise surgical jargon only occasionally. I have no medical training, and I found the book a smooth read. I just finished reading the book yesterday. I'll probably read it again soon.

Gawande's style is enthralling and straightforward. His book is broken into short stories that share the beauty, mystery, honesty, and challenge of medicine. I appreciated that Gawande presented his stories in a straightforward manner without shading the information for or against medicine. They leave you with a sense of wonder and reflection. Most of all, they provide the reader with an appreciation for what is means to be a physician and what the world of medicine is really entails.

I think this book is an excellent selection for anyone who is in the field of medicine, considering the field of medicine, or has experienced the field of medicine. It is a truly enjoyable read with much to offer.

As a second year medical student, I found the book "Complications: A Surgeon's Notes on an Imperfect Science" by Atul Gawande to be quite deserving of my time. Gawande's writing style makes for a fast-paced and intellectually satisfying read. He makes pertinent points about many areas of medicine, particularly that physicians are fallible and don't always have the answers.

The book focused on Gawande's training as a surgeon, and also dealt with patients whose problems presented a unique challenge. Another aspect of the book dealt with M&M, or Morbidity & Mortality Conferences. These meetings are attended by physicians to discuss the cases that went wrong during the previous week, and see what could have been done different in order to rectify the situation. Gawande was privy to one of these meetings, as a mistake made by him was reviewed at the M&M conference. The attending physician took responsibility for Gawande's action, as he was head of the team. This situation provided insight into both the training of a future surgeon, and the difficulties physician's face during their training years.

Overall, this book was a fascinating read. I highly recommend it for both the health care professional and for those individuals who are interested in the process of training future physicians.

Well, not exactly. All doctors aren't perfect. Atul Gawande's book, "Complications: A Surgeon's Notes on An Imperfect Science" clearly explains why doctors aren't perfect. The fact is that all humans make mistakes, therefore doctors make mistakes. Since I'm intending on going into a medical field, this book makes me realize how much effort you have to put forth in order to receive a medical education. Atul Gawande gives you an opportunity to take a journey through his medical training and it shows the rigours of a surgical residency. Think how scary it would be performing surgery on a patient for the first time? If I were the patient I would be petrified because I wouldn't want the surgeon to make a mistake, risking my life. His incredible experiences with gastric bypass surgery, the case of the pregnant woman, the dead baby mystery, the case of the red leg, and many others kept me completely captivated with this book. The book is written in such a way that you never want to put it down. It's very intense, scary, and breathtaking, since you don't know what's going to happen with his patients. "Complications" is a must read, especially for those heading into a medical field.

Atul Gawande, who is currently finishing a medical residency in Boston, has some pretty big shoes to fill. As a surgeon writing essays about his profession for the general public, he follows in the footsteps of Richard Selzer, who has been writing wonderfully about the complexities and oddities of surgery for several decades. And writing in the pages of The New Yorker, he follows in the tradition of the great Berton Roueche, whose "Narratives of Medical Detection" are among the best pieces ever to appear in the magazine. Perhaps wisely, Dr. Gawande neither tries to be as lyrical as Dr. Selzer nor to plumb the mysteries and the adventure of medical investigation as did Roueche. Instead he offers us an entree to the world of the physician in training and tries to be scrupulously fair in his treatment of the various and often competing concerns of doctors, patients, ethicists, insurers, etc. He's generous in sharing his own experiences and discussing his mistakes and the essays are often interesting, but they are somehow antiseptic and less engaging than they might be if he took firmer positions on the issues or at least revealed more of his own opinions and prejudices.

Dr. Gawande writes that :

Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people, put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however-close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes -- is how messy, uncertain, and also surprising medicine turns out to be.

He's at his best when he's leading the reader through the mess. From doctors with psychological problems to the vagaries of diagnosis to the strange, but surely coincidental, occurrences of a Friday the 13th with a full moon, he shows us that for all the advances in medicine in recent years, there is still much we don't understand and a stubborn persistence of quite alarming human error. He's less good in essays like the one on the decline of autopsies (which happens to be on-line) when he strives so hard to take a blanced and empathetic approach that he borders on abandoning medical judgment.

The book is definitely worth reading and I'll be keeping an eye out for his essays. I suspect, and hope, that his best work lies in front of him and that as he gains experience and confidence he'll be willing to give his writing a little harder edge. Hopefully he can do that without losing his welcome humility, rare enough in doctors in general but almost unheard of in a surgeon.

