Book Review

author-surgeon’s book describes the limitations of surgery and improvements and the scope for future advances. Complications: a Surgeon’s Notes on an Imperfect Science by Atul Gawande Metropolitan Books, Henry Holt & Coy LLC, New York, 2002 269 pages, no index. US$24 Brien Briefless THE writer is a surgeon and staff writer for the New Yorker magazine. He is also a teaching professor at the Harvard Medical School. He is one of several New England surgeon/teacher/essayists, for example, Sherwin Nuland, of Yale University Medical School (How we die, 1994; and The Wisdom of the Body: How we live, 1997), and Jerome Groopman (The Measure of our Days, 1998; Second Opinions, 2000; and The Anatomy of Hope, 2003) also of Harvard. All three write well and knowledgably and this reader would expect a similar high standard in their practice of surgery. Gawande’s research interest is in improving surgical care in the US and developing countries and forms the basis of this collection of essays which have previously been published in the New Yorker and the online internet “magazine” Slate. I can recall having previously read several of these articles in the New Yorker. While this volume lacks an index it does have chapter notes, allowing the reader to delve deeper if desirous of doing so. Gawande investigates why it is that things go wrong — it is not because there was no need for the word “iatrogenic” that it was coined: this is where the medical care is indeed worse than the disease. An interesting observation is that according to research cited by the author medical malpractice suits do not reduce medical error rates (this is a contradiction of the rationale cited by plaintiff trial lawyers that tort litigation is the only effective learning process for otherwise indifferent tortfeasors). Added to that, fewer than 2 per cent of patients who do have a cause of action actually litigate. And, of the medical malpractice suits filed, only a small minority are held to be victims of negligent care, and the best guide to ultimate success in litigation is the severity of the patient’s adverse outcome regardless of causation.