Book Review: Atul Gawande's New Book, Better: A Surgeon's Notes on Performance

Ever since my breast cancer experience in 1996, when I started spending lots of time with medical professionals, I have become fascinated by how doctors think about their profession and their patients. There is such a wide variation, I have found, in bedside manner and people skills, from compassionate to arrogant. Thus, any magazine article or book that sheds light on how doctors think and act is interesting to me, and by extension, to anyone who has had a life-threatening disease, and regularly spends time in doctors’ offices and hospitals.

Atul Gawande’s book Better: A Surgeon’s Notes on Performance is a good example of such a book. A Harvard-educated surgeon who practices at the Harvard-affiliated Brigham and Women’s Hospital in Boston, he is the rare combination of a sensitive doctor and a fine writer. (For the another example of this combination—Harvard doc and fellow New Yorker writer Jerome Groopman). The book’s underlying theme is his own, and other doctors’ quest, to improve and to do better by their patients. He writes, “What does it take to be good at something in which failure is so easy, so effortless?”

Although several of the chapters have previously appeared in The New Yorker, where I first read them, the pieces hold up very well when combined in a book, and are well worth re-reading in this form. The topics he explores include struggles with malpractice, a tricky diagnosis, and consistent hand washing to lessen infection rates in hospitals, and deaths in combat among the armed forces.

What is striking about Gawande as a doctor is his sensitivity and respect towards his patients, which is not a universal trait. The moral dimension of being a doctor and healer is often lost in modern medicine, when patients are quickly shuffled in and out of appointments, not given enough time to ask questions or voice their concerns, and are treated more like their symptoms—41 year old woman, tumor in left breast — than as human beings. The best doctors, like Gawande, have not forgotten that patients are people, frightened and in pain.

The chapters I like the most are the ones where I identify with the patients. There's the woman with breast cancer who is left waiting for hours on a stretcher, after being prepped for surgery, alone, scared, and hungry, because the recovery room was overbooked. There's also the pregnant woman, herself a doctor, whose labor and delivery did not go at all as she had planned, although the outcome of a healthy baby and mother was achieved. I also enjoyed reading about some of Gawande’s personal dilemmas—the etiquette of examining women patients, and how to set his own salary as a surgery when he is asked to name his price in a job negotiation.

After reading the book, I’m left wishing that more of my own doctors were as caring and principled and thoughtful as he is. I recommend this book to all patients, everywhere, if for no other reason than to point out that the medical treatment many of us receive is often sub-par, and the bedside manner we get often can be better.