Aveneu Park, Starling, Australia

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Atul Gawande, a general surgeon at Brigham and Women’s Hospital in Boston, presented a self reflecting book ‘Better’ to physicians and an enlightening, humanising depiction of doctors at work to the rest. While drawing on a vast array of sources, including his own personal experience, Gawande interweaves into nearly every chapter amazing vignettes about the doctor-patient relationship. By ensuring that every message is personalised, he brings a warm, humane touch to his narratives. 
Steady and compassionate, Gawande takes us through engrossing examples of medical failure and triumph, giving rare insights into the elements of success, illuminating every area of human endeavour in health care, investigating into medical professional’s psyche and how they progress from merely good to great providers. Every doctor reading these essays revisits the much-discussed topics and experiences in a searching, self-critical interlocutor. The narratives are rich in detail with interesting anecdotes and engages the reader with the issues in health care delivery, provoking inquiry, and highlighting the irreducible human element in it! With the complex and ever growing bank of knowledge and technologies to learn, limited resources and imperfect abilities, he rightly describes that healthcare/ medicine is a multifaceted complex industry where failure is very easy! Yet, the need to do better is much more in medicine than in any other field, since lives are on line with every decision that a doctor makes!!
The author propounded on the most important and contended over issue of ‘performance in the field of medicine’ in this book. He says Medicine is just not about the competence to diagnose and treat with empathy, but also effectively managing the systems, resources, circumstances, people and also our own strengths and shortcomings!! Through thought provoking and engaging narratives, he describes how, achieving excellence is quite challenging and complex in medicine. Though there are no simple direct conclusions/ solutions; ‘Diligence’, ‘Ingenuity’ and the ‘Will to do right’ are the three qualities he describes as essential armours in achieving success.
He illustrates each of these qualities with stories from his own experience, as well as his observations of and conversations with other physicians. He takes the examples of how one can dramatically reduce the hospital infections through being diligent in simply hand washing and can enhance the survival rates among casualties significantly with diligence. The section of ‘Doing right’ tackles certain compelling ethical and moral issues, including the litigious nature of American society toward health care providers, difficulties associated with ameliorating the occasional harm that may avoidably result from health care etc. Gawande’s erudite approach allows all parties to consider this plaguey areas from enlightened viewpoints. As he states, litigation is a “singularly unsatisfactory solution,” bringing out the worst in everyone and often failing to help those injured by medical error. The search continues for more effective ways of compensating victims, but some creative potential solutions worthy of consideration are also offered. He further explored how doctors strive to bridge and close the gaps between best intentions and best performance in the face of hurdles that sometimes seem unassailable. He reflects that doctor’s decisions and omissions are moral in nature rather than just scientific/ technical and is based on the ethical underpinnings of our lives. He presented the multidimensional perspectives of the the most spiny and obstinate issues of malpractice law and the participation of physicians in the execution of criminals in an assiduous and fascinating way. The intriguing discussions further takes on a variety of issues such as, physician compensation, limits of medical interventionism, the ethical dilemmas of doctors participation in legal executions through lethal injections, influence of money in modern medicine, astonishing histories of obstetric forceps and hand washing, and many other brutally honest descriptions of work in the field where mistakes are both unavoidable and unimaginable. Gawande then addressed ingenuity as a matter of ‘attitude rather than of intelligence’. He shows how the rating scale devised by Virginia Apgar, neither an obstetrician nor a mother, transformed the practice of obstetrics.  A similar rating measure for every medical encounter, he believes, would inform patients and improve the performance of doctors and hospitals. He also reveals the fact that practitioners of this branch of medicine was often looked down by other specialists, yet they are the doctors who use instruments and measures more reliably and safely and save lives on a large scale than any other doctor!! The spirit of the obstetricians in trying any new strategy without waiting for the research grants and results is contradictorily amazing. 
While exploring the variations in standards of clinical practice, he challenges everyone involved in healthcare to adopt the role of “positive deviant” and cultivate “a science of performance,” to constantly improve the way of using the techniques, instruments, medicines and facilities available to them. He adds,”What is troubling is not just being average but settling for it. When the stakes are our lives and the lives of our children, we want no one to settle for average.” Elucidating the exceptional results in treating cystic fibrosis at Babies and Children’s Hospital in Cleveland, Gawande says that adapting a near obsessive nature to perpetually evolve to stay competitive and ahead, challenging ourselves  through continuous measuring and comparing our performances as doctors and hospitals and being transparent to patients in providing the information on our performances are few best ways to perform better.
In this astute, intuitive, persuasive and even inspiring book, Gawande asserts that monitoring and improving clinical performance (Measuring & Improving Operational Efficiency) would do more to save lives than advances in laboratory knowledge. In Medicine, where lives are lost or damaged permanently in the slim margins between 99.5 per cent and 99.95 per cent of getting it right, the author reiterates that vigilance, counting things, admitting errors, caring, innovative thinking, change, remaining clear sighted, continuous quest for improvement, designing a system that provides the best to the patient, a diligent self assessment, and ingenuity in detail and implications, can help one perform better.
He finally suggests five strategies for the young health professionals who aspire to create an impact through their service- Ask unscripted questions, don’t complain, “count something” (be a scientist as well as a doctor), write something (to make yourself part of a larger world) and change in response to new ideas.

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