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    Better: A Surgeon's Notes on Performance
    Better: A Surgeon's Notes on Performance
    Better: A Surgeon's Notes on Performance
    Audiobook7 hours

    Better: A Surgeon's Notes on Performance

    Written by Atul Gawande

    Narrated by John Bedford Lloyd

    4/5

    ()

    About this audiobook

    NATIONAL BESTSELLER

    The New York Times bestselling author of Being Mortal and Complications examines, in riveting accounts of medical failure and triumph, how success is achieved in a complex and risk-filled profession

    The struggle to perform well is universal: each one of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives are on the line with every decision. In this book, Atul Gawande explores how doctors strive to close the gap between best intentions and best performance in the face of obstacles that sometimes seem insurmountable.

    Gawande's gripping stories of diligence, ingenuity, and what it means to do right by people take us to battlefield surgical tents in Iraq, to labor and delivery rooms in Boston, to a polio outbreak in India, and to malpractice courtrooms around the country. He discusses the ethical dilemmas of doctors' participation in lethal injections, examines the influence of money on modern medicine, and recounts the astoundingly contentious history of hand washing. And as in all his writing, Gawande gives us an inside look at his own life as a practicing surgeon, offering a searingly honest firsthand account of work in a field where mistakes are both unavoidable and unthinkable.

    At once unflinching and compassionate, Better is an exhilarating journey narrated by "arguably the best nonfiction doctor-writer around" (Salon). Gawande's investigation into medical professionals and how they progress from merely good to great provides rare insight into the elements of success, illuminating every area of human endeavor.

    LanguageEnglish
    PublisherMacmillan Audio
    Release dateApr 3, 2007
    ISBN9781427200990
    Better: A Surgeon's Notes on Performance
    Author

    Atul Gawande

    Atul Gawande is the author of several bestselling books: Complications, a finalist for the National Book Award; Better; The Checklist Manifesto, and Being Mortal. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship, and two National Magazine Awards. In his work in public health, he is Founder and Chair of Ariadne Labs, a joint center for health systems innovation, and Lifebox, a nonprofit organization making surgery safer globally. He is also chair of Haven, where he was CEO from 2018-2020. He and his wife have three children and live in Newton, Massachusetts.

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    Reviews for Better

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    599 ratings42 reviews

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    • 3/5
      Probably one of Atul Gawande's weaker books. Primarily addressed to physicians rather than the general public, it argues that dramatic improvements in treating people can be had utilising current know-how by improving systems for its execution and performance, from doctors washing hands to soldiers wearing kevlar vests to improve chance of survival after surgery the book offers a voyeuristic look into the world of doctors seeking to improve themselves in their profession. Most memorable for me are his chapters on medical malpractice and on the death penalty. Gawande is advocating to record and grade the performances of doctors and hospitals so that those in the profession could learn from the best among them. He points out as model to emulate the Apgar scoring of newborn babies, which, according to Gawande, has saved a lot of babies and has improved neonatal mortality simply by providing a record of the status of babies wherein performance could be later compared and reviewed.
    • 5/5
      I could barely put down Atul Gawande's book on performance in medicine, "Better." Through true accounts that span different fields of medicine, Gawande relates his impressions on where medical practices fail and where they achieve brilliant innovations (often despite incredibly difficult working conditions). There are stories here about combating hospital infections, the WHO's effort to eradicate polio, Forward Surgical Teams in Iraq, basic etiquette for physical exams, medical professionals who have participated in executions of convicts, the malpractice system, and more. This is a broad look at doctors trying to do their best in all walks of the profession, and at times the book is terrifying for a person interested in medicine as a career. Ultimately, however, the tone of the book is very hopeful. We all do the best we can, and Gawande is interested in accumulating the information that can help doctors achieve this goal of perpetual betterment. While I think that medical professionals would benefit from reading this book, I also think that laypersons can get a lot out of these stories, and gain a better understanding of the healthcare system we have as well as healthcare across the globe.
    • 5/5
      An excellent sequel to [Complications]. Gawande continues with his thoughtful and thought-provoking essays on the art of medicine.
    • 5/5
      Great! Meaningful insight and not too technical. Perfect for a pre-med student or someone interested in medicine or public health.
    • 3/5
      I listened to this book after reading his bool being mortal, although this one offers some advice on performance in general but it's target audience are mainly doctors and health care professionals
    • 5/5
      Think, Ask & Write. Be Intresting To Daily Work-Life & Around Us Talk About New Stuff To Get Conversation Going !
    • 4/5
      A doctor’s evaluation and suggestions for a medical system that is sometimes broken, sometimes miraculous, and always impactful. Gawande’s examination of the profession that he has devoted years to is surprisingly candid. He covers a lot of territory in a brief time, and, truth be told, I heard more about child birth than I cared to know. I listened to the audio version of the book, and I found the narrator’s voice pleasant and easy to listen to. This was both an interesting and entertaining read. I think it was especially good to listen to.
    • 5/5
      As a practicing surgeon, academic,inventor,business owner,positive deviant, father, husband, son and feeling human- this book is like having a conversation with a friend over a lovely long drink.

