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At the ripe age of 41, surgeon and writer Atul Gawande has a lot to
brag about. In addition to joining the faculty at the Brigham and
Women’s Hospital in 2003, he has been a staff writer for the New Yorker
since 1998, served as a senior health policy advisor in the Clinton
administration from 1992 to 1993, and is currently an assistant
professor at both Harvard Medical School and the Harvard School of
Public Health.
His 2002 book “Complications: A Surgeon’s Notes on an
Imperfect Science” was a finalist for the National Book Award, and in
2006 he received the MacArthur “genius grant” for his research and
writing.
But despite this success, Gawande is anything but complacent.
TAKING ON THE ODDS
“Medicine is a world where we have a 97 percent likelihood of
succeeding in avoiding complications,” Gawande says in a phone
interview with The Crimson. “Most people would look at that and think
that’s pretty good, but there are people out there who look at that 3
percent, recognize that it occurs with tens of millions of patients,
and see that it translates into a lot of deaths.”
The shortcomings that Gawande struggles to overcome in the
field of medicine are the subject of his new book, “Better: A Surgeon’s
Notes on Performance,” which consists mostly of essays previously
published in the New Yorker.
“I was trying to understand why medicine is imperfect and how
one navigates that world either as a doctor who is trying to learn the
skills along the way or as someone just trying to think about what
should happen in medicine from any vantage point,” he says.
In “Better,” Gawande looks critically at a host of problems
in healthcare that range from hand washing in hospitals to eradicating
polio in India.
“It’s really hard to solve these problems and it takes a kind
of attention to detail that we’re not used to thinking about in our
system,” he explained.
Gawande is adamant about the need for doctors to be critical of their own performance.
“In order to really know if you’re succeeding, you have to
measure how you’re doing,” he says. “Being willing to be transparent
about your failures is something we all find hard to do.”
POSITIVE DEVIATION
Central to this principle is his concept of the “positive
deviant” in medicine—a person who simply outperforms others in his or
her field. It is Gawande’s project in “Better” to understand why some
people or institutions in medicine are great while others are just,
well, okay.
“The answer wasn’t in how smart, necessarily, people were,”
he says. “It had much more to do with how they approached their own
fallibility. There are some at the top of the bell curve who have
abilities to look at their flaws and ask hard questions not only about
their flaws, but at the systems around them, and then to continually
focus effort and resources on how to overcome those flaws.”
He identifies three qualities of the positive
deviant—diligence, ingenuity, and moral strength—and structures his
essays around these principles. In the last chapter, he offers
suggestions for how individuals can strive to become positive deviants
themselves.
One suggestion is that doctors learn to ask questions.
“I suggested from something I saw in other people who are great
at what they do, that they take the time to ask something unexpected,”
he says. “It could be as simple as asking how they thought that Red Sox
game went or asking a colleague in the elevator what they think of a
certain idea.”
BRINGING PEOPLE TOGETHER
Gawande’s career as a writer, which began in 1997 when he
started writing a short column for the Internet magazine “Slate,” has
always emphasized the human side of medicine.
“There is an undervalued component of making good hospitals,
good organizations, good clinics work, and it is that effort to bring
people together in teams,” he says. “Medicine is now a team effort in a
way it just wasn’t, as recently as twenty years ago.”
But working in a modern bureaucracy presents its own set of problems and challenges, which Gawande tackles in his writing.
“The thing is that I work in a hospital that has 10,000
employees throughout the system. You will naturally disappear as a cog
in the machine. The pressure is to simply get through your day,” he
says. “But we all need human interaction to be effective at what we
do.”
The theme of human interaction is central to the essays in
“Better,” many of which tell the story of ordinary individuals and the
work they do to improve care on a case-by-case basis.
“You see people who have energy and optimism despite the
chaos, despite the flaws and disasters, and you recognize that a
fundamental component of that is a curiosity about the world around
them.”
That curiosity is paramount for Gawande in the pursuit of
personal and professional success. Despite his officially-deemed
“genius” status, Gawande continues searching for better solutions to
medicine’s many flaws.
As he is careful to add, “I don’t pretend to have clear answers.”
—Staff Writer Claire J. Saffitz can be reached at csaffitz@fas.harvard.edu.
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