Book download Complications A Surgeon's Notes on an Imperfect Science AUTHOR Atul Gawande – happypink.co.uk


Complications A Surgeon's Notes on an Imperfect ScienceY and it was all for the bestYeah because not giving a patient the full range of their surgical options is the same as encouraging a patient to do rehabilitative therapy Definitely Has this man done zero aw in the zillion years it must have taken him to get a MPH and become a surgeon Ok I ve parsed enough I will say that his musings on patient autonomy are truly disgusting though he thinks we should replace the autonomy principle with a concept of kindness because paternalism is not the enemy what the everlasting fuck and show that he doesn t understand the concept of patient autonomy or the emergency exception doctrine I only know about it through canadian aw but I m sure Americans must have the same thingThis was probably the most hateful thing I ve read in years Wow Complications is a book of anecdotes about a surgical resident s experiences and impressions of the current health care environment Gawande divides his stories into three sections fallibility mystery and uncertainty The fallibility section demonstrates that doctors can make mistakes Some fallibility arises from there being a earning curve For example it is hard to do a central The Value of Optimism line correctly the first time But for a doctor toearn how to do a central ine he must have a first patient to try it on The concern then arises as to which patients receive care from the inexperienced versus the experienced Yet fallibility occurs in even the most experienced doctors Gawande reports on one doctor who became so careless that he was no onger allowed to practice The frightening part of that story is how Storm of Locusts (The Sixth World, long his colleagueset him continue when they had concerns The Doctor also brings up this issue It is understandable that doctors are reluctant to come down too hard on their colleagues They need each other as a support system and thus need to maintain trusting relationships Further medicine is uncertain and it can take a La Chanson de Jerusalem long time to see a pattern of truly irresponsible behavior as opposed to just having complicated cases Gawande makes the point that discipline of doctors works best when it done by a group outside the doctors peer group or employer because it is objective Then this outside group can propose a plan of action which the employer can implement Unfortunately this model has been too expensive to be much of a viable option The mystery section details stories of conditions that cannot be explained by current medical scienceike blushing pain and nausea In each of these cases the doctors could not explain why the patient had the condition Much of the time the patient just wanted the doctors to believe them even though there did not seem to be a physiological source of the problem It is interesting that the patient is willing to accept that there is no medical explanation than the doctors Yet the doctors are the ones with the training and have probably seen many circumstances when they cannot make a diagnosis The uncertainty section deals with how to make the right diagnosis or judgment There are several points in this section that have come up in the other Biomedical Informatics literature reviewed for this independent study First is the declining use of the autopsy The autopsy is how doctors can determine what was actually wrong with the patient It is the final way to get rid of uncertainty Its purpose is to help the doctors recognize such conditions in the future Yet autopsies are doneess and ess Although many times the family is opposed to the autopsy and will not allow it Another recurring point is the decision making power of the patient Patients have become pro active in their desire for decision making ability but they are much ambivalent about actually exercising it Especially in situations where there is uncertainty patients do not feel comfortable or emotionally able to make the decision Some do not think they can handle the responsibility if it turns out to be the wrong decision Gawande notes that doctors also prefer to make the decision One of the things he had to earn as a resident is how to persuade patients to the decision he thinks is best As health care becomes consumer driven the debate over the The Story of Rose ONeill level of physician agency isikely to continue 45 starsI had a great time reading this with Heidi from My Reading Life The book is broken up into three sections named for ideas that vex doctors Fallibility Mystery and Uncertainty He ooks at the way surgeons are educated advancements in medicine hard to pin Down Diagnoses And With diagnoses and with iberal sprinkling of fascinating casesThe pacing is perfect there are edge of your seat moments to see if a patient makes it and he brings up ethical issues that appear in his ater books such as medical error and treatment decisions at the end of ife Those in the know will recognize that medicine has changed over