Monthly Archives: May 2007

Better: Notes on A Surgeon’s Performance

I just finished reading Better:  A Surgeon’s Notes on Performance. While mistakes are a part of learning, medicine is the profession where a doctor’s mistake could harm or kill a patient.   The decisions I make on a daily basis do not involve life or death–in medicine, doctors make these decisions every day.

Gawande explores how doctors can do "better." and takes readers on location–from forward military hospitals in Iraq to a polio mop up in India.  His conclusion–the technology isn’t nearly as important as process. 
He begins by talking about how hard it is to get something as simple as handwashing right–and why its so insanely difficult and finishes with a tour of a hospital in India where a patient dies because simple supplies were not readily available.  He also talked about the bias that we have here in the US toward new technology–which reminded me of this article where Shapin argues that "uses, not innovations, drive human technology." 
Gawande told of how resourceful, creative and persistent doctors were in developing nations.  In these settings, doctors are almost forced to be better–they turn out to be amazing generalists–administering chemotherapy using pirated drugs or pioneering new procedures for laproscopic stomach ulcer repair.  We would do well to learn from their ingenious approaches.
The ideas he suggests for doctors to get better at their medicine practice and become "positive deviants" are applicable for all of us–they are:

  • Ask an unscripted question–it helps develop rapport and has a way of illuminating what you’re working on.
  • Don’t complain: "it’s boring, it doesn’t solve anything and it will get you down."  Wonder what he would have to say about Kegan and Lahey’s work?
  • Count something:  Apply the scientific method.  Keep track, and use what you learn to make what you do better.
  • Write something:  Share what you know–take the opportunity to reflect.
  • Change:   Be aware of what you’re doing and approach it in a new way