An amazing thriller...

Dr.Atul's superb portrayal of finest qualities of a doctor, yet the limitations of an individual, their weekness,strengths, system flaws etc with vivid examples of real life cases makes "Complications" the best medical book I'v ever read.It's not the content of the book alone that deserves appreciation, it's also the flow of words that blend with the topic.

Certainly the pinnacle of the book is the story of Joseph Lazaroff, Atul's Anguish depicting the finest of human character and also the professionalism of a doctor, also his questions behind the ethics of "absolute insane rights of patient's expression". I felt a pain in the heart for that "unknown soul" ( a gist of that chapter is below)

Chapter : Whose body is it Anyway :
...I turned the ventilator off, and the suddenly the room was quiet .His breathing slowed ...Joseph Lazaroff had died.But Knowing how much Lazaroff had dreaded dying the way he died....

Chapter : Education of a Knife:
I said to the patient that there were "slight risks" involved.And the disasters weighed on my mind: the woman who had died from massive bleeding, the man who had to have a chest opened, the man who had a cardiac arrests.I said nothing of such things when I asked my patient's permission to do this

Chapter : When Doctors Make Mistakes:
At 2 A.M on a crisp friday in winter a few years agao, I was in sterile gown , pulling a teenage knifing victim's abdomen open, when my pager sounded "code trauma, three minutes"

Chapter : When Good doctor's Go bad:
Before the license of Dr.Goodman was taken away, he was a highly respected and sought after surgeon...he could do some of the best, most brilliant work around....In one case , he put the wrong-size screw into a patient's ankle,another case when he refused to do hip replacement. For the last several years, he was the defendent of a stream of malpractice suits.

Chapter : The Man Who Cannot stop Eating :
...He had to let his legs apart to let his abdomen sag between them. He cannot lie down and breath properly because of excess fat in the tongue and upper airway. He had to sleep in the recliner and every thirty minutes or so , he would wake up asphyxating, He could no longer stand up to urinate, he had to shower after moving his bowels to get clean

A Must Read book...Afterall, someday you might be an example in his future books!

I bought this book a year back but started reading just a month ago and finished it in no time. The theme of the book is to underscore medicine being an imperfect science. I hope all people read this book and understand that medicine is an imperfect science and the result of any surgical or medical intervention may not be what they expect. Unfortunate result doesn't always mean doctors were negligent.
The first chapter highlights the dilemma of allowing novice trainees to practice the procedures to become experts. While no patient wants to be treated by a trainee resident how shall we get doctors for the future?
I particularly liked the chapters on impaired physicians, 'When Good Doctors Go Bad.'. He depicts the life of an orthopedic surgeon who suffers from depression and is forced to leave the practice. And there is very little support for the impaired physician from the hospital they work for, the state they work in. A real tragedy.
The chapters on Annual Surgeons' conference - Nine Thousand Surgeons, The computer and the Hernia Factory, The pain Perplex are readable and very informative but not as dramatic as 'Full Moon Friday the Thirteenth.'
The 'Dead Baby Mystery' depicts how criminals can take advantage of mysterious facts of medicine where in a woman killed several of her babies and claimed her babies died from 'Sudden Infant Death Syndrome.'
The last chapter 'The Case of the Red Leg' is written like a suspense story.
I couldn't put this book down. The writing flows nicely, the human drama is depicted like a TV series based in the hospital setting and it is backed by scientific data just enough to make us believe, nay, live through the incidents.
My only grievance is while Dr. Gawande works every time in the OR with anesthesiologists why did he write so little about the imperfect science of anesthesiology?
I hope may be he will in the future.

If you have ever wondered about this body of yours and about what goes on in the minds of Doctors who treat the many ailments of this body of yours,this is certainly the book for you. Never has a book of Non-fiction managed to be such a riveting read.

Atul Gawande has written with intelligence, honesty, and with extreme respect and tenderness towards the many people that he introduces the reader to. Many of the complicated procedures of surgery are described in the most understandable language,that a person with no medical training such as I , feel very smart now!!
I thank Gawande for this wonderful book, and hope to read his " Better" soon.

