Tackling the imperfect science of medicine

From Floreat Domus Issue: 
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None of us likes going to see the doctor, but, when we do, we tend to have faith in his or her ability to diagnose and treat our ailments correctly – we have to. However, error is only human, and doctors frequently get things wrong. How we cope with this predicament is the subject of the latest book by Balliol Old Member, Atul Gawande (1987), Better: A Surgeon’s Notes on Performance.

[Atul Gawande]
Atul Gawande

As Gawande, a practising surgeon and staff member at Boston’s Brigham and Women’s Hospital, explains, the motivation behind this book was the desire to find out “the difference between being merely competent and being great at something like medicine, where there is high risk and inevitable fallibility.” His conclusions are that medicine is not a matter of genius, but that great doctors are great because they are able to understand their fallibility and then overcome it.

Gawande has written candidly about his own failings in his first book, Complications: A Surgeon’s Notes on an Imperfect Science, as well as in many articles and essays on medicine in The New Yorker, which have made him one of the most recognised American writers in this field.

He has also gone on to implement his findings in policy programmes designed to address the way in which the public health industry is organised in the USA. He is now the Director of the World Health Organisation’s Global Challenge for Safer Surgical Care, which aims to reduce surgical deaths globally.

Winner of the MacArthur Award

As if he did not already hold enough job titles, Gawande is also a staff member at the Dana Farber Cancer Institute, Assistant Professor of Surgery at Harvard Medical School, Assistant Professor in the Department of Health Policy and Management at the Harvard School of Public Health, and Associate Director for the Brigham and Women’s Hospital Center for Surgery and Public Health.

Better: A Surgeon’s Notes on Performance

In 2006 the writer/surgeon became the recipient of a MacArthur Award from the John D & Catherine T MacArthur Foundation – often informally called the MacArthur ‘genius’ grant – in recognition of his contribution to advances in the medical profession.

A portion of the $500,000 award will go towards funding his next book, which is a history of human experimentation. The 24 other ‘geniuses’ in 2006 included among their ranks an array of fellow writers, doctors, and scientists, as well as the jazz violinist Regina Carter and the painter Shazia Sikander.

Gawande attributes his writing ability in large part to his Tutor at Balliol while he was an American Rhodes Scholar here: “Having read my horrible essays out loud to Alan Montefiore, at the end of term he told me in no uncertain terms that my thinking and writing were unacceptable, and he was right. It was a tremendous challenge!”

Interestingly, Gawande studied PPE rather than medicine at Balliol. He wanted to be a philosopher, but, as he tells it, he realised early on in his academic life that he didn’t have the philosophical knack. After Oxford, he returned to the USA to study at Harvard Medical School, and so began an impressive career combining his love of ideas, writing, and medicine.

Better: A Surgeon’s Notes on Performance (ISBN: 978-1861978974) by Atul Gawande has just been published in the UK by Profile Books.