By Chet Yarbrough
Complications (A Surgeon’s Notes on the Imperfect Science)
By: Atul Gawande
Narrated by Robert Petkoff
Several years ago, “Being Mortal” was reviewed with appreciation of what the author had to say about a doctor’s responsibility for improving the quality of life for the elderly and terminally ill. Atul Gawande reinforces the double meaning of “Being Mortal” in his “Complications…Notes on the Imperfect Science”.
Gawande explains doctors are not superhuman beings. They are well-educated mortals that practice medicine with the intent of making the right decisions through attentive communication with patients.
Knowledge from teachers and practitioners is helpful but it is through practice on patients that doctors become proficient for those needing help. Gawande’s reflective words “practice on patients” are frightening to one who’s life is threatened by injury or disease.
Gawande notes decisions are not based on omniscience but on a doctor’s education and experience.
Gawande offers notes on the imperfect science of medicine. He explains why even the most conscientious physicians, let alone bad practitioners, make mistakes. To become a skilled physician, as with any skill, requires practice. The monumental difference is medical practice directly affects human lives. Other professional practices are indirect.
The compounding difficulty of the science of medicine is that even the most experienced physicians make mistakes. It may be because of missed diagnosis or motivations inherent in human nature (the drive for wealth, power, or prestige) but it is always at the expense of a patient.
Gawande reflects on the intuitive nature of medicine by telling the story of the fire captain that tells fellow fire fighters to leave a building when he senses the building is going to collapse (an anecdote also told in “Thinking Fast and Slow”). An experienced doctor often must rely on the same sense and can be perfectly right or catastrophically wrong.
Gawande tells the story of a young woman who is diagnosed with cellulitis in a leg that is swollen and inflamed. The attending physician asks Gawande to look at the patient to confirm the diagnosis.
Gawande questions the patient about how she might have acquired the infection. He suspects it may be from a rare flesh-eating virus even though all the symptoms are consistent with cellulitis which can be easily treated with antibiotics. Gawande suggests a biopsy and the diagnosis is changed. It is found to be to the rare flesh-eating virus. It is Gawande’s intuition that leads to treatment that successfully saves the young woman’s life.
A medical patient listening to Gawande appreciates his candor but fears the truth of human fallibility of a profession one relies upon.
Most realize all humans make mistakes. What is disconcerting is the lack of disclosure by many physicians and the doubt raised by Gawande in some doctor’s veracity in seeking what is best for their patients.
Gawande explains some organizational methods used to minimize mistakes and modify future medical practices. However, public disclosure of those mistakes (particularly regarding specific doctors and hospitals) is largely undisclosed.
Gawande is challenging his profession to do better. To that, the public should be grateful.