• Complain

Atul Gawande - Better: A Surgeons Notes on Performance

Here you can read online Atul Gawande - Better: A Surgeons Notes on Performance full text of the book (entire story) in english for free. Download pdf and epub, get meaning, cover and reviews about this ebook. year: 2007, publisher: Metropolitan Books, genre: Detective and thriller. Description of the work, (preface) as well as reviews are available. Best literature library LitArk.com created for fans of good reading and offers a wide selection of genres:

Romance novel Science fiction Adventure Detective Science History Home and family Prose Art Politics Computer Non-fiction Religion Business Children Humor

Choose a favorite category and find really read worthwhile books. Enjoy immersion in the world of imagination, feel the emotions of the characters or learn something new for yourself, make an fascinating discovery.

Atul Gawande Better: A Surgeons Notes on Performance

Better: A Surgeons Notes on Performance: summary, description and annotation

We offer to read an annotation, description, summary or preface (depends on what the author of the book "Better: A Surgeons Notes on Performance" wrote himself). If you haven't found the necessary information about the book — write in the comments, we will try to find it.

The New York Times bestselling author of 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 his new 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.Gawandes 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). Gawandes 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.

Atul Gawande: author's other books


Who wrote Better: A Surgeons Notes on Performance? Find out the surname, the name of the author of the book and a list of all author's works by series.

Better: A Surgeons Notes on Performance — read online for free the complete book (whole text) full work

Below is the text of the book, divided by pages. System saving the place of the last page read, allows you to conveniently read the book "Better: A Surgeons Notes on Performance" online for free, without having to search again every time where you left off. Put a bookmark, and you can go to the page where you finished reading at any time.

Light

Font size:

Reset

Interval:

Bookmark:

Make
Contents
ALSO BY A TUL G AWANDE

Complications:
A Surgeon's Notes on an Imperfect Science

Better

Better

A S URGEON'S N OTES
ON P ERFORMANCE



Atul Gawande


Metropolitan Books
Henry Holt and Company
New York

Picture 1

Metropolitan Books

Henry Holt and Company, LLC

Publishers since 1866

175 Fifth Avenue

New York, New York 10010

www.henryholt.com

Metropolitan Books(r) and Picture 2(r) are registered
trademarks of Henry Holt and Company, LLC.

Copyright (c) 2007 by Atul Gawande

All rights reserved.

Distributed in Canada by H. B. Fenn and Company Ltd.

Several of these chapters have appeared, in different form, in
The New Yorker and The New England Journal of Medicine

Library of Congress Cataloging-in-Publication Data

Gawande, Atul.

Better : a surgeon's notes on performance / Atul Gawande.--1st ed.

p. cm.

ISBN-13: 978-0-8050-8211-1

ISBN-10: 0-8050-8211-5

1. Gawande, Atul. 2. Internal medicine--Case studies. 3. Medicine-- Miscellanea. I. Title.

RC66.G392007

616--dc22

2006046962

Henry Holt books are available for special promotions and
premiums. For details contact: Director, Special Markets.

First Edition 2007

Designed by Meryl Sussman Levavi

Printed in the United States of America

1 2 3 4 5 6 7 8 9 10

For my parents and sister

Better

Introduction

S everal years ago, in my final year of medical school, I took care of a patient who has stuck in my mind. I was on an internal medicine rotation, my last rotation before graduating. The senior resident had assigned me primary responsibility for three or four patients. One was a wrinkled, seventy-something-year-old Portuguese woman who had been admitted because--I'll use the technical term here--she didn't feel too good. Her body ached. She had become tired all the time. She had a cough. She had no fever. Her pulse and blood pressure were fine. But some laboratory tests revealed her white blood cell count was abnormally high. A chest X-ray showed a possible pneumonia--maybe it was, maybe it wasn't. So her internist admitted her to the hospital, and now she was under my care. I took sputum and blood cultures and, following the internist's instructions, started her on an antibiotic for this possible pneumonia. I went to see her twice each day for the next several days. I checked her vital signs, listened to her lungs, looked up her labs. Each day, she stayed more or less the same. She had a cough. She had no fever. She just didn't feel good. We'd give her antibiotics and wait her out, I figured. She'd be fine.

One morning on seven o'clock rounds, she complained of insomnia and having sweats overnight. We checked the vitals sheets. She still had no fever. Her blood pressure was normal. Her heart rate was running maybe slightly faster than before. But that was all. Keep a close eye on her, the senior resident told me. Of course, I said, though nothing we'd seen seemed remarkably different from previous mornings. I made a silent plan to see her at midday, around lunchtime. The senior resident, however, went back to check on her himself twice that morning.

It is this little act that I have often thought about since. It was a small thing, a tiny act of conscientiousness. He had seen something about her that worried him. He had also taken the measure of me on morning rounds. And what he saw was a fourth-year student, with a residency spot already lined up in general surgery, on his last rotation of medical school. Did he trust me? No, he did not. So he checked on her himself.

