My stepmother, a retired nurse, has frequently made the joke that there’s a reason we use the phrase the “practice of medicine.” As much as we’d like to think our doctors know precisely what they’re doing, a lot of medicine involves educated guesswork by fallible people. Granted, our doctors are highly educated, and after years of “practice,” they’ve gained experience that helps them make knowledgeable choices and offer helpful advice, but medicine is still, as Atul Gawande notes in this title of his book, an “imperfect science.”
In Complications, Gawande, who was near the end of his surgical residency at the time of writing, draws from his own experiences and his research to explain how doctors make choices, why things sometimes go wrong, and why certain decisions are especially complex. There are chapters on training of new doctors, medical errors, specific medical conditions, the role of patient choice, and more. It’s fascinating reading, and more than a little unsettling. Not a lot that Gawande discusses came as a huge surprise to me, but suspecting something is true is different from having a knowledgeable person tell you it’s true.
I bought this book for my stepmother for Christmas last year, thanks to recommendations from Raych and Eva (and with the thought the back of my mind that I could borrow it back and read it myself, ’cause that’s how I roll, y’all). Anyway, she loved it, and it has started making the rounds among all her nursing colleagues, so I figured I might as well listen to the audiobook instead of waiting for my turn. And I’m so glad I did.
Frequently, contemporary nonfiction related to “significant issues” comes across as nothing more than a puffed-up magazine article. But Gawande’s book is not like that at all. He covers such a wide variety of topics related to medicine that the book never feels at all padded. And the chapters, each of which could work as a standalone essay, are beautifully constructed. He often draws in stories of real cases, sometimes starting with an initial encounter with a patient, then discussing the issues that surround the case, and then finally revealing what actually happened. It was downright suspenseful! (Seriously, the flesh-eating bacteria chapter had me yelling at the CD player.)
Gawande comes across as extremely compassionate and deeply concerned for patient care. This was especially evident in the chapter on obesity. Never once does Gawande take a condescending tone or treat obesity as a mere lack of will power. Gawande seems genuinely curious as to why some people have so much trouble curbing their appetite and why it’s difficult to impossible for so many to lose weight and keep it off. In a society that is too quick to dismiss fat people as lazy and gluttonous, Gawande’s concern and lack of judgmentalism are refreshing.
I was also impressed with the chapters on medical mistakes and bad doctors. Here, Gawande’s worry about patient care is palpable, but he remains honest and open. Errors are part of being human, and doctors are human. But medical errors don’t just mean embarrassment or inconvenience; they sometimes mean death. It’s a serious matter, and you can tell that Gawande feels the tension between the imperative for good patient care and the recognition that even the best doctors are going to flub it sometimes. And some will flub it frequently, as in the chapter on bad doctors, which focuses not really on the monsters, but on the formerly good doctors who have lost their touch, perhaps because of an addiction, perhaps because of stress, perhaps because of burnout. Again, honesty and lack of condemnation are Gawande’s watchwords. The primary question is not, How can these doctors be punished? Instead, it’s How can we keep such doctors from hurting more people?
As frightening as this book was in some respects, I’m grateful for Gawande’s candor. Living with a medical professional taught me long ago that doctors are not superheroes, but it’s refreshing to hear a doctor acknowledge it and even more refreshing to hear him explain how the profession is always looking for ways to improve. Highly recommended.