Thursday, May 22, 2008

Listened to: "Better" by Atul Gawande

Listened to: Better: a surgeon's notes on performance by Atul Gawande, 2007, from

I'll rate this as excellent. Some nonfiction books have a great subject that gets lost in crappy writing but this was compelling, well written and well organized. The narrator did a solid job, too.

Gawande is a surgeon in Boston and he got to thinking about how to improve performance in health care. It's a difficult question because each physician is self-driven and coached and faces obstacles of time, money, diligence, dedication, and other factors. Gawande's observations would rate diligence as the top factor in improving performance - people need to police themselves and follow through.

Gawande covered a lot in the book and if I read this rather than listened I wonder if more information would have stuck in my head. His chapter on the polio eradication campaign in India was astonishing. Further tales on his surgical sabbatical in India were also impressive. Physicians there are expected to know and do so much more due to lack of professionals and specialists. But, those Indian physicians are in some areas, like hernia surgery, the best in the world. At least I think it was hernias.

Innovation and the importance of tracking and publishing successes and failures were also very interesting. For example, cystic-fibrosis treatment centers all follow the same treatment methods and guidelines so why are some centers so much more successful in treating patients? Why not share that information to improve the performance of the other centers?

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