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Available
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Collection
Publication
Publisher Unknown (1969)
Description
A brilliant and courageous doctor reveals, in gripping accounts of true cases, the power and limits of modern medicine. Sometimes in medicine the only way to know what is truly going on in a patient is to operate, to look inside with one's own eyes. This book is exploratory surgery on medicine itself, laying bare a science not in its idealized form but as it actually is -- complicated, perplexing, and profoundly human. Atul Gawande offers an unflinching view from the scalpel's edge, where science is ambiguous, information is limited, the stakes are high, yet decisions must be made. In dramatic and revealing stories of patients and doctors, he explores how deadly mistakes occur and why good surgeons go bad. He also shows us what happens when medicine comes up against the inexplicable: an architect with incapacitating back pain for which there is no physical cause a young woman with nausea that won't go away a television newscaster whose blushing is so severe that she cannot do her job. Gawande offers a richly detailed portrait of the people and the science, even as he tackles the paradoxes and imperfections inherent in caring for human lives. At once tough-minded and humane, Complications is a new kind of medical writing, nuanced and lucid, unafraid to confront the conflicts and uncertainties that lie at the heart of modern medicine, yet always alive to the possibilities of wisdom in this extraordinary endeavor.… (more)
User reviews
LibraryThing member SqueakyChu
For anyone interested in the world of medicine and doctors, I heartily recommend this eloquently written and fascinating book of medical essays. At the time Dr. Atul Guwande wrote this book, he had been a surgical resident at a Boston hospital.
The book is divided into three parts, each dealing
I think a book such as this one is important for a variety of reasons. It is a way for patients to understand a different side of medicine. It “humanizes” medical practitioners who often no longer have the time to “really” get to know their patients. However, the most important reason for an individual to read this book would be to see how important it is for each person to be an advocate for his or her own health care. Patients and doctors should be full partners in medical care with both sides bringing honesty and thoughtful consideration into the course of any medical treatment.
The book is divided into three parts, each dealing
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with different facets of “complications” in modern medicine. My guess is that, for the general public, the middle section of the book, the part which addresses medical superstition, pain, nausea, blushing, and morbid obesity, would be the most interesting. For me, however, I was more captivated by the topic of fallibility of the world of medicine. I like how Dr. Guwande tackled this subject head on in a forthright and honest manner. Some of the subjects with which he deals through the book are unintentional medical errors, medical errors made through inexperience, medical diagnostic intuition, and the decreasing use of autopsies to correlate the cause of death diagnosis. Each topic he discusses is a world unto itself, fully described and offering much food for thought. I think a book such as this one is important for a variety of reasons. It is a way for patients to understand a different side of medicine. It “humanizes” medical practitioners who often no longer have the time to “really” get to know their patients. However, the most important reason for an individual to read this book would be to see how important it is for each person to be an advocate for his or her own health care. Patients and doctors should be full partners in medical care with both sides bringing honesty and thoughtful consideration into the course of any medical treatment.
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LibraryThing member gooutsideandplay
I've pretty much decided that I would read a telephone directory if this man wrote it. I didn't think there could be a, well, better book than his previous work, Better, but I think this tops it. Complications is about the imperfections in medicine -- the unexplained mysteries, the screw ups and
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the inconsistencies in decision-making. Reading this book is almost like being faced with a terrifying medical decision for a loved one, but while you face it Gawande has his hand on your shoulder. His compassion and wonder at what we don't understand about the human condition -- both of patients and of doctors -- is on full view -- but in such a way that you feel hopeful and brave. The chapters about morbidly obese patients, and also the one about doctors who have "gone wrong" are written with respect and almost tenderness that is as touching as it is illuminating and clear-eyed. Show Less
LibraryThing member the_awesome_opossum
Complications is a really neat look into how hospitals are run, and how doctors and surgeons get by in their careers day after day. Although my favorite parts were the unique cases that Gawande wrote about (it's like watching House, except it's nonfiction), the reader also learns about other parts
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of the career as well - morbidity and mortality conferences, for example, or how to approach a patient's family to consent for an autopsy. I didn't finish the book exactly reassured - Gawande is completely candid about the errors that have been made in hospitals - but I learned a lot and gained a lot of respect for the doctors in such high-pressure jobs. Show Less
LibraryThing member writer1985
Fantastic book by one of the New Yorker's premier writers. The stereotypical surgeon is arrogant and bombastic -- and I've met a few like that -- but Gawande writes with such insight and grace that I almost want to go into the field myself. He avoids the sentimentality common in so much of the "how
After reading this one, you should go out and read Better. It's geared toward more of a medical audience than Complications, but both are eminently readable by an educated lay public.