the years since publication but even so it holds up incredibly wellI kinda wish I had to Let s play the who wants to be horrified game Complications made it hard to sleep Not because of gore necessarily but because it made clear to me that doctors sleep Not because of gore necessarily but because it made clear to me that doctors just people who were given a scalpel Yes they have a ton of education but at some point they must get experienceIn one section Gawande discusses a procedure in which he must put in a central The Prince with the Silver Hand (Tale of the Eternal Champion, line which goes into a major vein in your chest which can technically kill you All he tells the patient is that he must put in a centraline not that it is dangerous or that it

"IS HIS FIRST TIME DOING THIS "
his first time doing this I completely understand why he didn t tell the patient but that doesn t make it any Haram Lokma less terrifying I have thought about how doctors have to start at some point but it was never so clear to me that there is a first patient for every procedure for every doctor For every surgeon there will be the first surgery There is a first time for cutting into the flesh of a stilliving personIt was published in 2002 so I m sure some things have changed but it s still current enough about how the training takes placeIt s an important realization of how much control doctors have over our bodies and how ittle they have over everything else in the hospital They don t get to chooseFor the full review please visit. Ly is uncertain perplexing and profoundly human  Complications is a 2002 National Book Award Finalist for Nonficti. ,
I See Your Name Everywhere Tanya and the Border Guard Tamarind Mem Beelzebub, Vol. 18 (Beelzebub,

characters Complications A Surgeon's Notes on an Imperfect Science

T somewhere So what s the solution There isn t a good one Deal with itPatients are humans so they re complicated They do things that are bad for them all demand the highest Unjust Deserts level of care Since the mid 80 s they ve been getting say in what their treatment is often they re not well euipped to do so either due to ignorance or just feelingike crap Balance between what the doctor recommends what the patient wants is toughMedicine has come a LONG way in a short time but they still don t know a ot As it becomes complicated it s tougher for doctors to stay on top of even their specialty Unspoken but obvious in the subtext is that it takes people to do the job a ot depends on every one thing s availability doing their job properly Facilities are often stretchedOverall it was an interesting tour inside the field from a young surgeon s point of view I think this was his first book it suffered a bit from that It s also a bit dated in some respects having been written 15 years ago or so Still it s well worth reading Read these sentences and tell me that this writer isn t an unbearable idiot If choice of one s surgeon cannot go to everyone maybe it is better when it is not allowed at allTaking time to bond with patients is fine but every X ray must be tracked down and every drug dose must be exactly right Hospital awyers warn doctors that although they must of course tell patients about injuries that occur they are never to intimate that they were at fault est the confession wind up in court as damning evidence in a black and white morality taleThis was not guilt guilt is what you feel when you have done something wrong What I felt was shame I was what was wrong And yet I also knew that a surgeon can take such feelings too far One surgeon with a national reputation told me about an abdominal operation in which he had ost control of bleeding while he was removing what turned out to be a benign tumor and the patient had died The case affected his performance for monthsIn its way the MM is an impressively sophisticated and human institution Unlike the courts or the media it recognizes that human error is generally not something that can be deterred by punishmentSo sophisticated that it doesn t include compensation for negligently injured patients Or conseuences for negligent doctors besides shame in the conference room There are all sorts of reasons that it would be wrong to take my icense away or to take me to court Those reasons do not absolve me Whatever the Daddy Daughter Incest 2 Series Bundle limits of the MM its fierce ethic of personal responsibility for errors is a formidable virtuePersonal responsibility soong as it s a fifteen minute shaming directed at your mentor And note that he doesn t discuss why it would be wrong to take his icense away wow what a great ook at the complexities of the situation rme But the problem of bad doctors isn t the problem of frightening aberrations ike James Burt a notorious Ohio gynecologist who subjected hundreds of women often they had been anesthetized for other procedures to a bizarre disfiguring operation involving clitoral circumcision and vaginal reshaping which he called the Surgery of Love It to a bizarre disfiguring operation involving clitoral