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Bookmarks Issue: 
29-July-Aug-2007
By: 
Atul Gawande
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A Surgeon’s Notes on Performance

A-BetterIn this new collection of essays, Dr. Atul Gawande questions the responsibilities of the doctor in modern medicine. "The Score" details the achievements of anesthesiologist Virginia Apgar, whose ingenuity and vigilance in a male-dominated field revolutionized childbirth practices in the 1950s. In "The Doctors of the Death Chamber," Gawande explores the ethical ramifications of physicians who attend to death row prisoners during execution. "The Bell Curve" describes the surprising success of the grading system used to rank cystic fibrosis clinics and proposes a similar practice for all institutions. Interweaving clinical case studies, statistics, and personal anecdotes, Gawande makes a convincing case for the sometimes radical and sometimes mundane, but always life-saving, medical improvements he advocates.
Metropolitan. 288 pages. $24. ISBN: 0805082115

Houston Chronicle 4.5 of 5 Stars
"These are areas in which the morality is anything but clear, but Gawande’s discussion of them, and the reporting he does in presenting all sides of the argument, are scrupulous and fascinating. … This brilliant, persuasive and even inspiring book, with its crisp writing and its abundance of well-told tales, might well be taken to heart by any reader." Charles Matthews

Boston Globe 4 of 5 Stars
"Mostly, and repeatedly, the question Gawande poses at the heart of each of his essays is deceptively straightforward and can-do: How do we get it right, or barring that, just an iota better?… Gawande is unassuming in every way, and yet his prose is infused with steadfast determination and hope." Gail Caldwell

NY Times Book Review 4 of 5 Stars
"While fans of his work may be disappointed to find they’ve already read half of the chapters in The New Yorker (where Gawande is a staff writer) or elsewhere, Gawande’s meditation on performance is not only an absorbing collection of essays on how some doctors manage to do better but also an exhilarating call for the rest of us to do the same." Pauline W. Chen

Oregonian 4 of 5 Stars
"The chapter endings are the book’s weakest points. … But a handful of so-so lines is nothing compared to what comprises a fascinating book overall." Kristin Thiel

Philadelphia Inquirer 4 of 5 Stars
"It is informative, thought-provoking, and simply a good read. … Each topic is knitted together with a compelling personal story—a mother in labor, a child with cystic fibrosis, a lawyer who represents patients in malpractice cases." Sandy Bauers

Entertainment Weekly 3.5 of 5 Stars
"Gawande’s Better is more wide-ranging, as he discusses the difficulty of getting doctors to wash their hands between patients, the ethical conundrum for doctors participating in executions, and even a short history of obstetrics. There’s much more, which is both blessing and curse; Gawande’s multi-topic approach makes for a gripping read, but sometimes suggests he’s wandered off course." Gilbert Cruz

Washington Post 3.5 of 5 Stars
"The question is whether scrutiny of such imperfections can lead patients to become better medical consumers and thus receive better care. … It is far from clear that sick patients, even if it is in their best interest, will have the wherewithal to analyze and challenge their doctors’ thought processes." Barron H. Lerner

Critical Summary

A surgeon at the Brigham and Women’s Hospital in Boston and an assistant professor at the Harvard School of Public Health, Dr. Atul Gawande succeeds in putting a human face on controversial topics like malpractice and global disparities in medical care, while taking an unflinching look at his own failings as a doctor. Critics appreciated his candor, his sly sense of humor, and his skill in examining difficult issues from many perspectives. He conveys his message—that doctors are only human and therefore must always be diligent and resourceful in fulfilling their duties—in clear, confident prose. Most critics’ only complaint was that half of the essays are reprints of earlier articles. Gawande’s arguments, by turns inspiring and unsettling, may cause you to see your own doctor in a whole new light.

Also by the Author

Complications A Surgeon’s Notes on an Imperfect Science (2002): Award Star National Book Award finalist. With wit and sensitivity, Dr. Atul Gawande explores the fallibility of doctors and the uncertainties of modern medicine in this first collection of essays.