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to be a doctor" writings, yet still demonstrates respect for his patients.After reading this one, you should go out and read Better. It's geared toward more of a medical audience than Complications, but both are eminently readable by an educated lay public.
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LibraryThing member khuggard
I read Complications shortly after I underwent a major surgery, so I was especially intrigued to read about some of the moral and ethical issues facing modern surgeons. Gawande, in a series of essays originally published in the New Yorker, explores the modern world of surgeons and hospitals in an
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engaging and accessible style. Highly recommended. Show Less
LibraryThing member Stensvaag
A wonderful book exploring the fallibility of physicians and the ethical challenges they face. By thoughtfully relating honest stories of failure and encouraging anecdotes of success, Dr. Gawande has given me a much better notion of what it must be like to be a practicing surgeon.
LibraryThing member lmnalban
Reading this book has not raised my confidence in the medical field, but it has made me a better patient. I read this book when it was first published, and the stories, the characters, and the lessons influence my behavior as a patient today.
LibraryThing member nicdevera
The necrotizing fasciiitis case was a great ending.
LibraryThing member chellerystick
Parts of this book, especially in the middle, primarily appeal to our curiosity about the body. All well and good, but what takes this to the next level is Gawande's willingness to tackle the philosophical question of how to resolve the paradoxes of medical practice. Of course, there is no simple
Highly recommended, especially for those who enjoy things like Oliver Sacks and medical mysteries.
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answer to this, but his discussions add to our ability to choose and understand our doctors.Highly recommended, especially for those who enjoy things like Oliver Sacks and medical mysteries.
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LibraryThing member BenjaminHahn
A great collection of essays on the practice of medicine. Gawande really lays it all out there and is quick to point out his own mistakes and failures. I felt like I was getting a straight and honest impression of the profession as I read it. Very humanizing. We read this for book club 2/09 and all
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nine readers really liked it. We had one of our most interesting talks in a long time. The book is divided up into three parts and the most fascinating section was on mysteries. I particularly found intersesting the essay on pain and its origins in the body. How responsible is mentality when it comes to pain? How does the environment play into an individuals perception of toleration of pain? Very deftly handled in the book. Show Less
LibraryThing member jngrl7
I thought this book was fascinating. I had to read it for a medical sociology class in college, but I found it to be one of the most interesting books I "had" to read. I would definately recommend this book to anyone looking for an inside view into the imperfect science of medicine.
LibraryThing member JillKB
I should not have been surprised to learn from the Author's Acknowledgement that Gawande is friends with Malcolm Gladwell -- this book is the doctor's equivalent of a Gladwell book. I really learned a lot from this book and have found myself sharing some of the points with others as I've read it. I
Some of my favorite points were:
That every patient wants an experienced doctor, but the only way a young doctor becomes an experienced doctor is by performing procedures (very much like a teacher).
The evolutionary purpose of morning sickness
The role of intuition in medicine
How some doctor's go "bad"
The ways doctors try to police themselves
How much doctors and medical researchers still don't know -- the amount of uncertainty and subjectivity.
Other doctors have much to learn from palliative doctors, who take the patient's suffering as seriously as the symptoms.
