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Atul Gawande, who is currently finishing a medical residency in Boston, has some pretty big shoes to fill.  As a surgeon writing essays about his profession for the general public, he follows in the footsteps of Richard Selzer, who has been writing wonderfully about the complexities and oddities of surgery for several decades.  And writing in the pages of The New Yorker, he follows in the tradition of the great Berton Roueche, whose "Narratives of Medical Detection" are among the best pieces ever to appear in the magazine.  Perhaps wisely, Dr. Gawande neither tries to be as lyrical as Dr. Selzer nor to plumb the mysteries and the adventure of medical investigation as did Roueche.  Instead he offers us an entree to the world of the physician in training and tries to be scrupulously fair in his treatment of the various and often competing concerns of doctors, patients, ethicists, insurers, etc.   He's generous in sharing his own experiences and discussing his mistakes and the essays are often interesting, but they are somehow antiseptic and less engaging than they might be if he took firmer positions on the issues or at least revealed more of his own opinions and prejudices.

Dr. Gawande writes that :

    Medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug people,
    put needles and tubes into them, manipulate their chemistry, biology, and physics, lay them unconscious and open their bodies up to the world.
    We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however-close enough to see
    the furrowed brows, the doubts and missteps, the failures as well as the successes -- is how messy, uncertain, and also surprising medicine turns
    out to be.

He's at his best when he's leading the reader through the mess.  From doctors with psychological problems to the vagaries of diagnosis to the strange, but surely coincidental, occurrences of a Friday the 13th with a full moon, he shows us that for all the advances in medicine in recent years, there is still much we don't understand and a stubborn persistence of quite alarming human error.  He's less good in essays like the one on the decline of autopsies (which happens to be on-line) when he strives so hard to take a balanced and empathetic approach that he borders on abandoning medical judgment.

The book is definitely worth reading and I'll be keeping an eye out for his essays. I suspect, and hope, that his best work lies in front of him and that as he gains experience and confidence he'll be willing to give his writing a little harder edge.  Hopefully he can do that without losing his welcome humility, rare enough in doctors in general but almost unheard of in a surgeon.

(Reviewed:)

Grade: (B)

  

Websites:

