BOOK REVIEW / CRITIQUE DE LIVRE

**Better: A Surgeon's Notes on Performance.** By Atul Gawande. New York: Henry Holt and Company, 2007. 273 pages (hard cover). ISBN 978-0-8050-8211-1. US$24.00.

Diligence. Perseverance. Resourcefulness. Atul Gawande illustrates how these three virtues improve not only the larger sphere of medicine, but also the individual people who work within it. In his new book *Better: A Surgeon's Notes on Performance*, Gawande offers examples of the ways that medical professionals have solved problems ranging from mere hand-washing compliance to the shortage of doctors and supplies in rural medicine through diligence and perseverance and just plain making do with the resources on hand. In case after case, Gawande brings the reader back to the role of these interlocking virtues in improving the situation.

The book unfolds in three parts: Diligence, Doing Right, and Ingenuity. Each part consists of three or four chapters that cover different scenarios and illustrate how something was done better. The section titled Diligence, for example, tells stories of how attention to detail and careful documentation paid off in terms of reduced rates of infection, dealing with malpractice, and better medical care on the battlefield.

One of the highlights of the book is a chapter titled “The Doctors of the Death Chamber”, where the author addresses the sensitive topic of health care professionals assisting with lethal injections. Gawande provides a balanced perspective, giving both the views of the American Medical Association and health care professional organizations, and those of actual health professionals who discuss their reasons for participating. Gawande leaves his own views for the chapter’s conclusion. Some may criticize *Better* and its author for including his opinions. However, I enjoyed reading both sides of the story as well as the author’s views and found the personal reflection tied the chapter together. Gawande’s chapter gave me pause to consider the various views on this hot topic and reflect on how I feel about the idea of health care professionals assisting in the “death chamber”.

At the outset, my first thought was that the book was too positive for my liking. I feared I was in for a sermon on how

to improve the world. But my fears dissolved within a couple of chapters as I realized that Gawande is not telling sugar-coated stories but discussing very real and very difficult situations. The idea of “doing better” sounds cheery, and the pessimists out there will know that “doing better” is not a new message. But Gawande is the first to point out that finding solutions is usually a slow and difficult process, and yet we need to focus on the fact that “better is possible” and that it doesn’t require a rare genius but rather what he calls moral clarity, some ingenuity, and a willingness to try.

It is this call to improvement that is one of the many strengths of the book. Another strength is its constant reminder that success doesn't happen without continual reflection. Despite the book's focus on the medical profession, the central message of *Better* is that any profession can flourish as long as its members exercise thoughtful persistence, a resolve to go forward, and a certain degree of self-reliance when problems or issues arise.

Overall Gawande's book is a quick but valuable read; the author challenges the reader to think about what they do, how they deal with situations, and how they can do better. The book is written such that people do not need an extensive medical vocabulary to understand it or to enjoy the book, and motivated readers can further explore any of the topics covered by reading some of the literature cited in the endnotes. Gawande is a talented and clear storyteller who keeps the reader captivated through even the most serious and seemingly hopeless situations. Finally, for anyone intending to read this book, it is important not to skip the afterword because this is where the author really sums up and ties the themes of the book together, reminding us of how we too can be “positive deviants” in our various roles in the world.

**Melissa Helwig**

*Northern Ontario School of Medicine – NOVL*
935 Ramsey Lake Road
Sudbury, ON P3E 2C6, Canada
E-mail: melissa.helwig@normed.ca