Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition by Atul Gawande (PDF)

Description

A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine.Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one’s own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is — complicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpel’s edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause; a young woman with nausea that won’t go away; a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives.At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.Complications is a 2002 National Book Award Finalist for Nonfiction.

User’s Reviews

Reviews from Amazon users which were colected at the time this book was published on the website:

⭐This book is so well written and a delight to read!!!

⭐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.

⭐Having worked as an analyst in the healthcare industry, Atul Gawande’s name is no stranger to me. His high profile work as an advisor in healthcare reform and authoritative figure in the world of medicine prompted me to pick up his most popular book, Complications. To my surprise, this book turned out to be quite different from what I expected. I began reading with the impression that it would be more in tune with the healthcare reform-directed rhetoric ubiquitously heard in the media and other public debates these days. Instead, I found Complications to be an intriguing narrative on a wide range of lesser known issues in the medical practice.Complications explores a hodgepodge of topics through each chapter. Through captivating anecdotes, situations explored include areas such as the systemic problems resulting from the way healthcare is practiced, philosophical thoughts relating to limitations in understanding the human body, and the vital role that a physician’s intuition still plays in decision making despite the improvements in technology and evidence based studies. Some of the systemic issues addressed include: the ethical dilemma in training new doctors by allowing inexperienced hands to operate on patients, how a good physician can go “bad” because of a the perverse incentives of our reimbursement system, and how performing autopsies can help improve the delivery of care. I was particularly fascinated by the medical mystery chapters of the book, which presented some common but poorly understood areas of medicine such as pain, nausea, and eating disorders. I think an underlying theme is the uncertainty of medicine – that doctors are human and the complexity of their work requires intuition based decisions, even if at times such decisions may lead to unforeseen error.Although the memoirs make some very suspenseful reading and provide an eye-opening perspective on certain problems facing healthcare, I feel that Atul steers clear of the potentially politically charged ideals. While the reading is informative, it isn’t very opinionated. I think this makes the book more enjoyable to read and leaves the reader with a greater sense of awe from the narrative. I feel like it was written not with the intention of advocating an ideology, but to tell a good story. If you are looking for a specific commentary on the social issues of healthcare familiar to public debate, you won’t find it here. However, you will find interesting views on a number of other intriguing areas in medicine, from the eyes of a surgeon. Even though Complications turned out different than I anticipated, I found it to be a very entertaining and worthwhile read.

⭐I was referred to this book by a friend of mine who knew I liked the books of Malcolm Gladwell. I first read it near about when it came out, around 2002, and just got around to re-reading it. I had only remembered two of the stories from the book, so it was very similar to reading it again for the first time.The theme of this book is reflected in its three parts: Fallibility, Mystery and Uncertainty. Each part talks about a particular aspect of Gawande’s career as a surgeon that deals with the less-certain side of being a doctor. Each concept is accompanied by one or more anecdotal references to his own real-life cases that illustrate his point brilliantly.And that point is that doctors know a lot – but they don’t know everything. Their education and practical experience can help prepare them with knowledge, but skill comes from years of learned real-world practice. I could really sympathize with him and the stressors he has to deal with. I’ve been guilty as well of feeling my doctor must and should know everything that is right for me to do. The truth is a lot more complicated than that.This book doesn’t even take into consideration the patient frustrations with healthcare – cost, attention, etc. It really does focus on pulling the screen back and giving you a glimpse into the vast uncertainty that accompanies this sometimes wondrous profession.This is NOT a book that says, “I’m a surgeon. Here’s all the supercool things I’ve done and this is why I’m awesome and don’t you wish you could get me as your doctor?” This book shows the doctor, warts and all, and makes them much more human.

⭐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…

Keywords

Free Download Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition in PDF format
Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition PDF Free Download
Download Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition 2003 PDF Free
Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition 2003 PDF Free Download
Download Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition PDF
Free Download Ebook Complications: A Surgeon’s Notes on an Imperfect Science 1st Edition