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T’s hard to empathize with one’s surgeon, or anyone else for that matter, who proposes to knock you out and carve you up in the name of preserving your health. Perhaps that’s why most people see surgeons as scalpel-wielding superheroes to be alternately feared and revered. In his sharp yet engaging new book, Atul Gawande pulls back the sheet on his intimidating and often inscrutable profession by describing what doctors see-mishaps and all-and, most tellingly, what scares them. A Harvard-trained surgeon who interrupted his medical career to serve as an adviser to President Clinton, Gawande candidly acknowledges that doctors sometimes make mistakes, plain and simple. Even when they do everything right, the outcomes often can be unsuccessful, and in some cases, fatal. Bodies and illnesses are messily idiosyncratic, and what works in one case may not in another. Failure-whether the doctor’s fault or no one’s-is a frequent reality in surgery, yet one that is rarely acknowledged or talked about, even by physicians themselves. That code of silence only exacerbates patients’ fears. Breaking The Silence Yet in these 19 essays (many of which first appeared in The New Yorker and Slate), Gawande tries to allay those concerns by departing from his colleagues’ reticence. In exploring the physical and emotional curveballs that surgeons get tossed in a typical day, he shows how doctors themselves can occasionally act irrationally. Still, Gawande stresses that most surgeons are not only competent, but conscientious, and that they can fight aggressively for their patients. The first step in demystifying surgery is to show that its practitioners face challenges and fears of their own. In the first section of his book, “Fallibility,” the author tackles various categories of medical mishaps-inexperience, incompetence, and, in some cases, pure bad luck. Gawande drives home a dismaying truth: In order to gain competence, doctors must practice on patients, and, even in the best-controlled circumstances, mistakes will happen. Even worse, he suggests, the poor, disadvantaged, and uninsured are most often the ones selected to serve as guinea pigs for rookie physicians. Gawande gently probes these issues by relating anecdotes from his own experience. In the book’s gut-wrenching opener, the author describes a tracheotomy he nearly bungled as an anxious first-year resident. Another incident from the same essay explores how doctors face conflicting pressures when their professional and personal lives become entangled. Though he believes in giving young physicians hands-on experience, Gawande banished residents from the room when his own infant son required treatment for a heart condition. Despite the personal tone of much of his writing, the author also engages in broader analysis, as demonstrated in his study of a hernia treatment facility near Toronto. The clinic, an extreme example of the trend toward specialization in medicine, handles hernias in an assembly-line setup. As a result, it boasts a phenomenal success rate. But Gawande notes that a one-size-fits-all approach can miss the unique quirks of a particular patient. Though doctors at the Canadian clinic have become expert at handling routine situations, they aren’t trained for nonroutine cases, which, the author writes, “require ‘workaround’ solutions that are slower to develop, more difficult to execute, and more prone to error.” Such observations will resound with readers in other high-stakes professions (such as lawyers), who must also contend with a demand for perfection and efficiency. In medicine, Gawande notes, too narrow a procedural focus may put flexibility at risk-a danger that can also happen in the law. The Aversion To Autopsies The book’s remaining sections-”Mystery” and “Uncertainty”-focus on the biggest dilemma surgeons deal with: the body’s often baffling behavior. Though most of the later essays are thought-provoking, the reporting style seems weak and jumbled in comparison with the first section’s deliberate analysis. Gawande regains his footing in the penultimate essay, “Final Cut,” in which he links the downturn in hospital-performed autopsies to two very different attitudinal changes on the part of doctors. On the one hand, he writes, physicians have grown more reluctant to force what can be a traumatic procedure on grief-stricken families. On the other, medical professionals have grown so overconfident in their skills-and in their new technological tools-that they don’t want to risk uncovering evidence of possible mistakes. Those looking for firm conclusions and recommendations will be disappointed by Complications. Gawande’s goal is not to point fingers, but to make an inherently flawed medical field more understandable to patients, and in this respect he succeeds admirably. He opens up a strikingly complex profession and then puts it back together with precision, style, and grace. Preis is an assistant editor at Corporate Counsel.

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