I also liked reading Gawande's descriptions of his role as a surgical resident -- although how he managed to juggle writing this book with his work and family life (he has a wife and 3 kids) boggles my mind.
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should say that Gawande is very graphic in decribing medical procedures and conditions, and there were times I felt a little squeamish (Like reading the chapter on nausea as I was eating lunch; also I'll never be able to hear that TV doctors are about to "put it a line" without wincing) and realized I didn't want to know all this detail, but I'm still glad I read this book. Some of my favorite points were:
That every patient wants an experienced doctor, but the only way a young doctor becomes an experienced doctor is by performing procedures (very much like a teacher).
The evolutionary purpose of morning sickness
The role of intuition in medicine
How some doctor's go "bad"
The ways doctors try to police themselves
How much doctors and medical researchers still don't know -- the amount of uncertainty and subjectivity.
Other doctors have much to learn from palliative doctors, who take the patient's suffering as seriously as the symptoms.
I also liked reading Gawande's descriptions of his role as a surgical resident -- although how he managed to juggle writing this book with his work and family life (he has a wife and 3 kids) boggles my mind.
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LibraryThing member TheAmpersand
A brief, eloquent, and thoughtful book that describes the messy and occasionally miraculous business of surgery and traces the author's own development from greenhorn resident to accredited surgeon. Clearly written for a general audience, "Complications" makes surgery seem like a very human
Gawande's book also might give some readers a new perspective on their own bodies. While we tend to think that we know our own bodies pretty well, it's fair to say that surgeons have seen more of more human bodies than most people have, or care to. His descriptions of surgical procedures are clear and straightforward and free of unnecessarily technical language The author deserves some credit for not going in for shock value, even when he describes operations that would amaze doctors that practiced just a few decades ago. The human body, which is, perhaps, the real main character of "Complications" is made to look both eminently functional and endlessly strange, sometimes too delicate and sometimes surprisingly resilient, Gawande succeeds, I think, in convincing his readers that its thanks to the surgeons like him that we know as much about it as we do.
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endeavor, not the domain of mysterious, infallible wise men in white coats. In Gawande's telling, surgery full of unknowns and anxiety for both the doctors and their patients, it takes a great deal practice to get good at it, and everyone involved is faced with tough choices that they sometimes come to regret. The author never seems to forget that both the doctors and patients he describes were people before the operating table and have lives to go back to after the surgery is finished. Gawande makes a point of putting the practice of surgery in a larger context and takes several chapters to describe how new technologies and current social trends, like the idea that patients should have the final say about their treatment, have affected the way doctors do things. While he's aware that he has his own professional prejudices, his descriptions of these debates seem admirably fair minded and sensitive to his patients' interests. Gawande's book also might give some readers a new perspective on their own bodies. While we tend to think that we know our own bodies pretty well, it's fair to say that surgeons have seen more of more human bodies than most people have, or care to. His descriptions of surgical procedures are clear and straightforward and free of unnecessarily technical language The author deserves some credit for not going in for shock value, even when he describes operations that would amaze doctors that practiced just a few decades ago. The human body, which is, perhaps, the real main character of "Complications" is made to look both eminently functional and endlessly strange, sometimes too delicate and sometimes surprisingly resilient, Gawande succeeds, I think, in convincing his readers that its thanks to the surgeons like him that we know as much about it as we do.
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LibraryThing member cait815
Great book. It sagged a bit near the middle (the chapters on blushing and gastric bypass were, in my opinion, the weakest of the bunch). The rest was pretty damn riveting. And I found the section on nausea and vomiting fascinating!
