30 pages • 1 hour read
Better: A Surgeon’s Notes on Performance
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Themes
Diligence
Diligence is one of the three major themes that Gawande explores in Better. According to him, diligence is “the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles” (8). In order to accomplish this, one must hold oneself accountable when things go wrong. Gawande details a patient of his who came down with an antibiotic-resistant hospital-acquired infection. Language such as “came down with” and “hospital-acquired” skirt the fact that the hospital didn't Infect the patient—a doctor making a human error did. He states, “It had not occurred to me that I might have given him that infection. One of us certainly did” (28).
Gawande considers diligence to be “one of the three core requirements for success in medicine” (8), but it extends further than just the sphere of public health. Being completely devoted to the minutia of one’s life is a form of diligence, and Gawande believes it should be a central tenant in everyone’s life. He believes this because people almost always create better outcomes when they approach a task with diligence. The science of performance is a field of psychology all its own, but Gawande sets himself squarely in the camp of believing attention to detail sets the stage for success.
Doing Right
In Better, the idea of doing right refers to the act of putting the best interest of others above everything else. For Gawande, it is a moral responsibility for all people to create goodness in the world. Doing right also compels people to take responsibility for their actions and the results of those actions, both intentional and unintentional. Throughout the book, Gawande is mostly interested in how doctors can do right by their patients. He concludes that the biggest obstacle standing between doctors and this goal is their own egos. Gawande urges doctors to not allow their desire for success keep them from noticing their patients’ individual needs and providing them with the best possible care.
One of the main components of success, therefore, besides attention to detail, is empathy. This notion is seconded by much research. From DDI global leadership consulting firm to Bill Gates and 21st Century Skills, social-emotional Intelligence Is the #1 predictor of success. The question, then, of whether soldiers who may never return from a vegetative state are worth saving or whether its more ethical for a doctor to be an executioner than a layperson is especially poignant. Doctors, more so than many other professions, are in the crosshairs of some very dodgy ethical debates.
Ingenuity
According to Gawande, ingenuity “is often misunderstood” (9). True ingenuity is the ability to adapt, accept failure, and be open to change, even in uncomfortable situations. Resourcefulness is another way of describing Gawande’s understanding of ingenuity because he believes that it is a trait that arises from “deliberate, even obsessive, reflection on failure and a constant searching for new solutions” (9). Gawande applies this idea in contrast to concrete intelligence; just because one is intelligent does not mean he is ingenious. Gawande admires people who can employ ingenuity because they are able to look beyond what is right in front of them in order to benefit society on small and large scales.
Positive Deviance
Positive deviance is a term that was coined by Jerry and Monique Sternin. Researchers identify positive deviance as actions that are “affordable, acceptable, and sustainable because they are already practiced by at risk people, they do not conflict with local culture, and they work” (Marsh, David R et al. “The power of positive deviance.” BMJ (Clinical research ed.) vol. 329,7475 (2004): 1177-9). One example of positive deviance is:
In Egypt, contrary to custom, parents of poor but well nourished children were found to feed their children a diet that included eggs, beans, and green vegetables. Child nutrition programs that provided opportunities to parents of malnourished children to follow this and other new behaviors, such as hand washing and hygienic food preparation, improved child growth. (Marsh, David R et al. “The power of positive deviance.” BMJ (Clinical research ed.) vol. 329,7475 (2004): 1177-9.)
According to Gawande, the idea of positive deviance is something abnormal that creates positive change. Positive deviance does not necessarily mean doing things radically differently. Instead, it requires one to be observant enough to understand the minutia of a situation and be able to influence it from within. It is “the idea of building on capabilities people already” possess (25). Gawande seeks to show readers how they can be positive deviants in their everyday lives, which will help them to tackle big and small problems without having to make major changes to the world around them.
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By Atul Gawande
