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 Even "Better" than Complications Jan 05, 2009
Insightful, well-written, and goes beyond the limited scope of "Complications" to include medicine outside the walls of U.S. hospitals.
How A Local Hospital Reduces The Spread of Bacteria Dec 12, 2008
From: www.BasilAndSpice.com
Author & Book Views On A Healthy Life!
Book Review: Better by Atul Gawande, MD
Dr. Atul Gawande, General Surgeon at Brigham and Women's Hospital--Boston, Assistant Professor at Harvard Medical School, Staff Writer for The New Yorker, and Best-Selling author of Better writes about the importance of washing hands and how to actually cut the spread of potential lethal disease. He states that approximately two million Americans pick up an infection while in the hospital. Of these, ninety thousand will die from that same infection. Possible attacks come from rotavirus, Norwalk virus, Pseudomonas bacteria, resistant Klebsiella, MRSA-- methicillin-resistant Staphylococcus aureus, and VRE-- vancomycin-resistant Enterococcus--the last two frequently causing pneumonias, wound and bloodstream infections.
Admittedly, Dr. Gawande recognizes that studies show nurses and doctors do not wash their hands frequently enough, up to 50% of the time. Recalling the lesson taught by obstetrician Ignac Semmelweis, he points out the cause of childbed fever (puerperal fever) was the lack of washing hands. In 1847, 600 of 3,000 mothers delivering babies in Semmelweis's Viennese hospital, died from the bacteria Streptococcus, which leads to childbed fever. After instigating a wash up with chlorine and a nail brush for doctors and nurses, between patients, the death rate fell from 20% to 1%. Even though this procedure offered sufficient proof of success, doctors elsewhere declined to institute the hand washing. They simply could not believe that they themselves were making their patients sick.
Recently, a surgeon named Jon Lloyd hit on an idea from the Save the Children program: Positive Defiance, or building upon capabilities people already have, rather than making them change their behaviors. After meeting with small groups (from kitchen worker and janitor to nurses, doctors, and even patients) in a trial Pittsburgh hospital, and instilling the staff's ideas, change was made. For example, they themselves decided where to best place new hand-gel dispensers. By empowering the employees, they worked together toward a common goal. The result at the end of one year, "the entire hospital saw its MRSA wound infection rates drop to zero."
Dr. Gawande continues with news that The Robert Wood Johnson Foundation and the Jewish Healthcare Foundation are beginning to implement this initiative in ten more hospitals across the United States. To this point, no other idea has worked.
This is an excellent book.
5 Stars
Atul Probes Deeply Nov 12, 2008
Atul Gwande's "Better: A Surgeon's Notes on Performance" is a collection of essays that probe skillfully and poignantly into the depths of medical ethics and the performance of doctors. He is a fine researcher and an astute observer who carefully delineates many facets of each issue that he explores, be it washing hands, malpractice concerns, or the Apgar score.
As a non-fiction writer, I was acutely aware of how adept Gawande is at using narrative to illustrate and discuss complex moral and ethical issues. He does not skirt controversial notions such as what happens to the soldiers who have been saved from grave injury on the battlefield and come home limbless and with horribly scared faces? Or why hospitals avoid publicizing the results of their effectiveness in treating certain conditions?
At the end of his book, he makes five suggestions about how doctors might make a worthy difference. All of these suggestions make sense for anyone wanting to make a difference. I'm only going to mention one that hits close to home: He says, "write something. . . it makes no difference if you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group. Just write."
Let me add, just read Gwande's "Better."
Fascinating. Must read. Classic. Oct 31, 2008
A fascinating and quick read, in each section there are plenty of inspiring stores about doctors making a difference. Dr. Atul Gawande, a general surgeon at Brigham and Women's Hospital and staff writer for the New Yorker has keen observation and insight to make single stories demonstrate not only the failings of our healthcare system but also the solutions to them because of individuals asking questions on how to do better. Ultimately, one of the questions he asks is how can doctors and hospitals be positive deviants? How does one become a positive deviant or an outlier that pushes beyond convention and advances patient care to new levels?
He gives examples of how over four million children need to be vaccinated in Northern/Southern India in three days to prevent a large polio outbreak. An immunization rate of less than 90 percent would be considered a failure.
Dr. Gawande talked about the evolution of obstetrics. After a damaging report in 1933, the specialty consequently committed itself to standardizing childbirth ensuring that with the new medical knowledge that it was applied consistently and routinely throughout the country. As a result maternal death in childbirth fell 90 percent from one in 150 in the 1930s to one in 2000 by 1950s. With continued innovations and the commitment to do better, the chance of a woman dying in childbirth is less than one in 10,000 today.
There are plenty of amazing examples that you don't have to be a doctor to relate on how truly inspirational these individuals are in times when the stakes could not be higher - life or death.
As a practicing family doctor, I believe that our healthcare system can do better in providing all of us the best care consistently and routinely across the country. Although his book is easily a classic and should be required reading for all future doctors, sadly I think true healthcare reform and improvement are years away. I wrote the book Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System specifically so everyone has the information they need to get the best care today. Until our healthcare system improves to its full potential as Dr. Gawande challenges us to do, unfortunately will always remain benefiting those who are insiders and harming those who are not. The real question is which one are you?
The progress of medical science Oct 10, 2008
Like another Amazon reviewer, I found this book to be the best book written about the medical profession in some time. Dr. Gawande's style is lively and thought-provoking, particularly as he discusses practicing medicine in war-torn Iraq or how doctors struggle with ethical concerns relating to capital punishment.
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