Monday, April 30, 2012

Medical Self-help

I believe that Atul Gawande's Better had both a phenomenal strength and weakness. Gawande is an enticing story-teller, and provides the reader with captivating and fantastic anecdotes. His experiences and interviews truly portray his interest and commitment to medicine. At the same time I found the book to be weakened by a lack of theme and destination, which reflects its somewhat vague title. Given this sensationalist recipe, I finished the book in an afternoon, and it left me with a lot to think about. His stories gave the impression of a physician really dedicated to hone his art; something I believe is becoming increasingly important in today's healthcare climate. Gawande explores topics which are somewhat shunned to discuss openly; namely the sexuality and salary of physicians. I believe such candid discussion within the field will become a cornerstone of future medicine. Many of the subtleties of medical practice are seen as things you learn outside of medical school, through experience. Doctors are expected to lift themselves out of their struggles, to endure through arduous internships etc. This self-coaching approach towards the profession is risky and can lead to discrepancy in practice across the field. The more doctors are candid among their peers, the more they will be able to open up towards their patients, and deliver more personal and effective care. This could be an additional argument to search for students that are less introverted and more well-rounded.

In addition to this perspective, Gawande explores the work of physicians from the battlefields of Iraq to overcrowded Indian hospitals, and this provides a compelling landscape of how healthcare is delivered in a variety of conditions. Gawande's efforts to compare his Western practice against these different approaches indicates what I believe is a wonderful devotion towards self-development. In class today we discussed how modern medicine is fundamentally about manipulating within very narrow margins, and I believe that having such self-critical skills is absolutely essential to being an effective physician. This reiterates one of the broad themes of the book - the importance of diligence across the board - not only in order to be a competent health delivering machine, but to evolve communication skills, and to be able to navigate the uncertainty that is inherent in the practice. And in the end, that is how I believe Gawande frames his book; it is a testament to his self-development as a doctor. In his conclusion he puts forth five open-ended steps which are really geared towards critical self-development: (1) to ask unscripted, genuine questions to patients, (2) to avoid complaining, (3) to count something, critically study your practice, (4) to write your thoughts, and (5) to change and evolve the way you work. As such, Gwande's book reads more like a self-help book rather than a tangible to treatise to improve the system.

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