Complications

A Surgeon's Notes on an Imperfect Science

By: Atul Gawande

Narrated by: William David Griffith

Length: 7 hrs and 48 mins

Publisher's summary

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, why good surgeons go bad. He shows 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 also ponders the human factor that makes saving lives possible.

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.

©2002 Atul Gawande (P)2003 Audio Renaissance, a division of Holtzbrinck Publishers, LLC

Critic reviews

"Gawande's sharp eye, crisp prose, and insightful understanding make his book as enjoyable as it is edifying." (Los Angeles Times)
 

"These exquisitely crafted essays, in which medical subjects segue into explorations of much larger themes, place Gawande among the best in the field." (Publishers Weekly) 

"Diagnosis: riveting." (Time) 

It's about time...

When I finished this audio book, these words came to me: It is about time someone took the mysticism out of the medical community. It gives hope in large doses.

This is a very well written, informative book and very well read by the narrator. As a surgical nurse and patient advocate for 25 years, I have seen a lot and worked with hundreds of surgeons and the entire gamut of every physician type that this author speaks of. Yes, in the early days, with the crazy ones and the fools, I have watched the Good Old Boys Club protect their own even when they knew it was the wrong thing to do. But I have also seen true courage, love for the patients, love for the work, unwavering dedication, astounding skill, beautiful and artistic craftsmanship, and absolute advocacy for a patient's wellbeing.

This book helps the reader rethink the outdated impression that doctors should be deified and thus obeyed unequivocally. That there is as much of a balance of good and bad in the medical community as there is in any community and that, with an educated point of view, knowledge becomes your empowerment to help make the decisions effecting your life. This book instills in the reader the imperative to proactively undertake the partnership we all should have with our doctors regarding our own health care. And most importantly, even when to walk away from the situation if needed and seek out another doctor who will acknowledge the partnership. The doctor/author helps with the reader's understanding that the majority of our doctors/surgeons are, after all, only human and though experts at what they do, are simply doing what we do in our professions every day: do the best you know how with what you have to work with.

Great book

This is a great and informative book. However, it would be even better unabridged. There is a lot of good stuff left out of this abridged version.

it is a book on science

This is a book on theory and practice of medicine and the philosophy of science that informs them. It would be wrong to read it as a consumer-oriented book. Read in proper light, one is impressed of Dr. Gawande's intellectual honesty and curiosity. It is very well written and very thought provoking.

Controlling the Chaos

Wonderfully talented writer who captures the essence of the medical experience. I felt like I was an intern again, once again putting in my first central line. I had flashbacks of various complications that I had seen in my training. Both those complications that taught me to be a better physician, and those that were tragic leaving emotional scars.

The first part of the book where he goes into detail about how malpractice affects physicians and is ineffectual in improving health care should be mandatory reading for all physicians. We will all be sued. It is not a mater of if, but when. Even the most trivial lawsuit has a significant emotional effect on the physician. Somehow the tremendous personal effect of a lawsuit upon a physician is lost among the general population.

Another wonderful part of the book is the extended follow up that he has with some of the surgical patients.

My only regret was that this was an abridged version. Still I give it 5 stars.

I anxiously await the authors next book "Better" that comes out this spring. For more from this author you should read the commencement speech he gave at Harvard Medical School's graduation 2005.

Don't Listen To This Before Having Surgery

It's disturbing to realize that doctors are usually guessing when they diagnose and treat a patient. According to Dr. Gawande, whether you leave the operating room alive depends more on luck than on the skill of the doc. who's cutting you open. I'm not sure how doctors justify their exhorbitant fees or enormous egos if all they are doing half the time is spitballing. I've had loved ones in the ICU who nearly died because a doctor made an unlucky guess, and listening to this audiobok didn't improve my already jaundiced opinion of the medical profession. As a collection of horror stories "Complications" is mildly interesting, but is bogged down in tiresome detail and medical jargon. The reader has a pleasant voice but lacks conviction in his delivery and tends to drone on and on in a monotone.

Honest description of an imperfect science

Would you let a young inexperienced surgeon operate on your child or yourself, even if it involved a greater risk of complications, so that they could become better surgeons? Almost everyone would answer no to this question and indeed when the authors own son experienced a complication, he insisted on an experienced surgeon. Despite this it is an unavoidable fact that surgeon need practice and if they are not allowed to practice there will be no good surgeons in the future.

The reader of this book will receive an insight into the dilemmas faced by surgeons. It is a book that acknowledges the fantastic benefits of surgery while simultaneously acknowledging the fact that doctors are merely human beings and that even with the best of intentions mistakes are frequently made.

