Review: Complications - A Surgeon's Notes on an Imperfect Science

I'd read a bunch of other Atul Gawande's books before, but I somehow missed his early book, Complications. No matter, that just means there's no wait at the library when I checked it out.

Complications reads a lot like a collection of separate magazine articles (or columns) strung together and then arranged by theme. This is by no means a bad thing: you can read each chapter separately, or skip around as you wish. I chose to read it in sequential order.

Medical stories are challenging for me to read, especially for someone who's had health scares in the past (or know friends who've been on the receiving end of medical procedures recently). The chapters in the book frequently allude to what makes doctors different: a software engineering error might cost money or time (or both), but you don't regularly kill people or cause people massive pain directly when you make a mistake. A doctor suffering from a bout of depression (as described in this book) could cause damage that no amount of malpractice insurance can cover. Worse, the medical system itself works to try to protect physicians from honest errors but can be slow to act when someone repeatedly (or even deliberately) causes harm.

The book meanders from topics such as how doctors learn, whether patients should make all the decisions regarding their care, and the nature of doctor's intuition and persuasiveness. All the chapters are worth reading (though some might make you more queasy than others) and many make you feel grateful that you're not the patient who needs to have the procedure described. Some will make you question the nature of free will and human decision making, such as the chapter on gastric bypass procedures that suddenly cause its patients to voluntarily eat less!

The book is short, a quick read, and full of great stories and occasionally, great insight. Recommended.