What we read is a learning experience, maybe even for most
doctors. Take for instance one conclusion that is drawn from a
statistical study that if a machine analysis report says one
thing about your condition and the doctor says another, go by
the machine! Now this is a conclusion any patient would need
guts to accept, but then Gawande gives statistical proof. In one
study they made a very reputed cardiologist analyse 2240 ECG
reports under comfortable conditions and gave the same reports
also to an artificial intelligence machine. The machine gave 20
per cent more correct answers than the doctor! "Western
medicine is dominated by a single imperative—the quest for
machine-like perfection…." "A surgeon for whom most
situations have automatic solutions has a significant
This leads us to
the next example he quotes of a hospital that performed only
hernia operations. Such operations in the USA generally cost
$4000 and take 90 minutes to perform. The failure rate is about
10 to 15 per cent. At this particular hospital, the time taken
is 30 to 40 minutes, the failure rate about 1 per cent, and all
this at almost half the cost. How come? Focused practice and
procedures is the answer. The more the doctor is like a machine,
the better he is.
The radical (and
scandalous for doctors) conclusion is that "the
individualised, intuitive approach that lies at the centre of
modern medicine is flawed—it causes more mistakes than it
prevents." There are hundreds of studies within as well as
without medicine that have compared computers with human
judgement. The machines almost always win.
Then comes the hot
topic of suing doctors when they are thought to have made
mistakes. It is found that suing consistently fails to improve
the service of a hospital. Most doctors will make a certain
number of mistakes and suing can’t help that. Also, most cases
are not against "rogue" doctors. But these cases do
cause damage: they prevent doctors from coming out openly about
their mistakes and discussing them for future correction.
In explaining all
these phenomena, the writer takes us through his personal
experiences in emergency rooms and operation theatres and all
the tension and suspense of the cases. Reading the book
actually, at times, raises your pulse; such is the skill of
writing employed, all with mid-plot twists and surprise endings.
To know that it’s real case he’s describing, only adds to
The Pain Perplex
is probably the most involved and revealing chapter in the book.
Explaining all the physiological and mental issues involved in
chronic pain cases, the conclusion drawn is: never think a
patient is faking pain. All pain is finally felt in the brain.
Even if no physiological reasons are found for a particular
patient, his pain in the brain is no less. The solution may be
found outside the patient rather than inside.
Also taken up are
doctor issues like handling a colleague who may go bad, medical
conventions and their use and abuse. Less-seriously taken
subjects like nausea, blushing, and weight problem are explained
in rather new perspectives. One chapter, Whose Body is it
Anyway? touches the very delicate subject of who takes the
decision on the course of treatment, the patient or the doctor?
All this is brought to us through real-life cases.
If nothing else,
after reading the book you’ll see your doctor more as a human
than a god or devil, and hope he will perform like a machine!