Gawande is a wonderful, vivid writer and this book was well chosen as a National book Award finalist. He is not afraid to admit some errors he made along the way, including some regretable hubris that harmed some patients but he also writes about the way doctors learn - and the limits and challenges they still face in the imperfect world of medicine, where so much depends on following one's instincts, in spite of so many advances.
Whether learning about how autopsies first came to be used (for religious reasons) or how a newscaster dealt with a disabling case of blushing or about how and why "Good Doctors go Bad" (and how they are treated), I found this book a rich compendium of useful facts and information.
It will also help you ask the right questions next time you have to face a medical decision, large or small, guiding you to ask the right questions of your doctor.

I read "Complications" as part of a small discussion group at my med school. This book was wonderful!! It raised a lot of issues within medicine that aren't openly talked about. The book is a collection of short stories that have a central theme about how patients and physicians both want perfection, but that as human's we inevitably make mistakes. The hard part about mistakes in medicine is that they affect people's lives.

Dr. Gwande explores mistakes as students (the care students provide will be "lower quality" than a physician with years of practice, but how else can they learn?), residents, and physicians with years of experience (what do you do about a physician who is grossly negligent but still allowed to practice?)

The stories are well written, easy to understand, and a quick read. Well worth it!

This is an excellent book, especially if you are interested in medical ethics or in becoming a doctor. But for anyone, Gawande's stories are interesting and his writing style grabs your attention.

This book was very interesting, and it's taken me a week or so after reading it to decide what I think about it and formulate what I want to say in a review.

The book was split up into three sections. The first section, "Fallibility," made me not want to be a doctor anymore, because it was so brutally honest about what can go wrong and what does go wrong in hospitals and medical schools.

The second section was called "Mystery," and I found this section VERY interesting. There were individual chapters in this section about different issues in medicine - where pain originates from, nausea, gastric bypass surgery, and Sudden Infant Death Syndrome. I didn't know very much about any of these topics, so Dr. Gawande's thoughts on them were very much appreciated.

The third section was called "Uncertainty," and it kind of tied up all loose ends. It discussed possible solutions to problems in the world of medicine, but made it clear that in this field it's almost impossible to be 100% certain of anything.

All three sections of the book had numerous narratives of patients Dr. Gawande has encountered, and I enjoyed reading these case-studies. The book was a little slow going at time...I stopped reading it for about a month when I got too busy, and just picked it up again over the holidays. Overall, I enjoyed it, and I recommend it to anyone who is looking into medicine as a profession, because it will open your eyes!

This book was required for a friend's ethics class and she could not stop talking about it! I had to read it, too, thanks to her. We are nursing students, about to embark on our clinical rotations, and have both been strongly affected by this real and wonderfully written book. Dr. Gawande really has captured everything for the reader, who is left profoundly more knowledgable about a challenging and difficult, but rewarding, profession. He is amazing!

Doctor Gawande gives a scintillating account of how our medical system can harm us. None of us thinks that we will be the victim, but this book gives us, with alarming clarity, how we are mistaken if we believe that our medical system is infallible. While I have always believed, and still believe, that most doctors do their best to do right by their patients, this book shows how easy it is, in the system that we have for delivery of our healthcare, for us to be hurt by negligence, inattention, or lack of caring. Doctor Gawande has been a participant in the system that he describes, with great attention to detail. His prose is riveting, his descriptions are pointed, and his compassion for his patients is evident in this much-needed disclosure of the truth of errors in our medical system. Anyone who wonders what he might risk by submitting to surgery or medical care should read this book.

I use this book in my course "U.S. Health Care Policy & Politics" and the students love it. It's a great primer on the residency experience, the unpredictability of medical care, and a variety of topical issues: medical education, obesity, medical malpractice, physician monitoring, pain management, medical conferences, etc. I highly recommend this book to anyone interested in medicine and health care policy. The writing is superb.

A down to earth consice portrait of the problems and pressures facing surgeon's and surgical assistants. A good read. The reality of training - the variety of problems interestingly exposed. An excellent book.

Dr. Gawande, explores the surgical psyche both from a doctor's and a patient's perspective. This is what makes this book interesting.

He takes the reader into the mental state that often has an explanation for us, but sometimes does not. Cases in point being inexplainable deterioration in a doctor's performance or a hunch the prevents amputations. He exposes the fragility of our bodies and life.

