Better: A Surgeon’s Notes on Performance

As a Viennese obstetrician practicing medicine during the 19th century, Ignac Semmelweis was one of the first doctors to realize that there was a correlation between a lack of handwashing by medical personnel and the transmission of diseases to new mothers. He implemented a new handwashing policy, and it saved many lives. However, he was draconian about adherence to his policy, which made it difficult for his colleagues to accept. Gawande uses the cautionary tale of Semmelweis to show that new ideas must be accompanied with intelligent messages and accessible plans for implementation. Otherwise, such ideas will be difficult to enact because humans, especially doctors, are hesitant to change their methods without proof that a new one will work better. 

Virginia Apgar was a doctor who developed a method for scoring the health of newborn infants. Though being a woman in a male-dominated field made it difficult for Apgar to integrate her method into standard practice, her persistence eventually prevailed. The Apgar Score became a uniform way to assess the health of newborns by allowing nurses to rate the condition of their health at birth on a scale from 0 to 10. Thanks to Apgar’s dedication to innovation, her method required a more careful examination of newborn babies, which dramatically lowered infant mortality rates.

LeRoy Matthews was a Cleveland pediatrician who helped revolutionize the treatment for cystic fibrosis. By thinking outside the box, Matthews was able to do what no other doctor had been able to accomplish: understand cystic fibrosis as a cumulative disease. He began to institute a new way of treating the disease that prolonged the period before most patients were debilitated by it. Matthews represents the positive end of the healthcare bell curve because his work provided a quantifiable statistic for success and failure in the treatment of a disease.