      The clarity of thoughts and purpose are something to aspire to.
    • 3/5
      Better is the second book written by Atul Gawande, a general surgeon in Boston. His goal for this book was, by giving different scenarios, to explain how the medical system could be better. Gawande explains how the simple act of a doctor washing his hands can prevent the spread of disease within a hospital, how countries like India combat outbreaks of polio, and how doctors and nurses today are faced with the ethical question of participating in lethal injections for those on death row.His stories are intriguing and bring light to a world little see. This whole process, I believe, is Gawande's exercise in improving his own practice, and showing other doctors how they may improve theirs. While he does explain many things in layman's terms, Gawande is a physician, and there's really no getting around the occasional jargon. While I enjoyed his stories, I don't feel this was the most captivating work of non-fiction. Definitely interesting, but maybe better as a resource for other doctors rather than those of us in different fields. 3 out of 5 stars.
    • 4/5
      A doctor’s evaluation and suggestions for a medical system that is sometimes broken, sometimes miraculous, and always impactful. Gawande’s examination of the profession that he has devoted years to is surprisingly candid. He covers a lot of territory in a brief time, and, truth be told, I heard more about child birth than I cared to know. I listened to the audio version of the book, and I found the narrator’s voice pleasant and easy to listen to. This was both an interesting and entertaining read. I think it was especially good to listen to.
    • 4/5
      Atul Gawande could write about ketchup and it would be fascinating.
    • 4/5
      Dr. Gawande looks at ways medical people have improved the field.
    • 5/5
      I had learned about this book when trying to find medical material to read that would give me a better understanding of medical professionals so that I could pray for them. From the first chapter, I was hooked. Moreover, I was elated to find that I had a couple things in common with the author in having Indian ancestry also, and I was born at Brigham and Woman's Hospital! "Better" was truly an eye-opening and fascinating look at the world of medicine, its history, and unavoidable pitfalls. I now have more patience for the great medical professionals my family and I routinely see, and even more respect for what they do!
    • 4/5
      A thoughtful insight into what it means to be a doctor. Treating patients as efficiently and effectively as possible is all about trade-offs. This is fraught with danger given the constraints which span cost; equipment; staffing and expertise; weighing survival against quality of life; possibilities of litigation.There are some specific anecdotes which I recall. The challenges of getting all hospital workers to religiously wash hands. How large-scale polio vaccination is implemented in India. How staunching wounds and relocating soldiers to appropriate facilities yields better outcomes than immediate treatment. The benefits of spreading good practice rather than monopolising it as demonstrated by Cystic Fibrosis clinics. The final section is devoted to adoption of best practices at institutional and individual levels.A quick read and highly recommended alongside Gawande's Being Mortal: Medicine and What Matters in the End.
    • 5/5
      Atul Gawande is a surgeon in Boston who is now known for the best-selling book Being Mortal. Better was his second book, in which he collects essays (in slightly different form, probably expanded) that were previous published in The New England Journal of Medicine and The New Yorker. In each, he explores ways in which doctors have attempted to improve performance, through the three large themes of diligence, doing right, and allowing ingenuity.Though the book is was published in 2007, I imagine much of what he tackles in this book is still relevant in the medical field today. These themes are broad and allow him to reflect on topics as diverse as hand-washing (you'd be shocked by how much disease still travels because medical professionals don't wash hands between patients), ethical questions regarding doctors' presence or involvement in administration of the death penalty, and the difficulty in knowing when to stop fighting a disease and let someone live out their last days without medical intervention. It's a fascinating account that I would recommend to anyone.
    • 3/5
      This is the third of Dr. Gawande’s books I’ve read and reviewed for Cannonball Read, and it’s probably my least favorite. However, it’s still a decent book that I’m glad I read.

      The book is ostensible about ‘how success is achieved in this complex and risk-filled profession,’ talking about medicine. And there are certainly many really compelling stories about medicine. But I wasn’t really able to follow any sort of coherent theme to the stories. I almost felt like I was reading a collection of interesting essays as opposed to a book that was seeking to make a strong point about how to improve the field of medicine (and, in turn, other field).

