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Complications: A Surgeon's Notes on an Imperfect Science Hardcover – April 4, 2002
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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.
Complications is a 2002 National Book Award Finalist for Nonfiction.
- Print length269 pages
- LanguageEnglish
- PublisherMetropolitan Books
- Publication dateApril 4, 2002
- Dimensions5.69 x 1.09 x 8.54 inches
- ISBN-100805063196
- ISBN-13978-0805063196
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From Publishers Weekly
Copyright 2002 Cahners Business Information, Inc.
From The New England Journal of Medicine
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Review
“Complications is a book about medicine that reads like a thriller.” ―Malcolm Gladwell, author of The Tipping Point
“Complications is a uniquely soulful book about the science of mending bodies.” ―Adam Gopnik, author of From Paris to the Moon
About the Author
Excerpt. © Reprinted by permission. All rights reserved.
Complications
A Surgeon's Notes on an Imperfect ScienceBy Gawande, AtulMetropolitan Books
Copyright ©2002 Gawande, AtulAll right reserved.
ISBN: 0805063196
When you are in the operating room for the first time and see the surgeon press his scalpel to someone's body, you either shudder in horror or gape in awe. I gaped. It wasn't the blood and guts that enthralled me. It was the idea that a mere person would ever have the confidence to wield that scalpel. I wondered how the surgeon knew that all the steps would go as planned, that bleeding would be controlled and organs would not be injured. He didn't, but still he cut.
Later, I was allowed to make an incision myself. The surgeon drew a six-inch dotted line across the patient's abdomen and then, to my surprise, had the nurse hand me the knife. It was, I remember, still warm. I put the blade to the skin and cut. The experience was odd and addictive, mixing exhilaration, anxiety, a righteous faith that operating was somehow beneficial, and the slightly nauseating discovery that it took more force than I realized. The moment made me want to be a surgeon -- someone with the assurance to proceed as if cutting were routine.
Continues...
Excerpted from Complications by Gawande, Atul Copyright ©2002 by Gawande, Atul. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Product details
- Publisher : Metropolitan Books; First Edition (April 4, 2002)
- Language : English
- Hardcover : 269 pages
- ISBN-10 : 0805063196
- ISBN-13 : 978-0805063196
- Item Weight : 2.31 pounds
- Dimensions : 5.69 x 1.09 x 8.54 inches
- Best Sellers Rank: #656,566 in Books (See Top 100 in Books)
- #285 in General Surgery
- #673 in Medical Education & Training (Books)
- #1,407 in Medical Professional Biographies
- Customer Reviews:
About the author
Atul Gawande is the author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker since 1998, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by Foreign Policy and TIME. In his work as a public health researcher, he is Director of Ariadne Labs a joint center for health system innovation. And he is also co-founder and chairman of Lifebox, a global not-for-profit implementing systems and technologies to reduce surgical deaths globally. He and his wife have three children and live in Newton, Massachusetts.
You can find more at http://www.atulgawande.com.
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Learn more how customers reviews work on AmazonCustomers say
Customers find the book engaging and easy to read. They appreciate the author's candor in revealing thoughts, emotions, fears, and challenges of practicing medicine. The writing quality is described as accessible and unique. Readers enjoy the compelling stories and combination of personal anecdotes and factual data. The book covers complication issues clearly and dissects them in an easy-to-understand manner. Overall, customers find the book relatable and informative.
AI-generated from the text of customer reviews
Customers find the book engaging and easy to read. They praise the writing style as vivid and well-crafted. The human drama is described as depicted like a TV series.
"...Non-fiction? It is a unique thing to write and indeed high praise. “Complications” is hard to stop reading...." Read more
"Excellent book, I learned a lot about medicine and being a doctor. Easy to read. Would recommend. Book came in good condition." Read more
"...in the behind the scenes of the medical world this is a book worth reading...." Read more
"...any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific." Read more
Customers appreciate the book's insights into medicine. They find it helpful for patients to understand the challenges and perspective of practicing medicine. The book provides a realistic understanding of the medical profession and helps them ask the right questions. While the writing is informative, it is accessible and engrossing.
"...I appreciate his efforts to provide generalized / generalizable insights, illustrated by poignant anecdotes; and, I appreciate reading his point of..." Read more
"Excellent book, I learned a lot about medicine and being a doctor. Easy to read. Would recommend. Book came in good condition." Read more
"...It delves into unusual diagnosis and treatment of often only rarely seen diseases. As a nurse I enjoyed going behind the scenes." Read more
"...more defined by statistics than in the past, but personality and experience still play a great part...." Read more
Customers find the book well-written and easy to read. They appreciate the author's clear prose and engaging stories. The book is described as unique and informative, though not offering much.
"...Non-fiction? It is a unique thing to write and indeed high praise. “Complications” is hard to stop reading...." Read more
"Excellent book, I learned a lot about medicine and being a doctor. Easy to read. Would recommend. Book came in good condition." Read more
"...Gawande, both a skilled surgeon and an eloquent writer, shares personal stories and reflections that illuminate the fallibility of even the most..." Read more
"This book is amazing an easy read and so captivating! Arrived in perfect condition!" Read more
Customers find the book's storytelling engaging and insightful. They describe it as a captivating, profound read that provides an eye-opening perspective on certain problems. The writing flows smoothly and depicts human drama like a TV series based in the hospital.
