Performance

The last section of Gawande's book discusses the issue of performance in medicine. How do we measure ourselves? How do we know if we're doing a good job? This is not as straightforward an issue as it seems. He brings up how the Apgar score was developed in obstetrics so that the performance of a hospital could be compared to others. He raises the issue that a lot of things in medicine don't have evidence-based justification; there are no randomized double-blind controlled trials for much of what we do (especially if it was developed decades ago). Gawande has a really inspiring chapter on a center that works on cystic fibrosis and has unbelievably improved the lives of patients by implementing different treatments than the standard of care at the time. He also discusses the very scary idea that different hospitals have different track records; not every doctor's performance is the same, even though we'd like to think that every surgeon is competent, every physician equal. Lastly, Gawande tells of a remarkable experience when visiting hospitals in India, seeing how they could accomplish so much with very limited resources.

"'What is your preferred technique for removing bladder stones?' one surgeon in the city of Nagpur asked me.
'My technique is to call a urologist,' I said."

I really enjoyed this section of the book. It makes many points. We are by no means the best doctors in the world because we are trained at a great U.S. hospital. There is always room for improvement, and always opportunity to learn from colleagues elsewhere. Bettering ourselves does not take genius; it merely takes diligence, an ethical drive, and ingenuity.