Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science gives the reader exactly what is stated in the title: an insider’s look at a relatively hidden and allusive profession. Through this collection of essays, Gawande reveals what actually occurs behind the operating curtain and in various other aspects of medical care. Through earnestly detailed descriptions, he gives a broad overview of the medical profession and its inherent imperfections in terms that are accessible to a diverse audience that includes both doctors and readers without a medical background.

Gawande writes from the well-informed perspective of someone who has experienced the trials and triumphs of medicine firsthand. He was a surgical resident at Brigham and Women’s Hospital in Boston at the time of publication, and in the intervening years his career has skyrocketed. Among his many accomplishments, he has become a general surgeon at Brigham and Women’s, served as an associate professor at Harvard Medical School, written for The New Yorker, and received a MacArthur Award.

Complications is divided into three distinct sections designed to show different aspects of the myriad problems faced by doctors on a daily basis. The first, “Fallibility,” describes the rise and occasional fall of surgeons from the challenges of the learning curve during residency and the looming threat of burn-out that could lead to malpractice. The second and third sections, “Mystery” and “Uncertainty,” both treat areas in which doctors do not have the expertise to correctly diagnose a patient or to find a cause for a diagnosis and how these problems are dealt with through a combination new technology, new regulations, and educated guesswork. Gawande’s writing is at its best as he uses his personal experience as fodder for his work, regaling the reader with compelling medical mysteries worthy of prime-time dramas. He artfully builds suspense to engross the readers while describing how doctors proceed from the presentation of symptoms to the implementation of treatment.

The essays clearly show the perspective of one individual, which humanizes the sometimes intimidating medical system. Although this personal touch can be informative, it can also be highly unsettling to patients who put their health in the hands of hospitals. In many instances, the guidelines that doctors rely on to proceed with a case appear to be unclear, such as the case of a man with chronic crippling back pain or a case in which the end-of-life decisions of the patient contradict the recommendations of their physician. In other situations, the ability of the doctor to make a judgment comes into question, as in the description of a renowned surgeon who overbooked his schedule and thus jeopardized the health of his patients. Attaching names (in most cases pseudonyms) and life histories to the situations makes each case more personal, highlighting the central issue: how can doctors treat their patients perfectly when the doctors are imperfect?

The anecdotal evidence given to answer this question is covered in breadth but not necessarily in depth, which is appropriate to a book that gives an introduction to the world of medicine but leaves room for further investigation and expansion on topics. Topics vary from the preventable causes of malpractice, the relevance of autopsies in the future, and the new hour restrictions in residency programs all of which are still being debated with no certain outcome. Gawande provides a thorough introduction to different angles of these topics in addition to his own opinions on and recommendations about the matter, but the issues all merit further research into the current situation and the nuances of the debates.

Raising awareness and creating change seems to be one of the most important goals of the book. It is an example of modern-day muckraking, unflinchingly exposing the underbelly of medicine without pretensions. The triumphs of modern-day medicine are placed alongside its failures. Gawande admirably takes responsibility for his part as a cog in the complex machinery of medical decision making, describing both cases in which decisions he made led to the failure to save a patient and cases in which his decisions saved a patient against the odds. This convincingly conveys a full picture of such a precise science with unpredictable outcomes. The essays highlight the paradox of power in medicine; with the ability to save comes the inadvertent ability to do harm while struggling against the limits of scientific knowledge and technology.

Complications: A Surgeon’s Notes on an Imperfect Science
Atul Gawande. Henry Holt and Company: Picador.
New York, NY, USA. 2002
$27.00 (hardcover), 269 pages
$14.00 (softcover), 288 pages