Complications: A Surgeon's Notes on an Imperfect Science Hardcover – April 4, 2002

Recommended for anyone considering a medical career, or has had a medical career, or who has need of a medical professional.Uncertainty, fallibility, bad luck are uncomfortable things to think about, especially when you’re standing over a person’s open neck with a pulsating tumor between the internal and external carotid arteries staring back at you. On the other hand if you don’t know in your bones that you’re the best person with the right skills to be there, then you’ve got no business being there.This book is about the inevitable (and apparently irresoluble) conflict between the imperfection in our knowledge and judgement, and the requirement that we as medical professionals always be perfect, and the consequences of that conflict.A lot of fun bringing back memories of different versions of the same patients, and of taking a momentary rest on the roof of Fitzsimmons Army Medical Center and humming “Gethsemane” from Jesus Christ Superstar in the dark: “I’m not as sure as when we started. Then I was inspired; now I’m sad and tired… After all I’ve tried for three years, seems like thirty, seems like ninety.” But it’s all worth it.

How many non-fiction books have you read which you would describe as “hard to put down?” Describing a work of fiction as such is high praise. Non-fiction? It is a unique thing to write and indeed high praise. “Complications” is hard to stop reading.I appreciate Gawande’s attempts at candor, exposé (which it is not not but approaches), and balance. I appreciate his efforts to provide generalized / generalizable insights, illustrated by poignant anecdotes; and, I appreciate reading his point of view about those aspects of care which defy generalization.All writing has bias. It is inherent even if accepted conventions are followed flawlessly. It is therefore well to acknowledge that statements made in this book are also subject to error; and it is well to illustrate at least one specific instance. The author has written (page 249 of the Kindle edition),“His [Jack Wennberg’s] research has shown, for example, that the likelihood of a doctor sending you for a gallbladder-removal operation varies 270 percent depending on what city you live in; for a hip replacement, 450 percent; for care in an intensive care unit during the last six months of your life, 880 percent. A patient in Santa Barbara, California, is five times more likely to be recommended back surgery for a back pain than one in Bronx, New York. This is, in the main, uncertainty at work, with the varying experience, habits, and intuitions of individual doctors leading to massively different care for people.”The last sentence is inaccurate. Publications available at DartmouthAtlas.org, demonstrate that availability is a statistically significant factor in explaining much of the variation in surgical utilization from region to region. In other words, where surgery centers exist, surgeries which that center specializes in will indeed be done disproportionate to optimal care or even need. Stated more harshly, surgeons get paid to do surgeries.One cannot rule out financial incentive as a reason for the observed phenomenon.

This book was a fascinating look into the modern doctors world. It is a job more defined by statistics than in the past, but personality and experience still play a great part. I really enjoyed reading this doctor/author's book book on Checklists and their usage in medicine so I was not disappointed with his more random thoughts on doctoring in general.Some of it is quite unsettling as in the case of surgery and interns learning. You hate to be a learning experience when your life is at stake, but how else do interns learn? Still...most doctors insist that their loved ones, are not part of this experience. Doesn't seem really fair; does it?Doctors like everyone else do better with practice, and this is well demonstrated with these specialized practices that only do Hernia operations. It also makes it possible for robots and computers to be quite effective at simple procedures. However that gives me pause. Here the blue screen of death might have greater implications than a reboot.I liked the fact where he dealt with some of his mistakes and diagnoses of patients and how there was a struggle of procedure and how to approach things. One person was nearly harmed by a minor oversight and another person was saved with a hunch. Given that both of these areas (oversights and hunches) are in the gray areas of human cognition it shows how much luck plays a factor, or a sixth sense, that doctors with experience start to develop.A quick synopsis of what this book includes:INTRODUCTIONFALLABILITY*Education of a knife: How interns are trained in surgery. Odds are, you are their training.*The computer and the hernia factory: Repetition = perfection and efficiency*When doctors make mistakes: How mistakes happen. Like all of us they are human, but unlike all of us the ramifications are greater.*Nine Thousand Surgeons: Conferences provide an opportunity to compare notes and keep up to date.*When Good doctors go Bad: Peer review is necessary but whistle blowing on a colleague is rare. Not surprising there are remediation schools, but few and far between. Important note, if some doctors push you away from others...take note.MYSTERYFull Moon/Friday the 13th: Is there any truth to this. Statistically no, but the jury is still out.The pain perplex: Pain stumps most doctors as how and why it exists is not clear cut.There is no test for pain.A queasy feeling: Nausea is not one symptom, nor does it have a single cause and can be very difficult to treat.Crimson tide: Blushing, for some it undermines their confidence, but is it only cosmetic?The man who couldn't stop eating: Overeating is a life altering issue and surgery to address this is gaining ground as in the case of the morbidly obese, it works.UNCERTAINTY*Final Cut: Autopsy is not done as much any more unless there is a mystery surrounding the death. However, it helps educate doctors as to the accuracy of their diagnoses. Unfortunately to many it is a violation of the dead, who will gain nothing in return.*The dead baby mystery: Sometimes the answers are obvious*Whose body is is anyway: Doctors these days advise, not dictate and patients struggle to make the right choices. *Doctors have to let patients make bad choices despite their objections.*The case of the red leg: Gut feeling are sometimes all you have and often they are dead on. In the absence of this all that is left is statistics.SUMMARYThis book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea. Others associated with medical errors, bad doctors, cases that were swayed by errors and hunches. If you have any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific.