LibraryThing member trinityofone
This is a fantastic account by a surgeon in the last year of his residency. Gawande blends discussion of interesting and curious cases with thoughts on both ethical and technical issues facing doctors today, and makes it all immanently readable—I was never, not once, confused by jargon or
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technical terms. Gawande is thoughtful and compassionate, and willing to recognize faults both in his profession and in himself. If you're at all interested in medicine, or enjoy watching "Scrubs" or "House" or any of those shows, this is really well worth checking out. Show Less
LibraryThing member uttara82
I can think of many reasons why Complications is a brilliant piece of work. It is thought provoking and well-written, combining 'case studies' with analytical essays; it asks tough questions and comes up with tough answers and non-answers.
Complications is also the hardest book I've ever read - all
Brilliant. But not for hypochondriacs or those who don't take too well to honest medical writing.
Complications is also the hardest book I've ever read - all
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the more so because it is compelling and I did want to read it all. It is probably just me, but some of the descriptions (matter-of-fact descriptions that don't intend in any way to shock the reader)brought exceedingly disagreeable images to my mind and made me physically sick. In other cases, I began to ponder unpleasant thoughts and questions that I could have done without. All, totally not the fault of the book or the author, but the nature of the work itself - though very absorbing, can hardly be called joyful.Brilliant. But not for hypochondriacs or those who don't take too well to honest medical writing.
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LibraryThing member dvf1976
I picked this up after hearing a podcast speech by the author (Atul Gawande)... He said that the show "Grey's Anatomy" was kinda-sorta based on his book.
This made it a perfect book for both Erin and I to read.
Erin tore through it faster than I did (I was reading a few other books simultaneously),
I enjoyed when the author made suggestions on how to get better outcomes... Particularly the "If we can multiply the success here by every doctor, then we'll save X number of lives" advice.
The essays actually had the "feel" of a weblog post that a doctor would make.
This made it a perfect book for both Erin and I to read.
Erin tore through it faster than I did (I was reading a few other books simultaneously),
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but I did enjoy it.I enjoyed when the author made suggestions on how to get better outcomes... Particularly the "If we can multiply the success here by every doctor, then we'll save X number of lives" advice.
The essays actually had the "feel" of a weblog post that a doctor would make.
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LibraryThing member allthesedarnbooks
This is a well-written, thoughtful series of essays on surgery, medicine, and doctors as people. I came out of it feeling more informed about the decisions doctors make every day, what goes wrong and what goes right. There were very few dull moments. Gawande's prose is matter of fact but lively.
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Recommended. Show Less
LibraryThing member oldman
A book of scenes from a surgeon's years of residency. He writes well, but the format is not all that different from other books of this genre. The topics covered are truly those causing the most difficulty to those who provide care to us. The most interesting aspect of his chapters is his going to
Because I work in medicine and understand the issues, the complexity and the "art" besides the science I found the book somewhat a review of my day-to-day work. It is a truer view than many such books I have read. I would recommend this book, if only for the different scenes and how decisions are made in medicine.
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the effort to find how the patients did after going home. Few surgeons do this when discharged back to our regular physicians. Because I work in medicine and understand the issues, the complexity and the "art" besides the science I found the book somewhat a review of my day-to-day work. It is a truer view than many such books I have read. I would recommend this book, if only for the different scenes and how decisions are made in medicine.
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LibraryThing member yourotherleft
Complications is a collection of essays about Atul Gawande's experience as a surgeon and his acute observations of how the medical establishment is failing and succeeding. Gawande's essays offer us a look into the murky depths of practicing medicine that we fail to understand and appreciate despite
Gawande engages the reader using frequent case studies of patients he and his colleagues have encountered. These serve to draw the reader in and also as great jumping off points for Gawande to tackle the struggles and questions that plague both doctors and patients about the state of medicine today. In Complications, Gawande contemplates the mystery of pain, questions how we do and essentially must entrust patient care to doctors in training, the improbable victory of a surgeon's instinct over facts and logic, and many more fascinating topics.