The book illustrates medicine as the best way to monitor, examine and rectify any problems, but does not promise miracles.

I've barely visited any hospitals, but his vivid description of the aura and mental states of patient and doctors, brings to life what could have just been a set of journal entries.

Not recommended for the squeamish (or people about to go into the operating ward).

I grew up in a socio-economic environment, or perhaps its was a geographical environment, or maybe it was simply my family environment, in which medical doctors were revered as a sort of super-human species. They were perceived practically as demigods. Held in awe, they were above questioning by mere mortal patients. So strong was the impact of this reverence that even today, nearly five decades beyond my formative years, I become inarticulate and frustratingly compliant in the presence of a medical doctor. Yet, those who follow this profession are as human as the rest of us, and are as subject to human fallibility as are we who seek their services as healers.

Using actual medical cases to illustrate the many conundrums that confront medical practitioners, Gawande examines such ethical concerns as how to train inexperienced doctors by letting them treat the ill and the injured while, at the same time, trying to ensure top-quality care for all patients. He also examines some of the linguistic legerdemain that doctors must resort to when telling patients (or patients' survivors) that mistakes were made; after all, a direct confession of an error in judgement can lead straight to a malpractice lawsuit. What position does the importance of autopsy still retain in medical science? To what degree should patients themselves be controlling agents in determining treatment? What does one do when every observable symptom points to a diagnosis of an easily treatable skin infection, but a niggling doubt that something far more dire is present stubbornly persists? Does one go to surgery on a suspicion?

Gawande examines the ethical ramifications of all these questions and more, and in so doing he reveals some of the quandaries faced by a physician whose extensive training and extended learning have taught him humility as well as surgical skill. As he observes, we all want the one thing in our doctors that they cannot provide-omniscience in identifying our physical problems and knowing beyond doubt precisely how to heal them.

COMPLICATIONS is an interesting book to read, for the illustrative case studies are, for the most part, real medical thrillers, but the book goes beyond gruesome entertainment for it raises the reader's awareness of the limitations of even modern medicine, and it gives us a greater appreciation of the mental and ethical struggles that beset the physicians into whose hands we often place our health, our comfort, and, at times, our lives.

The book is not only good reading but it is also a reassurance that questioning our doctors and discussing our treatments and researching alternatives for ourselves is not blasphemy, for we are interacting not with heroes on the level of deities but with fellow humans who have suspicions, experiences, and beliefs that drive their conclusions and their solutions just as the same traits color our own views of every situation. I don't anticipate ever finding a copy of Gawande's book in the waiting room of any medical practitioner, clinic or hospital, but it ought to be there. It is definitely prerequisite reading to any visit to a doctor.

In the not so distant past, professionals in the medicos, particularly general physicians and surgeons, were placed on pedestals, revered as all wise and without fault. What one's physician suggested in diagnosis was considered gospel, and one would not consider contradicting their judgement. Well, times have certainly changed. Where twenty-five years ago a mal-practice suit was extremely rare, a practicing surgeon in present time pays many thousands of dollars for insurance premiums, and the cost continues to rise. (In some cases the premiums make up almost half of the doctor's entire earnings) In Dr. Gawande's critically acclaimed Complications, his surgeon's notes on an imperfect science, illuminates the layman on the fear and responsibility that the present medical practitioner has to confront everyday. This book is an insider's look into a doctor's world, a surgeon's first years, revealing the all too human behaviour of these highly trained individuals.

Dr. Gawande's parents are both practicing physicians, his memory as a child of the look and scents of ER's, having had to sit in waiting rooms as a little boy while his parents worked to make a living, made his first years as a student quite comfortable - these were, of course, familiar surroundings, however, as he entered the world of medicine, the sheer intensity of the infamous gruesome training did not diminish or become easier for him in the slightest. After reading about training hospitals, I would have to think twice before being treated in one. Staffs need to be trained, and they need to train on real cases. Although ruthlessly supervised, it is still an uncomfortable feeling knowing your life is in the hands of a student. Dr. Gawande communicates the awful terror a training doctor experiences to become fully qualified, and I came to the conclusion that it takes a certain type of individual to be a surgeon, one should be almost born to the task.

