Book Review: “Better: A Surgeon’s Notes on Performance” by Atul Gawande

Better: A Surgeon's Notes on PerformanceBetter: A Surgeon’s Notes on Performance by Atul Gawande
My rating: 5 of 5 stars

After reading
Being Mortal
by Atul Gawande, I added all his books to my to-read list.

Gawande is not only a conscientious physician, but he is also a thoughtful leader (who admits his own shortcomings and failures) and an excellent writer, and that combination is always appealing to me.

This book should be on everyone’s must-read list. While Gawande tackles performance and the medical profession – and does an excellent job of saying “this is how it looks” and “this is what we all need to do” – here, the principles apply to each of us a humans in every aspect of our lives: personally (as individuals and in our relationships), professionally, socially, and spiritually.

One of the overarching things that comes out time and again in this book is that while skill, knowledge, and abilities are important, it is how we use (and measure the outcomes) them – performance – that matters most.

When we measure the wrong things with the wrong things, we come up with a wrong analysis of our performance.

Too often, in medicine, performance is measured in two default ways.

First, medical professionals and institutions measure themselves against each other. This is faulty because each of us tends to rate our skill, knowledge, and abilities as much higher than they actually are. Therefore, when we compare ourselves with others, we are under the wrong impression that we are either doing as well as or better than others. It’s kind of like a student who has a C in a course where everyone else has a D or an F. The student with the C is at the top of the class, but is still just average.

Second, medical professionals and institutions measure statistics about performance in broad terms on a success/failure scale. For example, surgeons are measure on a life/death scale (how many people survived the surgery and how many people did not).

This looks like a good way to measure performance, but it isn’t really because it does not take into account quality (for example, were surgical instruments left in the living that will cause a problem down the road or were sutures not done properly which will lead to an infection in a week or two that could lead to death?) nor does it take into account specific areas in relationship to those being treated that give a more accurate picture of performance.

The reality is that these flaws in measuring performance are not limited to medical professionals and institutions.

All of us tend to measure performance individually and collectively this way. And we all end up measuring the wrong things with the wrong things and coming to wrong conclusions about how successful our performance is.

Gawande highlights this tendency with some very interesting stories about how a few peole in medicine have become and are becoming better in their performance. It’s incredibly illuminating and interesting, but if we’re paying attention, we should come away from this book rethinking our own ideas about our performance and committed to becoming better all the way around, using the right measurements, in how we perform life.

I’d guess, though, that most people who read this book will say, “It’s about time medicine started getting their act together,” without realizing that it is each one of us whose time has come to get our act together.

The reason is that often we get comfortable on life’s road and we don’t want to do anything to disrupt that place of comfort. So we stay there, drifting along, doing, saying, and believing all the same old things that we’ve always done and believed, effectively shutting down our minds and refusing to change.

And we stagnate, believing that we already know everything we need to know and believing that we’re doing just fine.

And that’s the most common lie we tell ourselves. We don’t know we’re lying to ourselves, but we are.

Because becoming better in performing our lives means getting out of our comfort zones. It means being willing to change. It means thinking outside the box. It means learning, growing, and, being willing to put our own egos at bay and watch and listen to others in our lives (with wisdom, of course – there are too many vacuous noisemakers out there that we should immediately shut out and never give any room to in our own heads).

This is case Gawande compelling makes. He lays down the gauntlet for himself and for each us. I hope we pick it up.

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