Better – Atul Gawande

Non-Fiction
Paperback from Amazon - $10.98
Extra Super Nerdy Award: Lewis Skolnick

Buy if if: You’re curious about medicine and ethics

Don’t buy it if: You find no joy in frank discussion about the medical field


I’m not entirely sure what made Atul Gawande decide to give writing a shot. You’d have to think that becoming a very successful and respected surgeon is a pretty decent accomplishment in and of itself. Fortunately for the rest of us, Gawande saw enough in his medical experiences to encourage his own documentation. First in Complications: A Surgeon’s Notes on an Imperfect Science, and now in Better, he looks at how medical professionals across the globe are exceeding the limits of what was previously assumed impossible and the role of ethics and standards in medicine.

The stories alone make fascinating reading for anyone with an interest in medical technology and/or healthcare disparities around the globe. But Better really shines while investigating how this improvement is achieved by doctors from Minnesota to India. The story of Drs. Warwick’s and Matthews’ drastic improvement of cystic fibrosis life expectancy is remarkable, a tribute to just how much can be gained by continual and rapt attention to detail. But the invention of laprascopic ulcer repair by a doctor working in the small, Indian village of Motewar borders on the miraculous.

Some medical breakthroughs are impressive enough coming from big city hospitals that have been loaded to the brim with doctors from the world’s best universities… But to then ascribe breakthroughs to men working on a shoestring in a village where clean water is a luxury? It does sound like a miracle. Yet that couldn’t be further from the truth…

And that is exactly the point that Gawande makes continually over the course of his book. That these ‘miracles’ are anything but. Instead, they are very conscious and concerted efforts to do everything better than it’s been done before. Like the jar so full of sand that you assume nothing else could fit…until you pour in water. Better explores the medical personalities who refuse to accept that certain techniques, technologies or curatives have been ‘maxed out.’ It highlights those who would seek to find improvement where others haven’t and in doing so simultaneously awes and inspires a reader. Not to mention opening their eyes to a fascinating set of circumstances and medical achievement…

Hopefully I’ll never get to personally test Gawande’s surgical skills, but I’m duly impressed by his writing. I has a very ‘BBC print’ feel to it. Not sterile, but clean and elegant. There’s passion there, but it’s subdued and set nicely into the facts. He lets situations speak for themselves. If you’ve ever heard a BBC 2 Radio news program, you’ll know exactly the tone I'm describing… In it’s restraint the emotion of the writing tends to be more poignant as the importance inherent to some of these procedures and goals becomes more pronounced, a result of their excellent presentation. Moving beyond medical procedures, he also covers issues ranging from malpractice to patient privacy to the very fascinating conundrum that is the role of doctors in state executions. Gawande tackles these big questions with depth, reserve and candor. It’s writing at its finest..

More impressive is the author's personal stake in the dilemmas he presents. He’s a doctor himself. As a practicing surgeon, it’s his responsibility to take these issues to heart more than anyone. He gives thoughtful consideration to things like what a doctor owes society and what in turn society owes a doctor. Broaching the subject of money is a brave move, but a fair one and it’s refreshing to hear someone discuss it with the balance he does.

For my money, you'd be hard pressed to find a more precise, yet passionate look at these subjects in a mainstream bookstore. The scope of the book is wide enough to maintain a diversity of interests, yet still allow a discrete and focused concentration on the details. Coupled this breadth with a superb writing style it becomes difficult to find a better work of non-fiction at any bookstore.