This is not a book for the faint of heart. Gawande discusses many operations in graphic detail, and some that failed miserably. Above and beyond training, the doctor must also develop a sixth sense or strong intuition concerning diagnosis, because "science", as he proposes does not have all the answers. The body continues to throw out mysteries, research continues unabated, and it will probably be that way forever.

This is an excellent book for the genre; extremely well written and entertaining, keeping me spellbound for hours. If you want to gain greater insight into the medical profession, you would not go wrong reading this fine text.

As a premedical student who is interested in surgery, I have always looked for books that address the fact that medicine isn't a perfect practice. This book pointed out how some of the possible complications occur, what improvements are being made, and also lists some future ideas for improvement. Gawande uses very simple language so people with or without a medical background will be able to relate to his stories. A great book, one that has definitely further fueled my desire to go into medicine.

I highly recommend this book for all of us who entrust our lives to our doctors. This book gave me a good view behind the curtain of just how speculative medicine is and how fallible doctors are. It's made up of short pieces, previously published in magazines such as The New Yorker, which detail incidents and thoughts from the life of a resident who skillfully recorded medical cases and his involvement in them over the years. At first, I had a hard time just reading about medical procedures
involving needles piercing heart walls and lungs being collapsed. But after the initial shock, I found the anecdotes and cases to be fascinating and instructive. I came away with a new appreciation of our fallibility and a stronger sense that we, as patients, need to take charge of ourselves and see to it that we get the best care out there from the most experienced hands. Perhaps this was not the author's intention in writing this work, but I thank him for opening my eyes to the need for constant vigilance.
I give this book an A+.

This book, "Complications" was not at all what I expected. Having a love of anything medical-related, I was floored by the honesty and emotional offerings by Dr. Gawande. His ability to draw you in and explain this profession was incredible, in my opinion. I have a new-found appreciation for those who choose this profession. Dr. Gawande's candid expressions of reality in practice is something we all need to read about to better understand our medical caregivers.

In this book, Gawande dissects many of the current problems in medicine from both the patient's and doctor's point of views. His unbiased approach allows the reader to get both sides of the story. He illustrates that medicine is fallable just like every other profession and proposes ideas of how to make the practice of medicine safer for the patient. Gawande's engaging prose kept me interested throughout the book and really made me examine why I decided to enter into the medical profession and in what ways will I be able to improve my future profession. This is a must read for anyone considering entering the medical field.

Gawande manages in this one little book to gel many ideas I've been mulling for years. He succinctly gets across with his examples the uncertainty and fear doctors feel at times, as well as the caring and even exhilaration. The book is very readable and fun. I'm so glad he dealt with the case of the orthopedic surgeon gone bad--so often these cases are dealt with one-dimensionally, as if these were just inherently evil people. I quite disagree with the reviewer below, as I think it's clear from Gawande's writing that he feels this doctor was wrong to keep practicing as he was, and that his peers were wrong to let him keep going as long as he did, but his treatment helps us see how that could have happened so we can think more comprehensively about what it will take to help prevent other situations like this. I also disagree with the reviewer that doctors be held to a higher standard than the other professions he mentions--lawyers who make mistakes can be responsible for financial ruin, lifetime incarceration, or death of their client.

When we think of science, we think of a lofty ideal full of certainty and devoid of doubt. After all, when we learn science in school, we are taught that a water molecule always contains only hydrogen and oxygen, if we drop something gravity will always pull it down, and we will all surely die. With inalienable certainties such as those, to say nothing of other certainties science offers us, then it should follow that medicine, which after all, is firmly rooted in the hard sciences of physics, chemistry, and biology, have no ambiguities or difficulties.

But then we expect our politicians to be above reproach, and are continually disappointed in them. This is the paradox Gawande explores in his book: society expects that medicine, that very scientific endeavor, be perfect, yet perfection is impossible when people are involved. Mistakes are bound to happen, ambiguities are bound to occur, communication is bound to breakdown, doctors are bound to become bad (or at least less capable) doctors, etc. In effect, Gawande points out that all doctors are human and all humans are fallible, and therefore, medicine is unable to live up to the lofty ideal of inviolability placed upon it by society.