"...efforts to provide generalized / generalizable insights, illustrated by poignant anecdotes; and, I appreciate reading his point of view about those..." Read more
"This book is amazing an easy read and so captivating! Arrived in perfect condition!" Read more
"...the memoirs make some very suspenseful reading and provide an eye-opening perspective on certain problems facing healthcare, I feel that Atul steers..." Read more
"...I also still have this book. It offers an eye opening account of how doctor's don't always get it right or know what's wrong with a person...." Read more
Customers find the book's complication coverage thorough and engaging. They appreciate the author's clear explanations, knowledge of certain procedures, and well-defined methods. The book helps readers understand and appreciate each doctor's challenges. It provides descriptions of how the field works and diagnostic puzzles. Overall, customers find the book comprehensive and easy to read with a wealth of information.
"...SUMMARY This book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea...." Read more
"...While the reading is informative, it isn't very opinionated...." Read more
"...All his writing is a pleasure to read; his explanations are clear and easy for non medical readers to understand, his data well researched, and the..." Read more
"...I could also feel the pain in the absent of standards, and well defined methods...." Read more
Customers find the book's look engaging and relatable. They describe it as candid, graphic, and simple in style.
"...This honesty creates a beautiful tone that is rare in non-fiction...." Read more
"...Atul Gawande is an amazing writer with a captivating writing voice and style, and this book is a brilliant gift idea as well. Highly recommend it!" Read more
"Engaging, a must-read. Simple in its style but engaging. Would highly recommend this book as well as others written by Atul Gawande." Read more
"This is a pretty candid look into the world of surgery and medicine in general. One of his better efforts." Read more
Customers have different views on the book's scariness level. Some find it an emotional journey and moving, while others consider it terrifying.
"The first few chapters of this book are more terrifying than any horror novels I've ever read...." Read more
"...Very moving" Read more
"...so much of himself and what goes on in the surgeon's world.....rather terrifying, actually, but I would want him to be my surgeon...." Read more
"A heartfelt journey into the doctor's unknown..." Read more
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Top reviews from the United States
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- Reviewed in the United States on January 28, 2023How many non-fiction books have you read which you would describe as “hard to put down?” Describing a work of fiction as such is high praise. Non-fiction? It is a unique thing to write and indeed high praise. “Complications” is hard to stop reading.
I appreciate Gawande’s attempts at candor, exposé (which it is not not but approaches), and balance. I appreciate his efforts to provide generalized / generalizable insights, illustrated by poignant anecdotes; and, I appreciate reading his point of view about those aspects of care which defy generalization.
All writing has bias. It is inherent even if accepted conventions are followed flawlessly. It is therefore well to acknowledge that statements made in this book are also subject to error; and it is well to illustrate at least one specific instance. The author has written (page 249 of the Kindle edition),
“His [Jack Wennberg’s] research has shown, for example, that the likelihood of a doctor sending you for a gallbladder-removal operation varies 270 percent depending on what city you live in; for a hip replacement, 450 percent; for care in an intensive care unit during the last six months of your life, 880 percent. A patient in Santa Barbara, California, is five times more likely to be recommended back surgery for a back pain than one in Bronx, New York. This is, in the main, uncertainty at work, with the varying experience, habits, and intuitions of individual doctors leading to massively different care for people.”
The last sentence is inaccurate. Publications available at DartmouthAtlas.org, demonstrate that availability is a statistically significant factor in explaining much of the variation in surgical utilization from region to region. In other words, where surgery centers exist, surgeries which that center specializes in will indeed be done disproportionate to optimal care or even need. Stated more harshly, surgeons get paid to do surgeries.
One cannot rule out financial incentive as a reason for the observed phenomenon.
- Reviewed in the United States on November 5, 2024Excellent book, I learned a lot about medicine and being a doctor. Easy to read. Would recommend. Book came in good condition.
- Reviewed in the United States on December 25, 2024For anyone interested in the behind the scenes of the medical world this is a book worth reading. It delves into unusual diagnosis and treatment of often only rarely seen diseases. As a nurse I enjoyed going behind the scenes.
- Reviewed in the United States on May 27, 2012This book was a fascinating look into the modern doctors world. It is a job more defined by statistics than in the past, but personality and experience still play a great part. I really enjoyed reading this doctor/author's book book on Checklists and their usage in medicine so I was not disappointed with his more random thoughts on doctoring in general.
Some of it is quite unsettling as in the case of surgery and interns learning. You hate to be a learning experience when your life is at stake, but how else do interns learn? Still...most doctors insist that their loved ones, are not part of this experience. Doesn't seem really fair; does it?
Doctors like everyone else do better with practice, and this is well demonstrated with these specialized practices that only do Hernia operations. It also makes it possible for robots and computers to be quite effective at simple procedures. However that gives me pause. Here the blue screen of death might have greater implications than a reboot.