That was not a two-second matter, either. She was up on the fourteenth floor of the hospital. Our morning teaching conferences, the cafeteria, all the other places we had to be that day were on the bottom two floors. The elevators were notoriously slow. The senior resident was supposed to run one of those teaching conferences. He could have waited for a nurse to let him know if a problem arose, as most doctors would. He could have told a junior resident to see the patient. But he didn't. He made himself go up.

The first time he did, he found she had a fever of 102 degrees and needed the oxygen flow through her nasal prongs increased. The second time, he found her blood pressure had dropped and the nurses had switched her oxygen to a face mask, and he transferred her to the intensive care unit. By the time I had a clue about what was going on, he already had her under treatment--with new antibiotics, intravenous fluids, medications to support her blood pressure--for what was developing into septic shock from a resistant, fulminant pneumonia. Because he checked on her, she survived. Indeed, because he did, her course was beautiful. She never needed to be put on a ventilator. The fevers stopped in twenty-four hours. She got home in three days.

W HAT DOES IT take to be good at something in which failure is so easy, so effortless? When I was a student and then a resident, my deepest concern was to become competent. But what that senior resident had displayed that day was more than competence--he grasped not just how a pneumonia generally evolves and is properly treated but also the particulars of how to catch and fight one in that specific patient, in that specific moment, with the specific resources and people he had at hand.

People often look to great athletes for lessons about performance. And for a surgeon like me, athletes do indeed have lessons to teach--about the value of perseverance, of hard work and practice, of precision. But success in medicine has dimensions that cannot be found on a playing field. For one, lives are on the line. Our decisions and omissions are therefore moral in nature. We also face daunting expectations. In medicine, our task is to cope with illness and to enable every human being to lead a life as long and free of frailty as science will allow. The steps are often uncertain. The knowledge to be mastered is both vast and incomplete. Yet we are expected to act with swiftness and consistency, even when the task requires marshaling hundreds of people--from laboratory technicians to the nurses on each change of shift to the engineers who keep the oxygen supply system working--for the care of a single person. We are also expected to do our work humanely, with gentleness and concern. It's not only the stakes but also the complexity of performance in medicine that makes it so interesting and, at the same time, so unsettling.

Recently, I took care of a patient with breast cancer. Virginia Magboo was sixty-four years old, an English teacher, and she'd noticed a pebblelike lump in her breast. A needle biopsy revealed the diagnosis. The cancer was small--three-quarters of an inch in diameter. She considered her options and decided on breast-conserving treatment--I'd do a wide excision of the lump as well as what's called a sentinel lymph node biopsy to make sure the cancer hadn't spread to the lymph nodes. Radiation would follow.

The operation was not going to be difficult or especially hazardous, but the team had to be meticulous about every step. On the day of surgery, before bringing her to the operating room, the anesthesiologist double-checked that it was safe to proceed. She reviewed Magboo's medical history and medications, looked at her labs in the computer and at her EKG. She made sure that the patient had not had anything to eat for at least six hours and had her open her mouth to note any loose teeth that could fall out or dentures that should be removed. A nurse checked the patient's name band to make sure we had the right person; verified her drug allergies with her, confirmed that the procedure listed on her consent form was the one she expected. The nurse also looked for contact lenses that shouldn't be left in and for jewelry that could constrict a finger or snag on something. I made a mark with a felt-tip pen over the precise spot where Magboo felt the lump, so there would be no mistaking the correct location. Early in the morning before her surgery, she had also had a small amount of radioactive tracer injected near her breast lump, in preparation for the sentinel lymph node biopsy. I now used a handheld Geiger counter to locate where the tracer had flowed, and confirmed that the counts were strong enough to indicate which lymph node was the "hot" one that needed to be excised. Meanwhile, in the operating room, two nurses made sure the room had been thoroughly cleaned after the previous procedure and that we had all the equipment we needed. There is a sticker on the surgical instrument kit that turns brown if the kit has been heat-sterilized and they confirmed that the sticker had turned. A technician removed the electrocautery machine and replaced it with another one after a question was raised about how it was functioning. Everything was checked and cross-checked. Magboo and the team were ready.

Next page
Light

Font size:

Reset

Interval:

Bookmark:

Make

Similar books «Better: A Surgeons Notes on Performance»

Look at similar books to Better: A Surgeons Notes on Performance. We have selected literature similar in name and meaning in the hope of providing readers with more options to find new, interesting, not yet read works.


Reviews about «Better: A Surgeons Notes on Performance»

Discussion, reviews of the book Better: A Surgeons Notes on Performance and just readers' own opinions. Leave your comments, write what you think about the work, its meaning or the main characters. Specify what exactly you liked and what you didn't like, and why you think so.