This volume was originally published in 2002, when the author was a junior doctor undergoing surgical training in an America hospital. It was the first of a subsequent series of books that, together with giving the 2014 BBC Reith Lectures, have established him as a household name. It consists of a series of essays based on cases he worked on. They vary very widely, but all are linked by highlighting important question about the role of the doctor in medical treatment and the doctor-patient relationship, particularly in a hospital setting where decisions often have to be taken quickly against a background of imprecise information or knowledge.A perfect example of this, although extreme, is the final case he discusses of an otherwise healthy young woman who presents with an inflamed red leg. Is this a severe case of cellulitis (probability approaching 100%) or is the leg infected with the bacteria necrotizing fasciitis (probability vanishingly small, but with potentially devastating consequences)? The author honestly admits that hunches, gut feelings and other unscientific considerations inevitably play a role in decisions about what actions to take, however much he wishes that they didn't. He is just as frank about other aspects of medical practice, such as the need for surgeons to hone their technique on real patients, with the inevitable consequences that the less advantaged in society become the `guinea pigs' and some operations will not be done well. But when his own child becomes dangerously ill he honestly confesses that he does not want an operation to be done by an inexperienced junior surgeon, as would any parent wanting the best for their child. How do we resolve this dilemma?There are many other dilemmas of medical practice discussed in the book, such as: how should poorly performing surgeons be disciplined in a way that does not make the profession in general too conservative and hence hinder surgical progress; to what extent is a surgeon entitled to `steer' a patient into a course of action that they, the doctor, thinks is the right choice, even though the risks may be high; and should a doctor attempt to prolong life, even when the treatment will not prevent the inevitable outcome and may even produce more suffering?This well-written book brings home to the reader not just the technical difficulties of being a surgeon, but also the ethical responsibilities it entails and the stark problems that surgeons have to face daily. It can usefully be read by both medical students and professionals, as well as by anyone who is liable to be a patient at some time, and that means all of us.

This fascinating book provides insights into the world of medicine. It is about the author's triumphs and failures and about his mistakes and his almost miraculous intuitions. I enjoy his writing style and he must be an interesting person to know in real life. There are strange and puzzling cases and even more strange and puzzling people - both as patients and in the medical profession. The author talks about marvellous recoveries and tragedies and about cases where medicine intervenes too much rather than letting the human body work things out for itself.I think the one thing which comes over to me from all the medical books I read is that however much medical science advances there is just so much about the human body which remains undiscovered. Doctors are never going to get it right all the time however well trained they are and however much experience they have. I was interested to see how much of an inexact science diagnosis is and the autopsy figures quoted by the author show that the cause of death may turn out to be incorrect as many as a third of cases. The figures haven't changed in the US since the 1930s in spite of the huge increase in modern technology and ways of seeing inside the human body.It is all too easy to assume that modern medicine has all the answers and this book will swiftly disabuse the reader of this idea. I found the chapter about patients being given all the risks and options fascinating. Do we want doctors to make decisions for us or do we want to be given enough information to make our own decisions? What should a doctor do if he/she believes a patient is making the wrong decision? This author's books are a must read for anyone who has had any dealing with modern medicine if only because it helps to remind us all that doctors are people too

Complications is a book for everyone and anyone; in theory we know many of the points Gawande raises - but in reality we don't know what it means to be a surgeon or medical practitioner. There has always been such mystique about the practice of medicine, even for those who practice it, that it's inevitable that few people know let alone understand of the doubts and responsibilities associated with this profession. And how many of us want to be operated on by a trainee? We all want the best surgeon. Yet how can the trainee student doctors ever learn to be surgeons and physicians if they are never given any responsibilities other than with those who have no money to pay for procedures? How many ssurgeons can excel at every possible type of surgery? How can they keep up with all the changes and advances in medicine and surgery? It's just not possible.Thought provoking and highly recommended.

You must read this book if you have any interest in Surgery or medicine! I have learnt so much from reading this. Atul's style manages to grip you so that you cannot put the book down. I did not realise that this is actually a collection of stories he wrote at different times and has been put together in a book. So some of the stories do not seem to follow on very well from the previous chapters. However this book has taught me to question Doctors and to ask them for second opinions. Doctors are not infallable and they do not know all the answers. A lot depends on how much time the Doctor has to diagnose you and on his/her "hunch" being right! In a way medicine becomes more of an art than a science at times! Hard to understand unless you read the book. Buy this book. You will not regret it!

This is an honest account of the issues facing doctors and especially surgeons on a daily basis. The account of the specialist hospital in Canada devoted to just one operation shows demonstrates the adage that Practice makes Perfect - another example from Malcolm Gladwell's The Outliers...