Thursday, April 2, 2009

'Better': More than merely good

Every year, two million Americans acquire an infection while they are in a hospital. Of these, ninety thousand die of that infection. Yes, you read that right. Ninety thousand. About twice as many as die in motor accidents. About 3% of all deaths in a year. Caused by infections you catch after you get into the hospital. What can doctors do to reduce this silent epidemic? Wash their hands. No fancy technology, no multi-million dollar pieces of equipment, no research break-throughs. Just wash their hands more thoroughly, more often. A simple but effective way for doctors to get better at their core responsibility - keeping patients alive.

Better is a book about improving performance. On surface, it is about how a surgeon can improve his performance in medicine. In his first book, Complications, Atul Gawande explored the imperfectness of the science of medicine. Here, he talks about what one can do to be a better surgeon. And the themes are practical, almost prosaic ('wash your hands'), and truly universal.

I had recently been reading Malcolm Gladwell's Outliers. The question there was - what makes someone exceptionally good at something, an Outlier. Better, in comparison, looks (in large part) at the more modest proposition of how to make each of us just a little bit better at what we do. And as it turns out, doing just a little bit better as a surgeon saves a lot of lives. Gawande sees three broad chracters of a better professional - diligence, moral clarity, and ingenuity. To make each point, he unearths the most intriguing cases from his broad and extensive experience.

The thing that strikes you most when reading Better is Gawande's ability to not flinch. He casts his light on some of the toughest questions in the medical world, and in the process, creates some memorable writing. I found his discussion on medical malpractice lawsuits one of the most sensitive and balanced discussions on the topic that I have come across. No simplistic sound-bites, no name-calling, no painting in black and white.

The other remarkable thing is Gawande's choice to write about the small things one could do, rather than the big flashy stuff. "We always hope for the easy fix" he says, "the one simple change that would erase a problem in a flash. But few things in life work this way. Instead, success requires that many a hundred small steps go right - no slipups, no goofs, everyone pitching in." He could as well be talking about writing a great book.

In the end, Better is about doing the small things right. About making the right moral choices. About practical, no nonsense creativity. There is genuine warmth in Gawande's tone, hope in his voice, grit in his stories. This is a book I found on the Medicine shelf of Barnes and Noble. But it could just as easily have been on the self-help shelf. Or the philosophy shelf. Or the management shelf.

"Someone's got to be average", says Gawande. "If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right? Except, of course, there is. What is troubling is not just being average, but settling for it. Everyone knows that averageness is, for most of us, our fate. And in certain matters - looks, money, tennis - we would do well to accept this. But in your surgeon, your child's pediatrician, your police deparrtment, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average."

Better doesn't. Not even close.

1 comment:

  1. I love Gawande from his New Yorker articles, mainly because he comes off as unbiased by ideology. Looks like the book is a winner also.