Better: A Surgeon's Notes on Performance

#137
Title: Better: A Surgeon's Notes on Performance
Author: Atul Gawande
Publisher: Picador
Year: 2007
Genre: medical, history
288 pages 

In his second collection, Gawande ranges further afield than he did in Complications: A Surgeon's Notes on an Imperfect Science. There, many of the essays dealt with surgical training and socialization. Here, while still grounded in hospital practices (such as handwashing, or the lack of it), Gawande recounts the history of Ignac Semmelweis, whose handwashing crusade against puerperal fever was thwarted by his lack of both empirical studies and interpersonal skills. Other chapters of note include on on polio vaccination in India and the restructuring of battlefield triage. Throughout, Gawande promotes the concept of "positive deviance" as a way to break out of presuppositions and mindless practices.

I enjoyed Better at least as much as Complications. Gawande manages to speak conversationally but not callously about some pretty horrific stuff. However, at times the material seemed either oversimplified or not updated. For example, contemporary concerns about handwashing gel, polio outbreaks in Europe, and the shocking conditions at Walter Reed are simply missing. While some of these essays appeared first in The New Yorker and The New England Journal of Medicine, the publication date for the book is 2007, and Gawande should have updated some of these pieces, or appended an epilogue.