Book Five: Better by Atul Gawande

It can be a bit disconcerting to learn that surgeons in rural India are more skilled than surgeons in the United States. But such is the result when Indian doctors are forced to address a range of problems a U.S. doctor would send off to another specialist. Of course, this is not to say the U.S. surgeons are not intelligent -- the just have the "luxury" of not needing to expand their skills.

Gawande is a U.S. doctor with an Indian background who went back to his ancestral home for a couple months of work after finishing med school. Gawande is a bright guy -- you know someone is bright when they were a Rhoades scholar but do not mention that in their bio. That fact was crowded out by his MacArthur grant (commonly referred to as a "genius" grant). What is striking in this book is Gawande's humility about his own work. He is quick to share his failures and loathe to take credit for successes. This offers credibility to what is really a virtue based work.

"Better" focuses on what he says are "three core requirements for success in medicine--or in any endeavor that involves risk and responsibility" (8). These simple traits are diligence, doing right, and ingenuity. While he supports his argument with medical examples, it is clear that these traits or virtues apply to how we approach life.

Diligence refers to focusing on details in order to avoid errors. In medicine, a lack of diligence on any one case could lead to death. Most of us do not see such a result from our errors, yet we also do not pay attention to how it impacts others. I'm as good as anyone at making a mistake due to a lack of diligence, but if I make it a habit then my reputation in whatever field I may be working will be impacted. We sometimes note that certain people are not "detail people," and what we are noting is that this person lacks diligence. (Although if anyone points out my lack of diligence when it comes to proofreading, I will not be amused).

"To do right" seems straightforward enough, but of course it is one of most challenging aspects of any life. Gawande says that since medicine is a human profession "it is therefore forever troubled by human failings, failings like avarice, arrogance, insecurity, misunderstanding" (8). Well, I cannot think of a non-human profession since the nature of a profession is that it is human. Therefore, all professions meet the same challenges. What Gawande interestingly explores is the systemic challenges which exist making the desire to do right so difficult. A simple example was when a doctor whose son's tumor was missed on a x-ray wanted to talk about options, he was shut out due to fear of litigation. In the end, the only way to explore the issue was through litigation, which could have been avoided if people felt comfortable talking. But the structure does not allow for that and the ability to do right is compromised.

Finally, Gawande turns his attention to ingenuity, which he quickly defines as "thinking anew." My favorite insight here is that ingenuity "is not a matter of superior intelligence but of character"(9). Becoming a better person is an ongoing activity and therefore only a person of character can sustain the need for ingenuity. Plus, ingenuity requires the ability to look at the familiar in a new way, and this has nothing to do with intelligence -- indeed, it has more to do with poetry (this would of course be my slant, not Gawande's).

Gawande spends the book building up these three traits with numerous medical examples. In fact, the one failing of the book is that we get the points faster than he thinks and he provides more examples than needed. While doctors will appreciate his focus on medicine, Gawande is clearly aware that these traits extend beyond his profession. Not surprisingly, he is hesitant to offer advice to people in areas he is not familiar with, but he does create a foundation those of us not in the medical field can apply to other areas.

Perhaps the strongest lesson comes from the highly skilled Indian doctors. When we allow ourselves to be compartmentalized we limit not only our existing skills, but our chance gaining insight from the unexpected.

Bottom line: a good read which can be used to reexamine how you approach much in life, especially from a professional standpoint. If you want to learn more visit
Gawande's Website.

Reading Challenges
This was an easy week because I finished this book way ahead of time. The last couple of nights have been unexpectedly busy due to the "flood of Holland" on Friday which had me going into work when I had just started working on this blog. Saturday offered the opportunity to test out my Guitar Hero skills on a couple of my daughter's friends, so I'm glad I had time to waste. Gawande's books is easy to read and you can get through it quickly. I even had time to work on my Vatican stamps this week!

Next Up?
As hinted last time, Cormac McCarthy's The Road is the book of the week. McCarthy has a strong reputation and although I loved "All the Pretty Horses," I lost interest in "The Crossing" and have been hesitate to return to him. But Rob (last name held for security reasons -- I think it may be witness protection) recommended it and my oldest son mentioned he gave me the book for my birthday a couple of years ago (oops!) so I found it and already started. It is an intriguing beginning.

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Happy reading!