"Better" by Atul Gawande MD, a general surgeon's notes on Performance

This book is the second book written by a general surgeon, Atul Gawande MD, from Harvard. The theme of this book is about performance in medicine. “As a doctor, you go into this work thinking it is all a matter of canny diagnosis, technical prowess, and some ability to empathize with people. But it is not, you soon find out. In medicine, as in any profession, we must grapple with systems, resources, circumstances, people, and our own shortcomings, as well. We face obstacles of seemingly unending variety. Yet somehow we must advance, we must refine, we must improve.” The picture to the left is from http://www.amazon.com/ you can also buy the book there.

In medicine, there are three core requirements for success: Diligence, Doing Right, and Ingenuity.

• Diligence is “the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles. It is central to performance and fiendishly hard.”
• Doing Right is dealing with and puzzling “over how we know when we should keep fighting for a sick patient and when we should stop.”
• Ingenuity is “thinking anew. It is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.”

Betterment is a perpetual labor. Dr Gawande gave some illustrations in the book regarding each of these three principles. For Diligence, he gave stories of the “efforts to ensure doctors and nurses simple wash their hands; one about the care of the wounded soldiers in Iraq and Afghanistan; and one about the Herculean effort to eradicate polio from the globe.” For Doing Right, he gave examples to address some uncomfortable questions about “how much should doctors get paid; what we owe patients when we make mistakes; and participation in executions of prisoners. For Ingenuity, he gave examples of people who have transformed everyday medicine by improving “the way babies are delivered; the way an incurable disease like cystic fibrosis is fought; and exam how much more of us can do the same.”

Those people who can successfully attempt and accomplish these three principles, Dr Gawande calls them the “Positive Deviant.” Here he gave 5 suggestions on how to become one:

1. Ask an unscripted question – our job is to talk to strangers, why not learn something about them?
2. Don’t complaint – “nothing in medicine is more dispiriting than hearing doctors complain. Medicine is a trying profession, but less because of the difficulties of disease than because of the difficulty of having to work with other human beigns under circumstances only partly in one’s control. Ours is a team sport, but with 2 key differences from the kinds with lighted scoreboards: the stakes are people’s lives and we have no coaches. Doctors are expected to coach themselves. We have no one but ourselves to lift us through the struggles. But, we are not good at it. Wherever doctors gather, the natural pull of conversational gravity is toward the litany of woes all around us. But, resist it. It’s boring, it doesn’t solve anything and it will get you down.”
3. Count Something – do a study of your success and failures, count how often mistakes happen of certain sort that interests you.
4. Write Something – put in words your experiences to add some small observation about your world. Don’t underestimate the effect of your contribution, however modest it may be.
5. Change – people respond to new ideas in one of three ways, “A few become early adopters, most become late adopters, and some remain persistent skeptics who never stop resisting. Make yourselves early adopters and look for opportunity to change. Be willing to recognize the inadequacies in what you do and to seek out solutions. The choices a doctor makes are necessarily imperfect but they alter people’s lives. Because of that reality, it often seems safest to do what everyone else is doing. But a doctor must not let that happen.”

Once you become a physician, the question is not whether you have to accept the responsibility. By doing your job well, you have accepted responsibility. Then the question becomes, “having already accepted responsibility, how does one do such work well.”