That these are considered to be novel observations is a disquieting notion; it should be implicitly obvious to anyone who has ever dealt with another person that mistakes are bound to occur. The waitress at the restaurant brings you coffee when you ordered tea. The elevator gets stuck between floors because the repairman left debris that blocked the elevator's path. Your wife (or husband) cooks steak, after you told her (or him) you are watching your cholesterol. In other words, anyone who has had to deal with the unpleasant imperfections in daily life (a population which includes everyone) realizes implicitly that we are fallible because we are human, and humans make mistakes. But we do not apply this standard to medicine. All participants in medicine-patients, doctors, medical device manufacturers-wish to operate under the assumption that doctors exist on some exalted plane in which mistakes never occur. That, after all, is why they became doctors and not lawyers or businesspeople, right? Because law and business can tolerate mistakes, but, well, the stakes of medicine are too high.

All of this is very compelling, and generally accurate. It is unreasonable and unusual to assume infallibility on the part of someone with whom you are dealing. However, this has some troubling implications, of which Gawande does not come to terms with. Implicit in the trust endowed in a doctor, and the power that the law gives to a doctor to perform surgery, administer medication, and so on is the assumption that, despite our human imperfections, doctors do everything humanly possible to avoid error.

Gawande proceeds to relate the story of a `good doctor gone bad' by which he means a doctor that quickly became incompetent and who was not stripped of his license in due course. His is a sympathetic portrait of this incompetent doctor; sympathy is an inappropriate response to the doctor's plight and tells us little but that doctors have trouble confronting their unreliable colleagues and that it takes a while before a doctor is stripped of his license to practice. This is troubling, given the power doctors assume.

On the whole Gawande's book is a remarkable portrait of the complexity and ambiguity of modern medicine. When he ventures outside that limited terrain, however, and explores the ethical questions surrounding the phenomenon of good doctors becoming bad doctors, he trips on his own innate sympathy and objectivity. One wishes he took a firm stand; a doctor's excuse that he is overwhelmed, or has worked too many hours does not wash. A person who assumes responsibility for the health of another simply cannot get away with the excuse that he works too many hours. If a doctor works too much, it is clear he has an ethical responsibility to cut back on the number of hours; this is neither a point of subtle debate nor a particularly difficult concept to understand. If it is true that doctors, like the rest of us, are fallible then it follows that doctors need to avoid situations in which the number of hours worked exacerbates deficient care of patients.

Gawande would serve his interests better if he quit trying to see the innate good in everyone he comes across. There are, of course, people who simply are not good people. A formerly good person can quite easily become a bad person and focusing your attentions on the formerly good qualities of that person at the expense of the newly bad qualities simply is a method by which to avoid the unpleasant duty of having to judge another person. A doctor who has worked himself to the bone, and has therefore become derelict in his responsibilities to his patient is neither a good doctor nor a good person. Such a doctor has utterly failed to heed his responsibility for his patients; he deserves nothing less than to be rebuked for his actions.

Atul Gawande's book Complications: A surgeon's Notes on an Imperfect Science is a gruesomely descriptive account of the path to becoming a good doctor through the successes and failures of being a medical resident. To those with weak stomachs, this book can be difficult to read at times. However, it shows the true humanism of even the most trusted in society. Without failures, there are no successes.

The book begins by describing a trauma incident, involving a young man who had been shot. He was hooked up to a catheter when it was discovered that he was internally bleeding, so he was told that he needed immediate surgery. He was put under, and his chest was opened up. The surgeons looked for a hole or excess blood in his bladder or rectum. What was found? Nothing. Not even a bullet was found. About a week later, a bullet was found in a completely different spot than where it had entered. How can one, as a surgeon, explain this rare phenomenon? Sometimes there are mistakes or misjudgments, and other times there are just bizarre occurrences.

The book is beneficial to read, since all people are patients at one time or another in life. Yes, with successes in medicine, there can always be strange and rare mistakes. However, through reading this book, one can learn that being educated about their health and asking questions no matter how trivial is not only beneficial to the patient; it is beneficial to the resident. This book forces us to nurture an understanding between the doctor and the patient, even in times of trouble. No one wants to be the patient that the resident is "practicing on," but how can we have experienced doctors if no risks are taken?

