What do we expect from a surgeon? To be precise and trustworthy is not enough, we mostly want him to save lives and spare people from death. Surgeons’ job is a tough one. “That’s why they are so well-paid”, we say. They have to save lives. Isn’t this supposed to be a God’s task?
Atul Gawande gives us an unexpected vision of doctors, particularly surgeons, which enhances a very simple fact, though very difficult to accept too: medicine is not a science and it is much more related to uncontrolled facts than what people might think (and would like it to be). Though the persistent attempts of the last two centuries to emphasize the technological and logical aspects of medicine while sacrificing the relational and humanistic sides of this scientific art, doctors are still human beings and they’re still fallible and subdued to human mistakes. Certainly, technology and scientific progress have much increased patients’ possibilities to survive. Nowadays few people die during an anesthesia and many risks, like inserting a breathing tube in the wrong throat channel or forgetting instruments inside patients’ bellies, have been drastically reduced thanks to the introduction of better monitoring systems and higher standards to control doctors’ work. Reduced doesn’t mean eliminated, though. The more scientists and doctors know, the more they would need to know. Moreover, our society and our world are getting more and more complex, some diseases have been almost definitely defeated, some new others have and will come out. Medicine needs to learn how to cope with this evolving environment, but, like all evolutionary processes, this needs time to proceed through a slow progressive adaptation.
Indeed, as it is human and deeply involved with the contradictions that mark the human soul, medicine is full of paradoxes. Medical education is as necessary as dangerous. Patients would like their doctors to be the most professional and prepared on the market. To become so, doctors need to practice a lot. At the same time, almost nobody would accept to be operated by an assistant, who still has to practice his techniques and is certainly more exposed to mistakes than the veterans. Medical education and continuous practice are the only ways to improve doctors’ professional skills. Nevertheless, they have a cost.
It’s also impossible to trace a definite paradeigma. Some people want to be conscious of their health situations, some others don’t. Doctors mainly have to follow precise protocols but they also need to adapt them to the single individuals they’re dealing with. Patients’ situations are pretty unique. If a doctor has to consider the amputation of a young girl’s leg diagnosed with necrotizing fasciitis (the so-called flesh-eating disease), he will think about cutting off the leg twice the times he would consider the same operation for an old man.
Medicine is deeply human because it doesn’t simply deals with bodies and their pathologies, but with the personal perception that accompanies those same bodies. The operation to stop pathologic blushing may cause irreversible damages to the patients’ face, expressions and sometimes it also leads to death. Still, some people prefer to risk and to try to improve their quality of life. A TV reporter that keeps on blushing every time she’s in front of the camera will never have a career with such a disability. She has to do something to achieve her life-goals. Risk is part of challenges. Improving the quality of a life, saving it is a huge challenge, don’t you think so?
Doctors are not machines and they have to deal with human conditionings like everybody else. To go further and make things better is the purpose, to do some steps backwards is part of life, something that has to be accepted. Beside the fragility of our medical knowledge and the misunderstood status of medicine, this book makes us remember that those ‘steps backwards’ may happen, sometimes for a reason, sometimes without.
That’s the first message Gawande seems to give. Our life is extremely fragile, which makes it even more precious.
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