Book-related and General Links:
    -BOOKSITE : Complications (Written Voices)
    -ESSAY : FINAL CUT : Medical arrogance and the decline of the autopsy (Atul Gawande, The New Yorker, March 19, 2001)
    -ESSAY : Why Money Won't Buy Fat : In rich countries, the rich get rich and the poor get fat (Atul Gawande, Dec 25, 1998, Slate)
    -ESSAY : No Medicare Scare ? Yet : The system's real problem isn't the flight of a few HMOs. (Atul Gawande, Oct 23, 1998, Slate)
    -ESSAY : Juicy Journals : For us doctors, medical publications aren't just vital knowledge. They're gossip. (Atul Gawande, Sep 25, 1998, Slate)
    -ESSAY : The Dead Baby Mystery : Telling homicide from Sudden Infant Death Syndrome isn't as easy as you think. (Atul Gawande, Sep 04, 1998, Slate)
    -ESSAY : The Buck Stops With the Doc : Sometimes, blaming the system is fair. But in medicine, it can be a dangerous cop-out. (Atul Gawande, Jul 23, 1998, Slate)
    -ESSAY : Manning the Hospital Barricades : Why do groups--even groups of doctors--instinctively hate each other? (Atul Gawande, Jun 26, 1998, Slate)
    -ESSAY : Organ Meat : Letting people peddle their kidneys might save lives, but the ethical price is too high. (Atul Gawande, May 29, 1998, Slate)
    -DISCUSSION : Organ Peddling (Richard A. Epstein and Atul Gawande, Jun 05, 1998, Slate)
    -ESSAY : Viagra Creep : Quality-of-life drugs may threaten more than insurers (Atul Gawande, May 15, 1998, Slate)
    -ESSAY : The Human Cost of Crippling Castro : Health care is still pretty good in Cuba--unless you die waiting for embargoed supplies. (Atul Gawande, May 01, 1998, Slate)
    -ESSAY : E.R. and the Triple Hex : When a full moon and a lunar eclipse collide with Friday the 13th, do more accidents really happen? (Atul Gawande, Mar 20, 1998, Slate)
    -ESSAY : One for My Baby, but 0.08 for the Road : Why the liquor lobby's arguments against cutting blood-alcohol limits are all wet. (Atul Gawande, Feb 27, 1998, Slate)
    -ESSAY : Partial Truths in the Partial-Birth-Abortion Debate : Every abortion is gross, but the technique is not the issue (Atul Gawande, Jan 30, 1998, Slate)
    -ESSAY : Cold Comfort : Zinc may help your sniffles--but only because you really believe it will. (Atul Gawande, Dec 26, 1997, Slate)
    -ESSAY : Suicide Watch : The strange case of Air Force Capt. Craig Button. (Atul Gawande, Nov 22, 1997, Slate)
    -ESSAY : Does the Third World Deserve Second-Class AIDS Treatment? : Yes; some help is better than no help. (Atul Gawande, Nov 08, 1997, Slate)
    -ESSAY : Of Course You Don't Like Your HMO : It's because your employer chose your health plan, and you didn't. (Atul Gawande, Oct 25, 1997, Slate)
    -ESSAY : Drowsy Docs : If tired truckers are a threat, what about those sleep-deprived medical residents? (Atul Gawande,  Oct 10, 1997, Slate)
    -ESSAY : Cybertests : Hate exams (medical or otherwise)? What if a computer designed them just for you? (Atul Gawande, Sep 27, 1997, Slate)
    -ESSAY : Gamma Burgers : Food irradiation is safe, even if it is overkill. (Atul Gawande, Sep 12, 1997, Slate)
    -ESSAY : The Hunger : Body chemistry--not willpower--is the key to losing those 10 pounds. (Atul Gawande, Aug 29, 1997, slate)
    -ESSAY : Rx: Profit : Can hospitals serve both patients and stockholders? (Atul Gawande, Aug 15, 1997, Slate)
    -ESSAY : DOA : The feds' $24 billion health care program for kids is a flatliner. (Atul Gawande, Aug 02, 1997, Slate)
    -ESSAY : The Unkindest Cut : The science and ethics of castration. (Atul Gawande, Jul 12, 1997, Slate)
    -ESSAY : Diary : Atul Gawande (Atul Gawande, Jun 04, 1997, Slate)
    -ESSAY : Gulf War Syndrome (Atul Gawande, Oct 26, 1996, Slate)
    -DISCUSSION : Where to go for Medical Advice on the Web (Slate, June 2000)
    -REVIEW : of A Fly for the Prosecution : How Insect Evidence Helps Solve Crimes By M. Lee Goff (Atul Gawande, NY Times Book Review)
    -INTERVIEW : Atul Gawande, a surgeon and a writer, talks about why he set out to demystify the world of medicine in his book *Complications.* (Atlantic Monthly, May 2002)
    -ESSAY : Smart Pills (Village Voice, February 1999, Cynthia Cotts)
    -ARCHIVES : Atul Gawande (Slate)
    -REVIEW : of Complications (F. GONZALEZ-CRUSSI, NY Times)
    -REVIEW : of Complications (Steve Martinovich, Enter Stage Right)
    -REVIEW : of Complications by Atul Gawande (The Economist)
    -REVIEW : of Complications (Merle Rubin, LA Times)
    -REVIEW: of Complications (Anthony Daniels, booksonline)
    -REVIEW: of Complications (Michael Bywater, booksonline)
    -REVIEW : of Complications (Julia Hanna, Boston Phoenix)
    -ANNOTATED REVIEW : of Whose Body is it Anyway? by Atul Gawande (Martin Kohn, Medical Humanities)

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