Complications: by Atul Gawande
A Surgeon's Notes on an Imperfect Science

Surgery is often perceived as the most respected of all the medical professions, but one surgeon's bravely written insiders essays paints a bittersweet picture of the medical practice of surgeons. In fact, "practice" is the operational word in describing what makes for a "good" surgeon - and Dr. Atul Gawande describes how the surgeon needs plenty of opportunities to wield the scalpel before he or she feels as competent as they look when they use one. "Complications: A Surgeon's Notes on an Imperfect Science" by Atul Gawande is a personal collection of spell binding first person medical stories. Gawands presents the reader with a physician who's as creative with prose as he appears to be with surgical sutures. Gawande is a frequent contributor to The New Yorker Magazine. Usually retrospective physicians in a reading group I participate in were unusually animated about "Complications" and validated some of Gawande's stories with similar versions of their own.
"Complications" is not a medical "who-done-it"; nor is it a non-fiction version of the popular television show "ER". It's about one surgeon's practice, but the stories are, to a certain extent, similar to the shared experiences of all physicians, regardless of their specialty. A surgeon must have a good medical education, lots of practice doing procedures that develop proficient skills and a fair amount of good luck.
Sometimes surgery helps patients to physically recover but the psychological side effects cannot be measured as easily as physiologic symptoms. One essay brings that point home titled, "Crimson Tide", about a girl who seeks a surgical cure for uncontrollable blushing. In this case, the patient felt her spontaneous blushing was holding her back as a television news anchor because it affected her job performance. After her successful surgery obtained in Scandinavia, she discovered she was self conscious about having it done in the first place, even though it cured her blushing! Essays in "Complications" begin with real people, identities protected, who somehow, either positively or not, are affected by medical treatment. One essay is about the conditions of physicians themselves, titled "When Good Doctors Go Bad". Gawande is certainly a terrific storyteller. Too bad the surgical profession has taken hundreds of years to finally support one of their own to tell their stories "in their own words". "Complications" also received an impressive distinction as a National Book Award Finalist.

This is a clear, well-written and thought-provoking consideration of the humanity of the people who provide us with medical treatment and services. Well-balanced, insightful and a truly educational experience. I wholeheartedly recommend this book.

This book has a great benefit both for those in the medical profession and those outside it. Gawande explores the relationships between doctors and patients by taking us through his own experiences in his medical training. We can see through Dr. Gawande's eyes the tensions that develop between doctor and patient, and between doctor and self. Time and again we are shown the dangerous ease in which patients stop being people and become "cases". Dr. Gawande conveys in a moving way his regret that medicine can so easily alienate and isolate both doctor and patient.
The topics of bedside teaching and morbidity and mortality conferences are handled in a way that allows the reader to see some of the difficulties encountered by both the student physicians and teaching physicians. This may help the non-medical professional see through the aura of infallibility that so harmfully surrounds medicine as a profession, and help them to realize that physicians are, in fact, only human.

This is one of those books you will not put down when the airplane lands and everyone else is waiting to get off! You may have read a few of these essays in The New Yorker, but it is still worth buying the book. Gawande is great at using cookbook methods to build suspense, but who cares?! It is a great airplane read when you are too tired to handle anything else. (Avoid it if friends or family are in the middle of complicated medical treatment-- raises too much doubt about the exactness of the medicine!)
Anyway, the author, almost a surgeon, suprisingly has humility and candor and is not so pedantic that you throw the book down in disgust! He digresses quite a bit to examine the statistics behind the physician decision-making process, but does so in a way to not put a reader to sleep.
It confirms your worse suspicions about medicine (its a crap-shoot), but gives you some hope about the humanity of the upcoming generation in medicine.
Makes you feel like a sloth however. Somewhere in the middle of surgical training and raising three, count 'em THREE (kinda sickly) kids, this guy Gawande cranks out a well-researched, nicely-constructed novel!

I found this book completely by accident by just browsing through Bargain Books on Amazon--and what a delight! This is most definitely one of the best books I've ever read. Gawande's way of placing the reader at ease--even when he's describing serious mistakes and disturbing statistics about medical errors--gives you some insight as to his real-life bedside manner.

Very readable, told in short vignettes about various patient cases, yet not "watered down" for the non-medical expert, this book was a joy to read. If you are interested in forensic science, medicine, operations, or case studies of unique patient situations, this book will interest you strongly.

I plan to seek out other books/articles by this author to read.

