Book - Better by Atul Gawande
What does it take to be good at something in which failure is so easy, so effortless? (like, being a doctor)
People often look to great athletes for lessons about performance. Athletes do indeed have lessons to teach - about the value of perseverance, of hard work and practice, of precision.
In medicine, as in any profession, we must grapple with systems, resources, circumstances, people - and our own shortcomings, as well. We face obstacles of seemingly unending variety. Yet somehow we must advance, we must refine, we must improve.
At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm.
The sections of this book examine three core requirements for success in medicine - or in any endeavor that involves risk and responsibility.
The first is diligence, the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles. Diligence seems an easy and minor virtue. (You just pay attention, right?) But it is neither. Diligence is both central to performance and fiendishly hard.
The second challenge is to do right. Medicine is a fundamentally human profession. It is therefore forever troubled by human failings, failings like avarice, arrogance, insecurity, misunderstanding. In this section I consider some of our most uncomfortable questions - such as how much doctors should be paid, and what we owe patients when we make mistakes. I tell the stories of four doctors and a nurse who have gone against medical ethics codes and participated in executions of prisoners. I puzzle over how we know when we should keep fighting for a sick patient and when we should stop.
The third requirement for success is ingenuity - thinking anew. Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything, a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions. These are difficult traits to foster - but they are far from impossible ones. Here I tell the stories of people in everyday medicine who have, through ingenuity, transformed medical care - for example, the way babies are delivered and the way an incurable disease like cystic fibrosis is fought - and I examine how more of us can do the same.
Betterment is a perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only humans ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two. It is to live a life of responsibility. The question, then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.
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Read from Part 1: Diligence