Constant Reader discussion

Discussion begins today for this nonfiction book.

While this author's "Being Mortal" focused on the larger topics in health care, "Complications," written during Gawande's surgical residency, brings us into the operating theater.

Topics include:

*Every surgeon does a procedure for the first time on someone, and only gets good at it with practice.

*All surgeons make bad mistakes sometimes.

*Pain is experienced in the brain.

*Appetite and bariatric surgery.

*Who makes decisions, the doctor, the patient, or some combination?

The section on how consistently successful outcomes come from a practice dubbed as "the hernia factory" (surgeons do the same procedure the same way, over and over, all day for years) made me think of my own experience with colonoscopies:

I had my first colonoscopy in a clinic by a gastroenterologist, reluctantly (hate the prep, hate the thought of my helpless lack of control while under anesthesia) late in life, but it went well and easily, finding and snipping a polyp that was likely precancerous.

Several years later, I had a mysterious lower right quadrant abdominal pain, went to the ER, was told I needed my appendix out, but then the surgeon came in, showed me the films, and said he didn't think that was it. I was hospitalized for a very high white count, which eventually came down under his care. He referred me for followup to a new young general surgeon in his practice, and she eventually recommended a colonoscopy, which I said yes to.

During this procedure, done in a hospital, I awoke in the middle due to pain with an assistant thumping down hard on my abdomen over and over, with the young female surgeon asking her to do it harder while she tried to maneuver the instrument in my colon. After enduring a little of this and fully waking up, I yelled, "Stop! You're hurting me! Just stop!" They did, and it was counted as a "failed coly," which I nevertheless had to pay for. She said my colon was "tortuous" and she wanted to reschedule with stronger anesthesia to keep me under. I resisted, feeling very glad she hadn't torn anything.

I wrote an email to the gastroenterologist who'd done my first procedure, wondering why he'd had no problem while she did, and telling him I would keep his answer confidential. He wrote back, telling me that gastroenterologists did 4000-5000 colonoscopies a year, whereas a general surgeon does maybe one or two, and this may even have been her first. He was very practiced in how to flick his wrist here and there to navigate a tortuous colon without difficulty.

On a different topic, it was amazing but not surprising to me that in the past patients had little choice about having procedures, doctors and surgeons feeling that they always knew what was best for the patient. Now, the standard has shifted to the surgeon giving the patient all the information, then having them decide.

After being lifeflighted off rafting a river in Glacier this June, in the ER the cardiologist told me I was having a heart attack and that he wanted to do a cardiac catheterization, and stent if needed. My symptoms had been so vague that I said, "I know I should believe you, but I feel absolutely fine." His response was to run and grab the rhythm strip and show me. I asked him what were the odds of successfully using the wrist instead of groin, and he immediately said, there's a 7 percent chance trying by wrist will fail. I held out my wrist. (30 mins later, had an RCA stent and am now fine). I think I got an excellent doctor with a wonderful attitude, confident in himself but respectful of me.

I hope there are others who read this book and have viewpoints and/or experiences to share.

I loved this book, and wished my late husband, who was an MD, could have read it. Unfortunately, I bought the book quite some time ago, plowed through it at a great rate. Now I want to do a reread and I can’t find it anywhere! 🤪

I read this last week and thought it was very interesting. Dr. Gawande demystifies medicine and shows it is based on a combination of science, learned knowledge, practice, experience, and educated guess work. I think the thing I appreciated the most about it was his humility and his acknowledgement that there is so much we know and so much we don't know about how the human body functions and/or malfunctions.

Oooh, I assigned this book last year when I taught Health Law! I shall dig out my notes and reread it. We used it to talk about how to address the incentives around reporting physicians who are starting to slip.

I worked in a teaching hospital (for a major medical school) for years. I always told people to avoid any surgical procedure in July if at all possible. The residents are brand new and hardly know where the bathrooms are, let alone what they are doing.

(FYI - I'm moving this discussion to the Nonfiction thread. I hope it doesn't confuse anyone, but that seems less confusing than having it in the Reading List discussions.)