Complications: a Surgeon's Notes on an Imperfect Science
Weve all read stories in newspapers about patients whose diseases are misdiagnosed and about some who even die. To some journalists, everything looks clear. How could they have missed the incipient rash of meningococcal septicaemia or not realised that the abdominal pain was due to a leaking aneurysm? I cant be the only one who has thought, “That could be me.”
Medicine is practised prospectively; working out what is wrong with a patient takes a skilful balance of knowledge and experience; a weighing up of probabilities; and, sometimes, sheer luck or an ill-defined gut feeling. Explaining this process is difficult; a failure to understand it may be the reason for the outraged articles about medical error that we so often read.
Gawande, a practising surgeon, tries to get to the heart of medical practice, to understand how doctors make decisions and why things go wrong. Starting with a section entitled