Health Files

How to wash your hands and other ways to understand medicine

Better: A Surgeon8217;s Notes on Performance
Atul gawande
Penguin, Rs 250
What is troubling is not just being average but settling for it.8221; Reading this line from Better, it is easy to conclude that this is a book for would be toppers. Indeed, Gawande8217;s resume8212;Boston-based surgeon, assistant professor at Harvard Medical School, MacAurthur Fellow and writer of best-selling books8212;makes him the quintessential achiever. But Better is not so much a prescriptive manual8212;though there is enough of that for those that would like pointers8212;but also the writer8217;s troubled search for quality.

8220;Betterment is perpetual labour,8221; writes Gawande. There is nothing flashy about this endeavour. In fact, the three requirements the author picks out 8212; diligence, doing right and ingenuity 8212; seem simple, almost mundane in scope. And yet, as the author goes on to demonstrate, they are probably the hardest qualities to come by; early in the book he illustrates, for instance, how hard it is to get health care workers to do something as simple and significant as washing their hands as often as required.

Gawande8217;s raw material is drawn from the world of medicine but he uses journalistic techniques 8212; he is also a staff writer for The New Yorker 8212; to accumulate his facts. The result is a somewhat large and varied canvas. The section dealing with doing right, also the most ambivalent for instance, considers matters such as propriety in physical examinations, the social responsibility of doctors, malpractice litigation and knowing when to stop trying.

The other sections are relatively straightforward. The book is replete with examples of ordinary, unsung acts of heroism. People who scour hospital rooms to check for practices likely to spread of infection; doctors in a backward region of India who meet to swap case histories in a spirit of learning and improving; Pankaj Bhatnagar, a WHO paediatrician who supervised a three-day polio vaccination effort involving 4.2 million children in 2003; these hardworking, unassuming men and women, going about their daunting jobs with patience and determination are some of the heroes in the book.

Others are people like Ignac Semmelweis, the Viennese obstetrician who discovered that puerperal fever that caused 20 per cent of maternal deaths in 1847 could be prevented by better hygiene. Or Virginia Apgar who devised the Apgar score that helped reduce infant mortality from one in thirty to one in five hundred. All these people made strides for humanity just by thinking hard and creatively about the work they did and, to use Gawande8217;s favourite phrase, by 8220;making a science of performance8221;.

The book 8212; with its plea for simple, practicable ways to quality 8212; is directed at communities and governments who aim to do better and at the individual yearning for meaning in his life, for the ingredient of involvement that makes the difference between merely doing and doing better. Gawande8217;s suggestions are perhaps not startlingly new, and he has a tendency occasionally to repeat himself. One wishes also that in the section on the Indian public health care system he had substantiated his argument far better.

But his contemporary tone, the ground he covers and his earnest fervour make the book an easy and persuasive read. For medical practitioners, managers and individuals in general, it should also provide fodder for thought.