Featured Work: Atul Gawande’s "Complications"

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.

References

Gawande, A. (2002). Complications: A surgeon’s notes on an imperfect science. New York, NY: Picador.