Gawande is a surgical resident, so he is experienced enough to have insight into the medical profession and practices of surgeons, but still new enough in the field to bring a keen critical mind and the clarity of a relative outsider's perspective. Also, his compassion is one of his distinct qualities and shines through in the writing.

If you are a regular New Yorker reader, you probably have already read all of these essays. The brilliant essay about why doctors make mistakes is included, as well as memorable essays about when good doctors go bad, and how the practice of autopsy goes in and out of fashion. The only one that was new to me was the one about a surgeons' convention, which was entertaining but not crucial reading. It is nice to have them all in once place, but unless you are a completist or a rabid Gawande fan, I'd recommend getting it from the library or waiting for the paperback.


Confident With Him As My Surgeon   May 8, 2002
 35 out of 37 found this review helpful

"Complications", by Dr. Atul Gawande is a very gutsy and honest discussion about medicine in general, and surgeons in particular. The book is also unique, for unlike others of its type it is written by a surgeon that is starting his career, and not looking back upon it. I would imagine that the book caused some consternation amongst his peers. The book does nothing to minimize the skills and accomplishments of the men and women who can reach in to the body and do some pretty spectacular work. The book does portray them as human beings that come with all the normal traits that any of us do. The pressure they must deal with is that when they make a mistake, it can irreparably harm or cause the death of the patient they are trying to help.

The vast majority of careers that people practice does not involve decisions that can cause the outcomes I mention above. And few occupations require of their practitioners near perfection, that if not delivered has a major legal industry prepared to hammer them with lawsuits. Incompetent or negligent doctors should be punished and removed from practice, but what about a human error, or a doctor that makes every single decision that is correct and appropriate for the patient he or she sees, and misses the 1 in 250,000 cases where doing everything correctly can cause a patient to die. The final chapter of this book deals with exactly those type of odds. Whether those odds are beaten often depends on the instincts of the physician. And these intuitive feelings they may or may not act upon are certainly helped by experience, but younger doctors without the years that familiarity brings can often make a decision largely because they are so new. Dr. Gawande makes clear that all the sophisticated technology available does not replace the one on one interaction with the patient.

If we ever need a surgeon we want a person we perceive as experienced, a person we are literally willing to risk our health and our lives with. The problem is that virtually no one wants to be part of a new surgeon learning his craft even with very experienced surgeons standing right at the table, watching and even directing the path the surgery takes. Dr. Gawande also shares his feelings when his children are ill and the contradictions he deals with as a parent, even as he is often on the other side with people judging him and his youth.

The statistics say that a surgeon will make a given mistake once every 200 times he or she performs a surgery that is described in the book, and that is also fairly common. If the mistake is made the results range from terrible to potentially terminal. The author does a great job of sharing what it feels like to be told that you will make the mistake, that doing the task 99.5% of the time without error can still cost a life.

A person who decides to become a general surgeon will study and practice until their mid 30's before they are able to operate on their own. That type of commitment is rare, and recent articles have said that less men and women are willing to devote that much of their lives before beginning their chosen career.

We want these people to be perfect when it is either we, or someone we care about that is to be operated on. They are not perfect, although those that are excellent can statistically come very near perfection. I would trust Dr. Gawande for he is a man that is clearly skilled, but is also acutely aware of how fine a line he walks every moment of his day.


Surgery as you've never seen it before   May 9, 2002
 29 out of 29 found this review helpful

This book reveals surgeons as human beings who learn and practice surgery, with the emphasis on the words human beings. Dr. Gawande exposes the myth of doctor perfection and replaces it with a compassionate look at the humanity of surgeons. Of course this comes at the price of a loss of confidence in surgeons or at least a heightened sense of concern when someone you know goes into the hospital.

Do surgeons make mistakes? They learn and practice on people and as part of that process they make mistakes. So should you use only experienced surgeons? What if they are not up to date on a newer and safer technique? They still have to learn and practice them. Where will our next generation of experienced surgeons come from if no one would use the less experienced ones?
These are tough questions that must be answered. It is easy to say that surgeons need to practice on people and should be encouraged to while under the supervision of a more experienced surgeon, but what if it is your child being operated on? Gawande even shares his experiences as he had to deal with this situation.

A thought-provoking and revealing book it will educate and entertain. For people who want to see the human side of the surgeon's profession it is a recommended read.


Complications= Great book for a small-group discussion   December 12, 2002
 16 out of 18 found this review helpful

I found Complications by Atul Gawande to be an exciting read from cover to cover. It is filled with a variety of topics centering around medicine's fallibility, mystery, and uncertainty, as perceived by Gawande who is himself a surgeon. Gawande's mastery of language makes each chapter come to life by developing the situation and revealing topics often ignored by the medical community. He also does a great job of leaving his own bias or opinions out of the chapters. This undirected, yet thought-provoking prose was ideal for our small-group discussion class which read his book. We found many topics to discuss and ethical issues to ponder. Although our time was limited as a class, I believe we could have spent much more time digging deeper into the issues Gawande addressed. Issues that we especially enjoyed pondering included the idea of "practicing" medicine on patients as part of the educational process, the robot feel of sub-specialty medicine vs. primary care medicine, and the stories of patients living with medical problems such as the "man who couldn't stop eating." Overall, I highly recommend this collection of short stories both because it is a delight to read, and because it raises some very interesting ideas that I hope to further investigate.

Jordan Wilson

Medical Student
UMD School of Medicine