circumcision and vaginal reshaping which he called the Surgery of Love It the problem of what you might call everyday bad doctors the illustrious cardiologist who has slowly gone senile and won t retire Ahahaha trying to treat James Burt as an isolated freak when other doctors knew what he was doing said nothing and ater refused to testify against him Years wherein they said and what he was doing said nothing and ater refused to testify against him Years wherein they said and nothing about this man who was not icensed as a surgeon and was bragging about mutilating women while they were unconscious James Burt is an illustration of the extent to which the medical community are willing to Sermons Not Spoken look the other way If doctors will ignore the James Burts of the world then how can we expect them to turn in the hypothetical illustrious but senile cardiologist It is the same problem Nice try though Gawande Was money part of the problemGawande tries to portray a surgeon who admits to booking far patients than he could handle and rushing through their care in order to make and money despite making 400k as a poorittle rich boy Sorry no The uestion is was greed part of the problem and the answer is yes There are both honorable and dishonorable reasons for doctors finding themselves unable to do anything decisive about bad doctors The honorable reason and probably the main reason is that no one really has the heart for it When a skilled decent ordinarily conscientious colleague whom you ve known and worked with for years starts popping Percodans or becomes preoccupied with personal problems and neglects the proper care of patients you want to help not destroy the doctor s careerI Julia love that his first concern isn t the patients or even the doctor but the doctor s career I alsoove that the example bad doctor he discusses didn t end up getting the sack for ruining a 28 year old woman s Dancing with Fireflies (Chapel Springs, life but because he didn t go to MM conferences Injure all the patients youike but don t you dare thumb your nose at our rituals wherein we discuss these injuries And then he cries about how this poor disgraced doctor only succeeded in getting malpractice insurance after a year Oh gosh a whole year How terrible for him People actually prefer the world of don t ask don t tell Just ask yourself could you abide by a system that rehabilitated drug addicted anesthesiologists cardiac surgeons with manic psychosis or a pediatrician with a thing for The Little House in the Woods and Other Stories little girls if it meant catching of themone of these things is notike the others and that isn t your only option and rn there are plenty of doctors who have been disciplined for egregiously terrible stuff and should never be allowed to practice again and yet somehow are so what would be the difference Could it have been a mistaken then even to have told him about the surgical option People are rightly suspicious of those claiming to know better than they do what s best for them But a good physician cannot simply stand aside when patients make bad or self defeating decisions decisions that go against their deepest goals goes into an anecdote about how a doctor convinced a woman to start her physical therap. Inching view from the scalpel’s edge Complications The Modern Art Invasion lays bare a science not in its idealized form but as it actual. This book wss filled with about 25 anecdotes flimsily tied together by Gawande sess than inspiring reflections I have the book in front of me at the moment and I am paging through rereading sections that I noted along the wayI had come into residency to The Faceless Ones (Skulduggery Pleasant, learn how to be a surgeon I had thought that meant simplyearning the repertoire of move and techniues involved in doing an operation or making a diagnosis In fact there was also the new and delicate matter of talking patients through their decisions something that sometimes entailed its own repertoire of moves and techniues pg 217Next to this paragraph I had written NO SHITThe book is full of these minor pseudo epiphianic moments that come off as weak aphorisms However given the audience of this book everyone he does well to treat people about how Although I am interested in the medical profession motivation to earn about it often elludes me Gawande was able to keep my attention and present points that I could understand in spite of my imited medical knowledgeAdmittedly some of his information scared me After reading some points about surgery I wondered how I ever allowed anyone to cut into me and place a plate and seven screws in my Neverland (Adventures in Neverland, leg Also some of his writing made me sueemish I had to pause or skip places that became too graphic for my weak stomach Some of his writing discouraged me Why am I trying toose weight if no one is able to succesfully Invisible Darkness lose weight and keep it off unless they are dangerous and intensive surgery I also felt discouraged over the problems he presented that really have no attainable