      Dr. Gawande splits the stories into three sections: diligence, doing right, and ingenuity. There are three-five stories in each section that purport to demonstrate the benefits of diligence, doing right or ingenuity. I think the strongest, most interesting section for me is the Doing Right section, especially in areas such as the ethics of physicians participating in the death penalty. And as I said, all of the stories are interesting to read, but I don’t think Dr. Gawande does a great job connecting them or really telling the ready what point he’s looking to make.

      The book ends with a few pages that seem to come out of nowhere but that I think could have been woven into the book to create that theme that I felt was missing. Dr. Gawande proposes five things to do to improve in your field: ask an unscripted question, don’t complain, count something, write something, and change. I can see applying these to my current work, and would have enjoyed reading more about them in relation to the stories he has told throughout the book.
    • 5/5
      I enjoyed Better almost as much as I did [Being Mortal]. In this book, Gawande discusses what it is that make some doctors and some hospital programs better than others. Why hand washing--so important in halting the spread of MRSA--is so difficult to convince staff to do--even doctors! He discusses the upward trend of C-sections and the disuse of forceps in childbearing. Plus, as they say, so much more!I especially like his five steps to making the practice of medicine--of anything, really--more rewarding. I'll add a zeroeth one right now (for Asimov fans): 0. Read the book1. Ask an "unscripted" question. Talking to the grocery clerk? Ask a non-grocery related question. See them as a person, not just a clerk.2. Don't complain. We can all gripe about something, but it tends to feed on itself. And all it accomplishes is to drag you down. Change the subject. 3. Count something. Find something you are interested in and become an expert in it. 4. Write something everyday. A paper to be published. A poem. A blog. A letter to your older sister. 5. Change. Become an early adopter. Exchange that old flip phone for a smart one. Upgrade your operating system. Luckily, we no longer have to learn to program the clocks on our VCRs (if you still have one, consider donating it for parts), but think about what has you stumped and waiting for your third grade granddaughter to come visit.
    • 4/5
      A great perspective on the varying roles of a doctor.
    • 4/5
      I've now read all of Atul Gawande's books, and I've enjoyed them all. Each brings something different to the table and to the reading experience. This book highlights initiatives to improve things, to make things "Better." It also humanizes doctors with perfect clarity. Never maudlin, always hopeful, striving for improved performance, I'd put myself in his hands any day.
    • 5/5
      I found this book surprisingly enjoyable. I don't read much nonfiction, but I took a chance on this after noticing the author's increasing profile (most notably on NPR) and seeing in his bio that he works at Brigham and Women's Hospital, which is in my neighborhood (and is also where my wife works).

      I thought at first I was getting into a collection of feature-length pieces on assorted aspects of medicine, and that is overall what comprises the book. Gawande is very good at explaining the basics about any of the topics he tackles (the importance of hand washing to stem the spread of infection in hospitals, innovations in battlefield medicine in our most recent military conflicts, the complicated ethics of having doctors attend executions, the ways in which doctors in India improvise with limited supplies and inadequate staffing), and he is a good storyteller besides, injecting every story with personal details and human stories to bring his subject to life. The book would have been quite good if it had been merely a collection, because these qualities appear throughout.

