What better way to prepare for the great medicine
trek than to begin by reading about the field itself? With literature being one of my passisons, reading books authored by experienced physicians provides
me with significant insight regarding my future interests. I’ve started with Complications by Atul Gawande, a general
surgeon at the Brigham and Women’s Hospital in Boston, staff writer for The New Yorker, and associate professor
at Harvard Medical School and the Harvard School of Public Health.
Upon finishing Part I of III, I can say that my
perspective on the field has changed for the better. Dr. Gawande seeks to
explore some of the flaws and limitations of medicine that are seldom mentioned
in the real world due to the potential controversies that could arise following
such discussions. He presents personal experiences he underwent as a general
surgery resident that include a variety of shocking patient stories. Among some
of the larger stories are minor anecdotes of patient deaths due to mistakes
made by residents, experienced physicians and errors by faulty machinery.
Mistakes in any career are inevitable – but in medicine, mistakes can (and
will) cost lives.
SUMMARY: "WHEN DOCTORS MAKE MISTAKES"
Among the cases mentioned was that of an
anesthesiologist’s friends who brought their eighteen-year-old daughter to the
hospital to have her wisdom teeth pulled under general anesthesia. According to
Dr. Gawande, a breathing tube was inserted into her esophagus instead of her
trachea (a “relatively common mishap”) but went unnoticed. The
patient was deprived of oxygen and “died within minutes” (Gawande, 2002, p.
64-65).
Dr. Ellison (Jeep) Pierce, the aforementioned
anesthesiologist and friend of the patient’s family, was elected vice president
of the American Society of Anesthesiologists in 1982, granting him a
long-awaited opportunity to do something about the death rates in the field
(65). Around the same time, ABC aired a program that put the specialty under
fire. They warned the public of all the potential mishaps in the field to
anyone who was about to be put under anesthesia, and presented a few
“terrifying” cases that had occurred at the time (65). Pierce put into effect
the focus on these critical errors in his specialty and sought out professional
aid from Jeffrey Cooper, an engineer and lead author of a paper published in
1978 entitled Preventable Anesthesia
Mishaps: A Study of Human Factors (65).
Cooper spent most of his time
analyzing the operating room and observing the anesthesiologists when he began
to notice the poor design of the anesthesia machines. As mentioned by Gawande,
“a clockwise turn of a dial decreased the concentration of potent anesthetics
in about half the machines but increased the concentration in the other half
(66).” Cooper borrowed the technique known as “critical incident analysis (used in
the 1950s to analyze aviation mishaps) in order to learn how equipment may be
one of the major factors in anesthesia mishaps. This technique involved receiving
honest reports of any sort of error occurring in the OR and identifying the
patterns which lead to such faults. Cooper had collected three hundred and
fifty-nine errors, considering this “the first in-depth scientific look at
errors in medicine” (66).
Cooper found that the most common problem consisted
of maintaining a patient’s breathing – a result of an “undetected disconnection
or misconnection of the breathing tubing, mistakes in managing the airway, or
mistakes in using the anesthesia machine” (66-67). Moreover, Cooper identified
other factors such as “inadequate experience, inadequate familiarity with
equipment, poor communication among team members, haste, inattention, and
fatigue” (67). Funding was directed into research on reducing the number of
error occurrences which eventually led anesthesia machine designers to discuss safety.
Dr. Gawande asserts that “it all worked”
(67). “Hours for anesthesiology residents were shortened” and machines were improved
through complete redesigning (67). This, of course, marks one of the greatest
achievements in anesthesiology known to this day, with credit given to the late
Dr. Ellison (Jeep) Pierce and Jeffrey Cooper – pioneers in medical safety.
CONCLUSION
Dr. Gawande presents many fascinating stories in Complications; a work that I’d recommend
to anyone who is interested in medicine, whether through a pre-medical perspective
or simply through curiosity of the industry itself. I will present additional
reviews in the near future regarding this book when I have finished Part II and
III.
Gawande,
A. (2002). Complications: A surgeon’s
notes on an imperfect science. New York, NY: Picador.
