Book Review: Better

The Essentials

Better: A Surgeons’s Notes on Performance, by Atul Gawande (288 pages)

$9.66 on Amazon, $9.99 on Kindle

Description from Amazon

The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision.


In Better, Gwande takes a look at our medical system and finds that we could be doing, well, much better. This book is perfect if you, like me, enjoy Malcolm Gladwell-style books. By this, I mean Gwande looks at a large, seemingly impossible problem and proposes simple solutions.

In the first chapter, Gwande talks about what would seem to be a rather simple problem. Doctors don’t wash their hands enough and due to this, diseases spread rapidly and quite easily in hospitals. This problem dates back almost 150 years as doctors who delivered babies were transferring infections from patient to patient. You might figure that today doctors would know to wash their hands regularly; however, the problem is still very real and often fatal. The simple solution? Asking workers at every level how they would solve the problem. The idea is one of “positive deviance,” which Gwande describes as, “the idea of building on capabilities people already had rather than telling them how they had to change.” Basically, they asked the people in the hospitals how they’d fix the problem instead of telling them what to do. This got people involved and invested in solving the problem. By doing this simple thing – asking people how they would fix the problem – diseases from a lack of hand-washing essentially disappeared. While he cautions that we might not know if these incredible results will hold up, “nothing else has worked, and this is the most fascinating idea anyone has had to solve the problem in a century.”

The following chapters follow the same trajectory.  They introduce a seemingly unsolvable problem, show a simple but untried solution, and then show how this solution is working (albeit with a small sample size). He analyzes how the military is treating the wounded, how the world is trying to eradicate polio, how we are we are treating Cystic Fibrosis patients, and more. In almost every case, Gwande shows how thinking outside of the box, or how putting the needs of patients ahead of the doctors’ personal pride can go a long way to fixing seemingly impossible problems.

As our country continues to struggle with fixing our broken medical system, the efficiency gains talked about in Better will become more and more important in helping to improve medical care. I personally found the book fascinating, and I recommend the Better if you enjoy these types of books.

Let me know if the comments if you’ve read Better and if so, what you thought of it.

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