      Yet I appreciated also the fact that the pieces were tied together both structurally and thematically. No matter the topic, Gawande underscores the way in which doctors strive to improve their practices and performances on an ongoing basis. While it is not difficult to see where any single chapter here could easily have been published without reference to the others, they have been reworked to form a more cohesive whole, and the theme works well both to tie them together and strengthen their effect. He caps off the book with a brief article that relays the five suggestions he makes to doctors to help them avoid the tendency toward routine practices and to seek out new ways for them all to continue to get "better." Often, I fault nonfiction books for tacking on similar "now what?" chapters, but this one felt like more than a rehash of the salient points and a few vague suggestions. It had the feel of being applicable for anyone who hope to do more than scrape by in his life and work. Yes, it smacks of some popular self-improvement books, but in the context of all the courageous, innovative, and humbling stories that have gone before it, the suggestions have unusual resonance.
    • 5/5
      This is an excellent insight into the intricacies of "performance" in medicine/surgery, but also provides good thoughts on being "better" in any industry or line of work.Included are thoughts on malpractice, disease eradication, etc... a worthwhile read to better understand the world and each of our roles within it.
    • 5/5
      It is a sincere pleasure to read/listen to these essays of Dr. Atul Gawande. He is such an articulate and thoughtful individual. Here are some of the topics he addresses: (1) diligence in hospital workers' handwashing, (2) eradicating polio in India, (3) increasing survival outcomes of war-wounded American soldiers, (4) using chaperones, (5) being the target of medical malpractice, (6) explaining how health insurance impacts a physician's practice, (7) medical ethics (or lack thereof) in assisting with legal sytem-mandated executions of criminals, (8) the choice of performing Caesarian sections, (9) the idea of improving medical care by paying for improved performance by surgeons, and (10) seeking excellence in care of cystic fibrosis patients. In the end, Dr. Gawande presents some simple (and yet profound) ideas for improving oneself (as a physician). Even if you haven't the time to read this whole book, simply pick one essay. My guess is that you will be very impressed by what you read and will easily choose to read even more.
    • 4/5
      This is a collection of medicine and health related articles by a young doctor. Some of the issues are correctable and some are not: injection control in the hospital, what we have done to childbirth, the death penalty and who is to administer it, med-mal, and healthcare in India. Very good and well written with lots to think about. I hope he updates it in a decade.
    • 5/5
      This book was great. Gawande incorporated stories throughout the book that made the topic at hand even more relevant. I enjoyed his writing style as well as his eye-opening honesty about the medical field.
    • 3/5
      This book is a collection of essays about the need for excellence in medicine because the cost of even a small error may be fatal. In the conclusion, Gawande makes suggestion on how the standards for being better can be applied to any field of endeavor.Topics covered in the essays in this book include: * The spread of infection in hospitals that should be preventable but habits of medical staff are difficult to change. * The people skills required to stop the spread of disease in India. * A review of the current state of malpractice law that offers a good balance between the surgeon’s fears and the rights of the patient. * Amazing stories of doctors in India who regularly perform procedures outside their specialty and with limited resources but are as effective in healing patients as doctors in the US. * The conundrum of whether doctors should participate in executions to help make them more humane or should completely eschew any practice that leads to a death.This book was selected by my book club and I was pleasantly surprised that it was better (ha-ha!) than I expected. Gawande writes in a direct – sometimes arrogant – manner but at the end one can’t help but agree that he is on to something. As an added bonus, he practices in Boston, so I know where to go if I’m looking for a good surgeon.
    • 2/5
      This book is far less engaging than his first, and espouses a mildly distasteful and shockingly simplistic message about doing better in the medical profession. Since David's review of this book describes my sentiments well, I won't rehash all of his comments. Don't look for a enlightened analysis in Gawande's small-minded views here. In each chapter, Gawande examines the complexities of the topic and then tops it off with a conclusion that ignores all the subtleties of the issues at hand.If you want a thinking person's analysis of a similar topic, read "How Doctors Think" by Jerome Groopman. There, the author seems to understand the complexities of the issue and doesn't aim for hubristic conclusions.
    • 5/5
      When I first picked up this book, I thought it would be a collection of memoirs about, well, making patients better. I was prepared to be entertained, but nothing out of the ordinary. I was pleasantly surprised when I realized that this was a book about making medicine better - the way we practice, our outcomes, our ethics. It's not just a book for doctors or people in medicine, but can really be read and appreciated by just about anyone. Additionally, I really like Atul Gawande's writing style - it is direct, easy to follow his train of thought, and he gives strong evidence for every point he makes. I also liked the way the book is set up - the chapters are relatively short, so it's in very manageable chunks and can easily be put down and picked up again. I think that one of the marks of a really great book is one that makes you think, even well after you've finished reading it. I'm sure this will be one of those books, as I hope to keep some of its principles in mind as I become a resident and beyond.
    • 4/5
      I was fascinated from the beginning with this book of essays about health and medicine. The first essay talked about the importance of doctors washing their hands. Gosh, we all know that, right? We know how absolutely essential it is. Well, get this: doctors don’t do it. And when they do do it, they don’t do it enough. Mind staggering. And the rest of the chapters were just as good.
    • 3/5
      This book of essays, by a practising doctor, argues that what makes the most difference in the quality of modern medical care is not technical skill as such, but "diligence and ingenuity" and attentiveness. It's a well-written book, with each chapter using one or more case studies to illustrate the point, but for me, the book lacked the 'so what' - it said "this is so", but not "this is so, because..." or "this is so, therefore...". This meant that it seemed like a primer on issues in contemporary medicine, but without too much wider relevance.
    • 3/5
      Nothing to write home about. Fine. Quite interesting, but still just fine. Almost dripping with Gawande's love for he and his fellow doctors (Am I biased? yes. Am I right to be? Probably)