answersIn spite of my difficulty with his unanswerable uestions I appreciated Gawande s straightforward honesty about the medical profession and its weakness Ironically his admission of the fallibility of doctors and medicine makes me willing to approach a doctor It makes it easier for me to ask uestions if I don t expect the doctor to have all the right answers especially if that doctor is willing to admit such a possibility Practice is funny that way For days and days you make out only the fragments of what to do And then one day you ve got the thing whole Consciousearning becomes unconscious knowledge and you cannot say precisely how I have always been intrigued by medicine I know it s a scary thought but inevitably illness will impact each of us in one way or another Either we will get sick or somebody we B. Altman and Cos Enlarged Store, 1914 love will get sick Which is whyearning about medicine and healthcare is so important However a ot of books about medicine and healthcare can be pretty dry which is where Dr Gawande comes to the rescue His clear prose makes even the most difficult medical concepts easy to understand In this book Gawande is just starting out his medical career Like most new graduates Gawande is excited yet nervous about the new challenges that await him in the workplace But he soon realizes that medical school only teaches you a tiny smudge of what being a doctor is actually about Medicine is so much than just a science it is a messy and imperfect art A ot of what doctors do is intuitive they piece together symptoms to formulate a treatment plan However uncertainty feels grander in medicine because human The Norton Anthology of World Masterpieces lives are at risk And as a doctor you not only need book smarts but the ability to navigate unforeseen challenges with integrity and fortitude Aot of this book comprises of fascinating case studies a victim who was shot in the buttock eaves the hospital virtually unharmed a pregnant woman WITH NAUSEA SO DEBILITATING THAT SHE HAS TO LEAVE nausea so debilitating that she has to eave a neurosurgeon who copes with severe blushing and a young woman whose inconspicuous The Book of SHE leg pain turns out to be a deadly infection If youike suspense then this book is for you The saying everything can change in an instant is ever so applicable to medicine Although I enjoyed this book I thought it was a bit dull at times I think it could have been improved if it contained a tad bit of humor But overall I did enjoy it I would recommend Complications to medical professionals or anybody who is interested in earning about the healthcare field A year or ago I mistakenly placed a review for Gawande s book Better under this title I have fixed the mix up and I have now read ComplicationsGawande is pure pleasure to read His writing is fluid and full of germane examples as he addresses big issues ike error and incompetence as well as topics that as he addresses big issues Kat (Darkest Powers, like error and incompetence as well as topics thatess significant but which he makes worthy of consideration such as blushing and nausea The headings for each section of the book Fallibility Mystery and Uncertainty are thematic in the text As one reviewer wrote Thank heaven someone wrote this book Gawande is unapologetic and totally direct in his appraisal of medicine What I really appreciate is that in Better which he wrote after Complications he gives eual time to discussing ways in which medicine can improve I m a fan A good writer and a good doc What could I ask for I finished this book about a week ago and the next day my mom fell and f % broke her hip So this is NOT the type of book to read or even think about when you have someone in the hospitalMost doctors especially surgeons are viewed as infallible but in reality they are just The Return of the Crazy Ladies like us They have bad days they make mistakes and some of them should really change careersThe author writes elouently with compassion and a clearove for surgery which made this a fascinating book to delve into Most of the stories felt anecdotal rather than a deep dive into the details which for a Hes So Shy (Bad Boys, laymanike me was perfectThe author also poses a ot of ethical uestions about the profession and how much patient autonomy should be allowed uestions about the profession and how much patient autonomy should be allowed making health decisionsIf you have any interest in medical memoirs you should try this author at east once Not uite a 4 star read but close enough It s fairly short does make his major points fairly well They boil down to medicine isn t perfectDoctors are humans so need to earn will make mistakes even with the best intentions Do I want a doctor to earn on me or mine Hell no Gawande admits that he doesn t either he makes sure they don t BUT we won t get any new ones if they don t star. In vivid accounts of true cases surgeon Atul Gawande explores the power and the imits of medicine offering an unfl. ,

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