BJS Bookshelf: Complications: A Surgeon’s Notes on an Imperfect Science

“But when you see your patient making a grave mistake, should you simply do what the patient wants? The current medical orthodoxy says yes. After all, whose body is it, anyway?”

-Atul Gawande

Surgeon and writer Atul Gawande provides a detailed and insightful account of medicine’s shortcomings. Through numerous stories given as examples, the author shows us where we as doctors may fall short of explanations, correct decisions and treatment options. This inadvertently results in complications. He also explores many different issues specific to surgical practice and their implications for both surgeon and patient; these include intraoperative injuries, morbidity and mortality meetings, the conundrum of chronic pain, refractory nausea, and the features of a good surgeon. The book is divided into 3 parts titled Fallibility, Mystery and Uncertainty and is about 250 pages long. 

This is a unique book that is a must-read for surgeons. Given that Gawande is a surgeon, he is already an insider, and surgeons will find the many stories he cites relevant to their everyday practice. This book will motivate surgeons to think about certain topics that are not directly addressed in surgical texts nor in training. Such topics include superstitions that drive surgeons to perform intraoperative rituals which are entirely devoid of evidence. Others include the frustration surgeons feel when patients refuse what is believed to be beneficial treatment, the true nature and purpose of informed-consent, and the perceptions surgeons have of their own operative performance compared to that of their colleagues. Another dilemma is that of surgical education where persistence and practice are needed in the pursuit of perfection, yet practice has to happen on human beings, often with the risk of imperfections and complications along the way. Failure is another theme which is addressed in the book as Gawande asks readers to contemplate the many factors that cause healthcare professionals to err or “fail”, and to differentiate between the failure of an individual and that of a healthcare system that sets up individuals for failure. To read this book is to look in the mirror and face the “fallibility, the “mystery” and the “uncertainty” of a science that  we think should be perfect, only to realize it is merely human.