Science is very much a work in progress, where unanswered questions are accepted and experimentation is encouraged. But in medicine, where lives are at stake, things are very different. We look for doctors and surgeons to be faultlessly skilled and well-informed, and for medicine to be a field of order, knowledge and procedure.
In Complications, American surgeon Atul Gawande tells us otherwise. Seen through his insider eyes, medicine is revealed as an imperfect science, full of “constantly changing knowledge, uncertain information, fallible individuals, and at the same time, lives on the line”. The “moments where medicine actually happens” are a fusion of science and intuition, knowledge and guesswork.
The books begins with a tour through an ethical minefield as Gawande considers why mistakes happen in medicine and how we should balance the quest for the best possible care with the need to train the next generation of doctors. New techniques carry steep learning curves, and while doctors improve greatly with practice, that is scant consolation to first patients they treat.
These difficult issues are considered with balance and humanity. Gawande the doctor calls for patients to accept the need for residents to practice their techniques. But Gawande the parent allows only the most experienced of surgeons to treat his own son. Throughout the book, he comes across as warm, considered and non-judgmental – exactly the type of doctor you would want handling your care.
But it is his skill as a storyteller that makes Complications truly compelling, with prose as taut as you’ll find in any thriller, and drama that the creators of ER could only wish for. You’ll wince as an inexperienced Gawande learns to put in a central line and cheer as a botched surgery is rescued at the last minute.
Complications is a collection of essays written for the New Yorker but as a whole, it maintains remarkable narrative focus. Only in a misplaced chapter on surgical conventions does the book briefly lose its way. As a whole, it is part thesis and part confessional. Gawande openly discusses the many gaps in our knowledge, such as how little we know about two of the most common of symptoms – pain and nausea.
As the media brings us stories of negligent care and poor communication, he alerts us to even more glaring and hidden problems. A modern arrogance is fuelling a decline in autopsies, but diagnoses are no more accurate with today’s technological advances than they were decades ago. And the rise of medical malpractice suits is creating a culture of denial that prevents doctors for acknowledging mistakes and discussing them openly.
Gawande challenges our tidy visions of good or incompetent doctors and right or wrong decisions, and instead presents carefully considered ways of reducing errors and improving care. His arguments are illustrated with a series of touching vignettes, from the fallen super-doctor who begins to endanger patients to the newscaster whose inexplicably severe blushing cripples her career.
And he saves the best for last. The idea that instinct and chance are as much a part of medicine as science and protocol is harrowingly illustrated in the final chapter where a patient admitted with harmless cellulitis is diagnosed with something truly horrifying.
Having a peer draw back the curtain on the profession so thoroughly must have irked some of Gawande’s colleagues, but they have nothing to fear. His invaluable honesty pays off, painting an inspiring picture of medicine as an imperfect pursuit, but a noble one nonetheless.
You can order a copy of Complications here. Best £7 you’ll ever spend.
[Incidentally, this is my first review – I’m trying to branch out into different writing styles. Let me know what you think. – Ed]