isbn-13: 9780805082111
Audible
I generally enjoy Atul Gawande books. I don’t think this is one of his best though. There’s only a thin thread connecting the chapters in this book which are more like a series of vignettes about different aspects of the medical profession. Some chapters are really compelling, some only mildly interesting. There’s no grand theory or overarching narrative though.
Chapter 1: “On Washing Hands” discusses why the discovery by Semmelweis in 1847 that having doctors wash their hands in between deliveries greatly reduced infections took so long to be adopted by the medical community as standard practice. Introduces the concept of positive deviance
Chapter 2: “The Mop Up” shows the difficulties faced by doctors on the front line of polio containment in India.
Chapter 3: “Casualties of War” covers the ongoing improvement in care for soldiers wounded on the battlefield. Chapter 4: “Naked” covers exam room etiquette especially when performing intimate examinations and whether having ‘chaperones’ improves the situation or not.
Chapter 5: “What Doctors Owe” discusses malpractice suits which pits doctors against insurers.
Chapter 6: “Piecework” concerns how much doctors earn and their relationship with the health insurance industry.
Chapter 7: “The Doctors of the Death Chamber” discusses death by lethal injection and the doctors that administer or oversee the procedure and the related ethics.
Chapter 8: “On Fighting” discussed the pros and cons of fighting to treat or save patients when the side-effects can be debilitating or the chances of success are slim.
Chapter 9: “The Score” dives into childbirth and the complications that can arrive. It discusses the invention of the forceps and why it is so rarely used nowadays. The score is a reference to the Apgar Score, a way of ‘measuring’ a child’s chances of survival after birth and the different means that doctors have come up with to improve those chances.
Chapter 10: “The Bell Curve” discusses hospital performance in combatting different diseases and what some hospitals do so that they outperform others.
Chapter 11: “For Performance” highlights difficulties faced by doctors in Indian hospitals where patients often die of treatable causes because of the lack of appropriate instruments.
Afterword: “Suggestions for Becoming a Positive Deviant” - see this summary
Publisher’s Description: “Explores the efforts of physicians to close the gap between best intentions and best performance in the face of insurmountable obstacles, discussing such topics as the ethical considerations of lethal injections, malpractice, and surgical errors.”