Book Review
Better By ATUL GAWANDE

Reviewed by PEGGY BARNETT

Most of us lay people are in awe of our doctors. We respect their knowledge and skill, and are aware that sometimes our lives are in their hands. It is refreshing and reassuring to read a book by a doctor who explores the performance of himself and his colleagues.

Atul Gawande is a surgeon in Boston, a professor at Harvard Medical School, and a staff writer for The New Yorker. He states in the introduction that he wants to know what it takes "to be good at something in which failure is so easy." When patients' lives are at stake, he believes that success goes beyond competence.

He discusses that concept in terms of "diligence, doing right, and ingenuity." His ideas, of course, are interesting, coming from someone who is involved in patient care on a daily basis. What makes his book "a good read," however, are the anecdotes about patients and situations in which those qualities made a difference.

The first essay is "On Washing Hands." The U.S. Centers for Disease Control reported that each year, two million Americans acquire an infection while they are in the hospital. The reader's initial reaction is to say, "Why in the world do not all hospital staff wash their hands after seeing a patient?" Gawande explains why not, and goes on to tell about heroic efforts just to make sure that hand washing happens.

Diligence matters in many areas. The effort to eradicate polio goes on, but cases of it continue to appear in some country in Africa or Asia. Gwande recounts the struggle by WHO workers and local doctors to locate and vaccinate children in the countryside in India.

In Iraq and Afghanistan, there has been a marked reduction in deaths from battle wounds. Gawande attributes this change not to technology or new treatments, but to the diligence on the part of the military doctors to make a science of performance, to improve how well they use technology and knowledge. The stories are both heart-rending and inspiring.

He looks at the treatment given to the poor and the moral obligations of doctors who deal with death-row patients. "Doing right" is certainly involved here. His final concept, ingenuity, leads him to consider obstetrics and the prevalence of Cesarean delivery, as well as the challenges of doctors working in remote and poor areas of the world.

He closes with a list of fivesuggestions for how one might make a "worthy difference." The suggestions can apply to any of us, and one hopes one's doctor read this book.

It is available at the Mary Willis Library.

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