Complications is an important book. It's a book that asks us to consider the fact that even the doctors who are treating us are merely fallible human beings who know a lot but are often forced to rely on gut instinct in a crunch which may work to the benefit of the patient but may also work to their detriment. It's a book that reminds the rest of us, as patients, that we have an important role to play in our own healthcare. All this, and it also features the sort of compelling, easy to understand writing that makes Complications almost impossible to put down.
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our often frequent contact with the system. Broken up into three sections, Gawande's essays explore doctors' fallibility, unknowns and mysteries that often crop up in the treatment of patients, and, finally, uncertainty itself, a prospect we often fail to consider given the perpetual technological advancement that seems inherent in practicing medicine. Gawande engages the reader using frequent case studies of patients he and his colleagues have encountered. These serve to draw the reader in and also as great jumping off points for Gawande to tackle the struggles and questions that plague both doctors and patients about the state of medicine today. In Complications, Gawande contemplates the mystery of pain, questions how we do and essentially must entrust patient care to doctors in training, the improbable victory of a surgeon's instinct over facts and logic, and many more fascinating topics.
Complications is an important book. It's a book that asks us to consider the fact that even the doctors who are treating us are merely fallible human beings who know a lot but are often forced to rely on gut instinct in a crunch which may work to the benefit of the patient but may also work to their detriment. It's a book that reminds the rest of us, as patients, that we have an important role to play in our own healthcare. All this, and it also features the sort of compelling, easy to understand writing that makes Complications almost impossible to put down.
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LibraryThing member caitykai
This book captivated me. I would definitely read this again.
LibraryThing member jellyish
Fascinating look at medicine.
LibraryThing member Periodista
I guess this just isn't the book for me. I am interested in science writing, but this just seems one more entry in the deification of doctors, like so many TV series or doctor's columns in women's magazine. And as one scientist remarked in discussions about the Jonah Lehrer errors and fabrications,
Does anyone else think he should disclose the costs of these surgeries, whether patients have medical insurance, and his own income? (Don't forget, he's also a staff writer for the New Yorker; all it takes is to be friends with the editor of Slate and with Malcolm Gladwell). I guess I have long been sensitive about this but the omission of financial factors was more in the forefront of my mind because I had just read Head Cases by Michael Paul Mason, where a thread throughout is the financial impact of brain injury on families and whether insurance will cover therapies.
Most ridiculous examples ... a super-obese working-class man who gets gastric bypass surgery. This might be the only profile in which we're told the surgery at the time cost $20,000. But the man is on the brink of bankruptcy, can't get out of his house and had sold off large equipment. Surely insurance can't be covering this? What is the financial impact on his family.
There's all this posturing about the Oh Great Doctors' ethical dilemmas: what should he recommend? Surgery or not? Some mention of the weight of pain and suffering. But *never* a mention of what must loom in the patient's and p's families' minds: "how much will this cost? We can spend up to here but not up to here. How many years to pay this off?"
Then there's the case of an elderly Mr. Lazaroff with a tumor around his spine. Already partially paralyzed, he is at risk for more paralysis and ending up on a ventilator until his death. He wants the surgery.
We're told that the few weeks of intensive care (what about the hours-long surgery?) incur "enormous" financial costs before his death. I guess the man must have been on Medicare, so no or few worries. But $100,000 on up is a safe guess.
Shouldn't that provoke a mite bit of musing of how the money might be better distributed. Breast screening for the working poor? A year of intensive therapy for a young brain-damaged man who might be able to support or take care of himself at the end of it? It would be interesting to see how a doctor under a state-run universal health service would weigh the choices. There is always *rationing* in such systems and the age of a patient is a large factor.
Also irritated by the young woman who wanted to be "on TV" but had a blushing issue. Now there are many jobs in broadcast journalism--responsible, well-paying jobs--where blushing wouldn't be a hindrance. But this woman wants to be "on TV" and her dream must be fulfilled, not matter what the cost (not that it's mentioned). How could a young person, perhaps making $20,000 in the late 1990s on a small station afford it? Couldn't have student loans, so must be rich parents. Insurance wouldn't cover this, right?
