Complications, by Atul Gawande

complicationsAtul Gawande’s Complications is an outstanding collection of essays about medicine from the doctor’s point of view. There are a couple of throwaway pieces in the book that are best ignored, including a very silly essay on the superstitions surrounding Friday the Thirteenth and a bizarrely self-pitying one about medical conferences. But for the most part the book provides a compelling picture about “how fundamentally human an endeavor” the practice of medicine is.

The book’s central message is simple: medicine is more of an art than a science. The view of medicine that Gawande implicitly attacks sees the human body as a machine (albeit a complex one) and doctors as skilled mechanics. When your car breaks down, you may have no idea what is going on, but you expect your mechanic to be able to interpret every rattle and gurgle, to twist the right bolt or install the right part to get things working again — and for the most part that will be true. We civilians tend to see doctors the same way. But Gawande’s point is that this comfortable view is an illusion. In fact, Gawande explains, the human body is still fundamentally mysterious, despite centuries of scientific progress; and doctors make decisions based on intuition and outright guesswork more often than we would like to think.

Complications would not be a very long book if this were the only point that it made. (Indeed, Gawande essentially divulges the entire thesis in the introduction.) What makes the essays truly outstanding is how insightfully Gawande probes the implications of his argument, spinning out long and beautiful thoughts from simple beginnings. In the first essay on doctor training, for example, Gawande begins with the fairly straightforward notion that medicine’s inherent uncertainty requires trainees to practice their skills on actual patients, since book learning can only take them so far. But he is then able to tie this need for training into a broader conflict between patient safety (which is best served by doctors doing only what they know) and innovation (which requires experimentation and, inevitably, disastrous mistakes). And he is even able to touch on the sensitive area of economic inequality, noting that the patients most likely to be treated by inexperienced residents-in-training are the poor and uneducated, while the wealthy and privileged few — including those like Gawande — have the luxury of receiving treatment only from those doctors who have already “practiced” on the less fortunate.

The second half of Complications is a little different. Rather than discussing the internal view of medicine, the essays here describe common phenomena that, it turns out, are medical mysteries, including pain, nausea, and blushing. There is somewhat more of a rote structure to these essays: they are all framed by an individual’s anecdote and contain in the middle highly readable summaries about medical research. All of these essays reinforce the main thesis about medical science’s uncertainty, but they are best enjoyed as individual pieces rather than as part of the larger argument.



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