Some questions discussed (without aspiring to provide a definite solution):
● How can you provide young surgeons with practice opportunities without compromising the care of patients (and on how many animals do you let them practice before allowing them to operate on humans)
● How much should you trust a doctors “intuition” - and how does it compare to neural networks and machine algorithms.
● How should you deal with bad doctors - doctors who compromise the care of their patients because they have a depression, are stressed out or have a drinking problem (again doctors are just human beings and are affected by such things too).

Gawande takes on these and other questions. He is consistently honest about the limitations as well as the benefits that surgery involves and it seems that he does not hide unpleasant truths. All in all, Complications is a good intriguing book which I would recommend to anyone interested in surgery or medicine in general.

Outstanding

This is a fantastic book. It will be enjoyable for anyone with some interest in medicine, and most likely will be thoroughly enjoyed even by those with no interest in medicine.

It's not really heavily focussed on technical aspects of medicine, though there is some detail about medical procedures but it's generally just part of setting the scene of the story.

The book is mainly a collection of stories with a common theme - that doctors are human and sometimes make mistakes. There are some stories about negligent doctors, but primarily it's about good doctors who aren't always right. There is a kind of running ethical dilemma about the balance between training and giving practice to new doctors and giving patients the best care.

Not what I expected

This book was one of the more interesting ones I have read. It was informative and entertaining. The author has definately done his homework as he has provided good insight, with statistics, into how we make decisions. It's really worth reading. I have told all my friends how great and suprising this book is.

missing

the audible book was missing 3 chapters of the book. I feel as if they need to add these chapters as to understand the book better.

thoughtful book that makes you think

This is a thoughtful, engaging and entertaining account of a doctor's experiences with the imperfect art of practicing medicine. It makes you think about human decision making, ethics, medical mistakes, the psychology of healing, etc. If only all doctors (and people) were as sensitive and thoughtful as Atul Gawande. I would recommend it to almost anyone because many of the topics apply to situations outside of medicine. If you like this book or want to read something similar I enjoyed, "Better," Gawande's newer book just as much or more.

Surprising and shocking insights

Any additional comments?

This was a very well written book with some interesting, surprising and shocking insights into the medical industry. One thing Gawande makes very clear throughout the book: doctors are human and thus as fatally flawed as the rest of us! His use of real cases is underpinned by something more striking: his knowledge of his patients as people beyond the hospital. He is not afraid to speak against his peers and admit that there are failings in the medical system itself and with individuals and that there are mistakes made that shouldn't be.

Far from leaving me reticent about ever seeing a doctor again, I applaud Gawande's plain speaking and honest admissions. Sadly, we all make mistakes and this is a profession in which mistakes can be both epic and tragic; however, perhaps the bigger tragedy is that fear of being sued for simply doing one's job to the best of one's ability but making a rare error is enough to prevent full open and frank discussion with colleagues and the patients' families to ensure that such mistakes are more easily avoided in the future.

In a world of 'Where there's blame, there's a claim' mentality, shouldn't we be assigning some blame to 'ambulance chasers' whose willingness to destroy someone's reputation and perhaps career for the sake of making money could deprive a hospital - and society - of another competent, well-skilled doctor. Not only that but they make it practically impossible for doctors to learn from the errors of others, so great is the fear of admitting 'I made a mistake'.

poor recording

Poor recording, music starting at random times and I think a half hour cut off from the end.

So internet

I loved all of this book. It was the book that solidified the fact I want a career in surgery.

best book on medical matters I ever read. great

loved it . great writings by clear genius thinker. will start on the 2nd book on complications

Atul Gawande never disappoints.

Atul Gawande never disappoints. Every doctor should read his books. Complication is a collection of experience from which we can learn...as secondary experience.

Excellent!!

This book has gripping content and the quality of narration is excellent. Will happily listen to it again.

SHORT AND SWEET

I could relate with this book quite easily.
I enjoyed it.
Performance was quite good.

Medical book

Some chapters, like the one about rash and about medical seminars , were really hard to finish because of their disconnect from the book. It appeared as a small-story driven overall arching narrative , but came out as a bit random experience. Thematically its great , but the details are repelling.
Overall still decent experience

Honest, compassionate and insightful

A painfully honest account of the limits of medicine. I really appreciated how the author manages to reach uncomfortable conclusions without resorting to easy crowd pleasing, e.g. on the use of technology in diagnosis (which he admits can outperform doctors). All without ever losing a deeply human and compassionate point of view. I wish there existed more books (and perhaps more people?) like this.

Fantastic book

Shame about the music at the end of chapters. Annoying and cloying and unnecessary. Otherwise Gawande is brilliant.