Atul Gawande's work is an achievement that should serve as testament to the power of scientific writing to change one's perception of the medical profession. All too often is it easy to presume that doctors know how to handle every situation they encounter, having been hardened by the years of training and experience that has served them invaluably. Although this is usually true, Gawande describes a "gray" zone, where the lines of science and practical care seemingly blur, that is larger than anyone might've guessed.

Through his numerous reports, Gawande relates anecdotes replete with personal concerns & troubles that enshroud the surgical profession, hopes about its potential to cure even the incurable, along with the inevitable fears and regrets that come from past failures. It is with a tone characteristic of hard-earned wisdom (neither overconfident nor pessimisitc) that Gawande leavens his stories of cases too bizarre (i.e. chronic pain sufferers with no physical signs of pain) or too emotionally-charged (i.e. good doctors suddenly going haywire) for anyone but a doctor to tell with such unwavering constancy. Doing much of the detective work himself, Gawande plays the role of the outside reporter who strangely also has inside access, being a surgical resident himself. Among the issues he tackles is the ongoing debate over teaching institutions vs. surgically-specialized centers (centers in which only one type of operation is performed and every surgeon is an inveterate expert at it), the often unpredictable nature and course of human disease (even in the face of new technological advances and better diagnostic methods), and the looming uncertainty that every doctor feels, but which, against all odds, demands a decision be made so that lives may be saved (or lost). Throughout his work, Gawande portrays the industry not as the cold & composed exterior that many patients are fooled by, but as an intensely more human endeavor prone to errors and uncertainties just like any other. Decision-making is examined in great detail only to reveal that doctors, just like experts in any other profession, can make mistakes, and what's worse is that these mistakes can been avoided or corrected long before they become hazardous. What Gawande strives for in this work is not so much a cauterizing chop-busting aimed at putting all doctors under the gun, but a series of sympathetic peaks into the lives of surgeons and the difficulties they must encounter not just as professionals, but as fellow humans.

Gawande is full of stories, and he tells them with such open-handed honesty and detachment, sometimes even putting his own cases into the objectifying pool of things, that one would be hard-pressed not to rethink how medicine actually operates across the United States. The cases themselves are sometimes amazing, sometimes bewildering, and sometimes out-of-this world, but through it all there is a voice of hope and compassion--one that reaches out in spite of all the bad decisions, malpractice lawsuits, and unceasing ethical debates intrinsic to the surgical field, and that bridges the all-too-common tenuous gap between doctor and patient. Through his anecdotal and research evidence as well his own personal expertise, Gawande builds understanding for the sheer complexity of patient care (e.g. nonstandard equipment for testing, misinformation, conflicting sources of information, inaccessible data due to ethical issues, rapidly evolving technologies with little or no hands-on training, limitations of the medical science itself) for doctors who themselves are human and therefore necessarily fallible to negligence, error, fatigue, irrationality, emotional fits, and even immorality--a cardinal sin for any practicing physician.

It is no wonder this book was a Finalist for the National Book Award as the merit of its insight into the medical field is unparalleled, and the depths to which we, outsiders, are taken into the trenches of clinical warfare are truly hard to grasp, but nonetheless they provide a hard look at some of the most difficult aspects for the surgical profession, and for doctors on the whole. It might be easy to be saddened or appalled to discover the hands we put our lives in are, afterall, only human, but this shouldn't change our hope that whatever their risks, surgeons remain a modern blessing to us today, and that hope should not be lost, for, as Gawande subtlely informs us, modern miracles (or blind luck as you will) are possible. That though medical science still has many limitations barring its potential to cure many millions more, this should not deter us from our belief that disease can be prevented and cured, or that medical science as it is now is not capable of many wonderful and glorious things, because it is and does. What Gawande's work ultimately shows is the need for continued alliance in the search for better medicine by addressing its most baffling and stringent limitations of today, in the hopes that one day those who have unnecessarily suffered in the past or are suffering currently won't have to.

Beautifully written book lacking in the self-congratulatory tone of so many medical memoirs. Perhaps most appealing is the doubt and uncertainty that surrounds some of the practioners and practices, serving to remind patients of the fragility of life and the limitations of medicine.

I picked up this book and the local [store] not expecting a collection of cleverly written short essays that not only entertain but inform and inspire. I am a current pre-med student who was looking for a book that could perhaps share with me the experience of what it's like to be a doctor. Gawande was exactly what I had been searching for.
His articulate brilliance, along w