I liked the fact where he dealt with some of his mistakes and diagnoses of patients and how there was a struggle of procedure and how to approach things. One person was nearly harmed by a minor oversight and another person was saved with a hunch. Given that both of these areas (oversights and hunches) are in the gray areas of human cognition it shows how much luck plays a factor, or a sixth sense, that doctors with experience start to develop.
A quick synopsis of what this book includes:
INTRODUCTION
FALLABILITY
*Education of a knife: How interns are trained in surgery. Odds are, you are their training.
*The computer and the hernia factory: Repetition = perfection and efficiency
*When doctors make mistakes: How mistakes happen. Like all of us they are human, but unlike all of us the ramifications are greater.
*Nine Thousand Surgeons: Conferences provide an opportunity to compare notes and keep up to date.
*When Good doctors go Bad: Peer review is necessary but whistle blowing on a colleague is rare. Not surprising there are remediation schools, but few and far between. Important note, if some doctors push you away from others...take note.
MYSTERY
Full Moon/Friday the 13th: Is there any truth to this. Statistically no, but the jury is still out.
The pain perplex: Pain stumps most doctors as how and why it exists is not clear cut.There is no test for pain.
A queasy feeling: Nausea is not one symptom, nor does it have a single cause and can be very difficult to treat.
Crimson tide: Blushing, for some it undermines their confidence, but is it only cosmetic?
The man who couldn't stop eating: Overeating is a life altering issue and surgery to address this is gaining ground as in the case of the morbidly obese, it works.
UNCERTAINTY
*Final Cut: Autopsy is not done as much any more unless there is a mystery surrounding the death. However, it helps educate doctors as to the accuracy of their diagnoses. Unfortunately to many it is a violation of the dead, who will gain nothing in return.
*The dead baby mystery: Sometimes the answers are obvious
*Whose body is is anyway: Doctors these days advise, not dictate and patients struggle to make the right choices. *Doctors have to let patients make bad choices despite their objections.
*The case of the red leg: Gut feeling are sometimes all you have and often they are dead on. In the absence of this all that is left is statistics.
SUMMARY
This book was interesting, as it was a mix of topics. Some associated with specific symptoms like pain, blushing and nausea. Others associated with medical errors, bad doctors, cases that were swayed by errors and hunches. If you have any interest in medicine, but not the background, these are great books to read, as you get the human side of it, rather than the scientific.
- Reviewed in the United States on October 23, 2024Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande is a compelling exploration of the human side of medicine. Gawande, both a skilled surgeon and an eloquent writer, shares personal stories and reflections that illuminate the fallibility of even the most trained practitioners. The book provides a fascinating look at how doctors grapple with mistakes, uncertainties, and the daunting responsibility of their profession. Gawande’s writing is clear and accessible, making complex medical issues understandable for any reader.
What stands out is the honesty with which Gawande addresses the imperfections of medicine. He doesn’t shy away from discussing errors and the inherent unpredictability of the field, offering a humbling reminder that even in the most advanced hospitals, doctors are human. This thought-provoking book will resonate with both healthcare professionals and laypeople, leaving you with a deeper appreciation for the challenges doctors face every day. Highly recommended!
- Reviewed in the United States on October 22, 2024This book is amazing an easy read and so captivating! Arrived in perfect condition!
- Reviewed in the United States on July 9, 2024Great, grounded, and realistic first-person review of medical care and the very human shortcomings of practitioners - as well as a perspective on how that may be an avoidable part of humans caring for humans.
Top reviews from other countries
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CeciliaReviewed in Mexico on January 18, 2022
5.0 out of 5 stars Buena lectura
Me encantó el libro, es bueno saber que uno no está solo al pasar por tantas experiencias en la medicina.
Cecilia
Reviewed in Mexico on January 18, 2022
Images in this review - Diksha maanReviewed in India on July 26, 2023
5.0 out of 5 stars Good and engaging read
This books takes you on s journey of life of doctors, whom we expect to be perfect. This book show their human side and each new case keeps you on edge, that what is going to happen to patient? What will be the result? they are going to be okay or not?
- FlorianReviewed in Germany on March 9, 2023
5.0 out of 5 stars Thrilling and informative
One of the most thrilling books I read in a long time.
It is picked with real-life experiences, interrupted by insights and thought experiements that keep you thinking. Highly recommended for everyone interested even slightly in medicine.
- MeatbagReviewed in Canada on June 1, 2019
5.0 out of 5 stars Very Well Written Book
I thoroughly enjoyed reading this book. The author takes you on a journey through just a few issues within their industry, dabbling on personal experience, hardships, and backs it up with factual research. In addition, I found the grammar to be nearly perfect, which I personally find makes for an easier read.
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Suzana MatayoshiReviewed in Brazil on March 25, 2018
5.0 out of 5 stars Realista e convincente
Atul Gawande mostra com exemplos e com linguagem simples um mundo que é vivenciado por médicos e por vezes incompreendido pelos pacientes. Mostra ainda a arte que cerca essa ciência imperfeita que é a Medicina. Recomendo tanto para médicos quanto para pacientes.