Once upon a time, when the circumstances and the medical care were in reach of most of the middle-class, even the working lower US middle-class, maybe these little pieces could stand alone but nowadays, I think not. And, no, I couldn't afford any of these illnesses,
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doctors aren't scientists either. The writing is smooth, New Yorker style: a little anecdote interspersed with the teaching nuggets. Nothing too technical or heavy on the science side. Not enough for me.Does anyone else think he should disclose the costs of these surgeries, whether patients have medical insurance, and his own income? (Don't forget, he's also a staff writer for the New Yorker; all it takes is to be friends with the editor of Slate and with Malcolm Gladwell). I guess I have long been sensitive about this but the omission of financial factors was more in the forefront of my mind because I had just read Head Cases by Michael Paul Mason, where a thread throughout is the financial impact of brain injury on families and whether insurance will cover therapies.
Most ridiculous examples ... a super-obese working-class man who gets gastric bypass surgery. This might be the only profile in which we're told the surgery at the time cost $20,000. But the man is on the brink of bankruptcy, can't get out of his house and had sold off large equipment. Surely insurance can't be covering this? What is the financial impact on his family.
There's all this posturing about the Oh Great Doctors' ethical dilemmas: what should he recommend? Surgery or not? Some mention of the weight of pain and suffering. But *never* a mention of what must loom in the patient's and p's families' minds: "how much will this cost? We can spend up to here but not up to here. How many years to pay this off?"
Then there's the case of an elderly Mr. Lazaroff with a tumor around his spine. Already partially paralyzed, he is at risk for more paralysis and ending up on a ventilator until his death. He wants the surgery.
We're told that the few weeks of intensive care (what about the hours-long surgery?) incur "enormous" financial costs before his death. I guess the man must have been on Medicare, so no or few worries. But $100,000 on up is a safe guess.
Shouldn't that provoke a mite bit of musing of how the money might be better distributed. Breast screening for the working poor? A year of intensive therapy for a young brain-damaged man who might be able to support or take care of himself at the end of it? It would be interesting to see how a doctor under a state-run universal health service would weigh the choices. There is always *rationing* in such systems and the age of a patient is a large factor.
Also irritated by the young woman who wanted to be "on TV" but had a blushing issue. Now there are many jobs in broadcast journalism--responsible, well-paying jobs--where blushing wouldn't be a hindrance. But this woman wants to be "on TV" and her dream must be fulfilled, not matter what the cost (not that it's mentioned). How could a young person, perhaps making $20,000 in the late 1990s on a small station afford it? Couldn't have student loans, so must be rich parents. Insurance wouldn't cover this, right?
Once upon a time, when the circumstances and the medical care were in reach of most of the middle-class, even the working lower US middle-class, maybe these little pieces could stand alone but nowadays, I think not. And, no, I couldn't afford any of these illnesses,
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LibraryThing member karenzukor
The man is amazing, surgeon, gifted writer, father, and he seems to track down the subjects of his essays years later regularly.
Some good insights into what medicine is doing, and what its limits are.
Some good insights into what medicine is doing, and what its limits are.
LibraryThing member melissavenable
This book was selected by a reading group on Twitter (#lrnbk) that focused on books "about how learners learn". It's not a book I would have picked up otherwise, but am glad I did. Through the author's telling of how he came to be a doctor you find out more about how doctors/medical students learn
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how to do what they do. The reality of "practice" in hospitals and doctor's offices can be difficult to read, but worth the time to do so. Gawande also introduces some of the most effective ways in which doctor's learn, such as in teams, and provides examples and stories of the good and bad from his experience. Show Less
Subjects
Awards
National Book Award (Finalist — Nonfiction — 2002)
Borders Original Voices (2003)
Notable Books List (2003)
Original publication date
2002
Other editions
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