Wednesday, September 12, 2007

COMPLICATIONS

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.

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