Complications: A Surgeon’s Notes on an Imperfect Science by Dr. Atul Gawande

Complications: A Surgeon’s Notes on an Imperfect Science by Dr. Atul Gawande

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Review By: Jill Cates
Complications: A Surgeon’s Notes on an Imperfect Science by Dr. Atul Gawande

A public health researcher, Rhodes Scholar, Harvard Medical School (HMS) graduate, former government health policy adviser, and staff writer for The New Yorker, Dr. Atul Gawande adds a fresh and exciting perspective to medical practice with his narrative non-fiction book Complications: A Surgeon’s Notes on an Imperfect Science. Gawande explores fallibility, mystery and uncertainty in medicine in a collection of 14 essays that reflect on his experiences as a senior general surgery resident at Harvard Medical School. These pieces—some of which are published in The New Yorker and Slate magazines—are built on extensive scientific research and interviews. They also incorporate Gawande’s personal stories about working as a surgeon in HMS.

In the first section of the book, “Fallibility,” Gawande provides a behind-the-scenes glimpse of the operating theatre that lays bare the “imperfect science” that is surgery. He sheds light on the error-prone nature of medicine through recollections of real-life cases in the wards and operating theatre: the orthopedic surgeon who amputates the wrong limb; the long-respected yet burned-out doctor who suddenly loses his touch; and the young resident who forgets to remove a surgical sponge from inside the patient. Gawande confesses his own mistakes too, from his failed attempts learning how to place a central venous catheter line for the first time, to his emergency tracheotomy crisis scenario that almost killed the patient. Through these cases, Gawande raises delicate questions that continue to stir controversy within the medical community: how many of these medical mistakes—or to be politically correct, “adverse events”—can be prevented? To what extent are doctors responsible for their mistakes? And to what extent should these mistakes be tolerated?

Surgeons work in an extremely high-pressure environment where any deviation from the procedure can result in serious complications, possibly leading to death. By tradition, it is the surgeon who is held accountable for any complication or adverse patient outcome, regardless of extenuating patient risk factors or comorbidities. However, Gawande highlights the naivety in placing the blame on the individual surgeon, as human error is a natural phenomenon in any high-risk industry—the operating room of a hospital, the cockpit of an airplane, or the conveyer belt of a car manufacturing factory. In fact, any system that relies on human perfection is particularly prone to “latent errors”—errors caused by the system, such as inadequate staff training, poorly designed medical equipment, lack of standardized protocols (i.e., “safety checklists”) and lack of organization in hospital management. The unfortunate truth is that surgeons are easier to blame than the system, and this makes it difficult to learn more about the systemic problems that underlie a complication.

In the second section of the book, “Mystery,” Gawande delves into the strange and perplexing patient cases that remind us how little we really know about the human body. A middle-aged man suddenly experiences excruciating chronic back pain with no identifiable physical abnormality. A pregnant woman suffers uncontrollable, debilitating nausea—far beyond the typical pregnancy sickness—for the entire duration of her pregnancy. A young anchorwoman is plagued with an unexplainable blushing problem that puts a halt to her career. The mysterious symptoms presented in these patients reveal the gaping holes in our current medical knowledge, despite decades of research devoted to understanding the complex machinery of the human body.

The repercussions of these medical knowledge gaps are further discussed in the final section of the book, “Uncertainty,” where Gawande describes the messy, chaotic, and uncertain world of medicine. Life-and-death decisions are often made in the spur of the moment, based on the “gut feeling” of the doctor rather than concrete evidence found in medical literature. The power of intuition is illustrated in the case of a young girl who presented a rash on her leg. First diagnosed as cellulitis, the rash was later tested positive for flesh-eating bacteria, an incredibly rare yet aggressive infection that is almost impossible to detect in time. So what spurred the decision to order the test? Gawande had a creeping suspicion—a suspicion that ended up sparing a young girl’s life.

Interested in reading more by Dr. Atul Gawande? Check out his other best-selling books Better: A Surgeon’s Notes on Performance and Checklist Manifesto, as well as his regular columns in The New Yorker magazine.

Rating: 4/4