Review of Better, by Atul Gawande
Doctors, Hospitals, Public Health and the Art of Making Things Work
Jul 13, 2009
Atul Gawande's name might be vaguely familiar to those who aren't keenly interested in the health-care field. This is because his essays are some of the best in the New Yorker, and he contributes frequently. That in itself is startling, considering that the author is also a surgeon (or the surgeon is also an author): what's more amazing is how good his writing is, how effervescent, how accessible. There is nothing of received wisdom to Better.
Thinking Better, Doing Better
Every thought process, every problem solved, is laid out on the page, and reading any one of these essays creates a building sense of excitement like that of viewing a race, as one watches his startling intelligence jump over hurdles and sprint around turns. The reader is engaged but needn't be in such athletic shape to enjoy the competition. Nonetheless, the chase is inspiring, and there's the little tingle the onlookers feel as they leave trackside: everyone could learn to leap just a little bit higher – right?
"The Bell Curve," about the success rates of cystic fibrosis clinics, captures the spirit of that drive for success: it's not even that the less successful clinics are bad, but that effort above and beyond can create huge differences in life expectancy.
Systems That Work
Gawande is a big-picture type, and many of the essays are highly relevant to the current health care crisis in America. In "The Malpractice Mess," first he shows how badly a meaningless malpractice suit can affect doctors, and how badly the costs of such litigation affect the entire health-care system, draining money out of the pockets of systems and payers alike, gumming up the works of the health care system. Then he turns around and demonstrates how necessary the vindication might be that comes from a meaningful malpractice suit can be for a victim - and finally, he deftly steps to a third angle on the other side of the problem, and shows off a system that works.
In "The Doctors of the Death Chamber," he interviews some of the doctors who have elected to provide advisory assistance with the death penalty, against the policy of medical professional organizations – because the alternative, standing aside, does not ensure a painless death for criminals sentenced to death. Gawande's take walks a scalpel edge of sympathy and censure.
These multi-leveled analyses turn up in piece after piece. There's nothing cold about the clinical precision in the author's outlook; every system has its human consequences, and it is the often overlooked connection between these systems and their consequences that Gawande often focuses upon.
Improvement is a Life's Work
The reader can walk away from this book with the sense that even if there is no single action that exemplifies absolute good, there is a way to make a plan that is objectively right; and learning how to make that plan is a life's work for everyone. Ultimately, especially, a life's work for doctors. If more people learn to think like Atul Gawande, it won't be hard to find a path out of the American health care crisis.
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