Quotes from Complications, by Atul Gawande

- ‘There is a saying about surgeons, means as a reproof: ‘Sometimes wrong, never in doubt.’ ’ (15)
- ‘People often assume that you have to have great hands to become a surgeon, but it’s not true. When I interviewed to get into surgery programs, no one made me sew or take a dexterity test or checked if my hands were steady. You do not even need all ten fingers to be accepted.’ (19)
- ‘There have now been many studies of elite performers – international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth – and the biggest difference… is the cumulative amount of deliberate practice they’ve had.’ (20)
- ‘We have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non-teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seem to help. But there is still getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of a colon… the ward services and clinics where residents have the most responsibility are populated by the poor, the uninsured, the drunk, and the demented… By traditional ethics and public insistence (not to mention court rulings), a patient’s right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden behind drapes and anesthesia and the elisions of language.’ (24)
- ‘In 1991, the New England Journal of Medicine published a series of landmark papers from a project known as the Harvard Medical Practice Study – a review of more than thirty thousand hospital admissions in New York State. The study found that nearly 4 percent of hospital patients suffered complications from treatment which ether prolonged their hospital stay of resulted in disability or death, and that two-thirds of such complications were due to errors in care. One in four, or 1 percent of admissions, involved actual negligence. It was estimated that, nationwide, upward of forty-four thousand patients die each year partly as a result in errors of care.’ (56)
- ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’ (57)
- ‘There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations.’ (61)
- ‘With the growing role of managed care, job satisfaction in the medical profession has plunged.’ (120)
- ‘Studies show women to be more sensitive than men to pain, except during the last few weeks of pregnancy.’ (121)
- ‘There is also striking evidence that very simple kinds of mental suggestion can have powerful effects on pain. In one study of five hundred patients undergoing dental procedures, those who were given a placebo injection and reassured that it would relieve their pain had the least discomfort – not only less than the patients who were given a placebo and were told nothing but also less than the patients who got a real anesthetic without any reassuring comment.’ (122)
- ‘No physical injury of any kind is needed to make the pain system go haywire.’ (125)
- ‘The subject gets little attention in medical school, and yet, after pain, nausea is the most frequent complaint for which people consult physicians. A majority of chemotherapy patients suffer nausea, and they consistently rank it as the worst part of the treatment. From 60 to 85 percent of pregnant women experience morning sickness.’ (133)
- ‘As the physician Eric J. Cassell points out in his book The Nature of Suffering and the Goals of Medicine, for some patients simply receiving a measure of understanding – of knowing what the source of the misery is, seeing its meaning in a different way, or just coming to accept that we cannot always tame nature – can be enough to control their suffering. A doctor can still help, even when medications have failed.’ (144)
- ‘We are a species that has evolved to survive starvation, not to resist abundance.’ (170)
- ‘The American College of Surgeons recently recognized bariatric surgery as an accepted specialty. The National Institutes of Health issued a consensus statement endorsing gastric-bypass surgery as the only known effective therapy for morbid obesity, one able to produce long-term weight loss and improvement in health. And most insurers have agreed to pay for it.’ (181)
- ‘My patient seemed much the same as before, except a little collapsed in the middle. (The standard consent allows the hospital to keep the organs for testing and research. This common and long-established practice has caused huge controversy in Britain – the media have branded in ‘organ stripping’ – but in America it remains generally accepted.) Most families, in fact, still have open-casket funerals after autopsies. Morticians employ fillers to restore a corpse’s shape, and when they’re done you cannot tell that an autopsy has been performed.’ (190)
- ‘How often do autopsies turn up a major misdiagnosis in the cause of death? I would have guessed this happened rarely, in 1 or 2 percent of cases at most. According to three studies done in 1998 and 1999, however, the figure is about 40 percent. A large review of autopsy studies concluded that in about a third of the misdiagnoses the patients would have been expected to live if proper treatment had been administered.’ (197)

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