Atul Gawande is a doctor who writes for the New Yorker. Or perhaps, at this point in his career, he's a journalist who also happens to be a doctor. He joins an illustrious history of physicians in print, from Maimonides to Anton Chekhov, and he writes in very clear, concise language, following the Malcolm Gladwell paradigm of exploring Big Concepts through small anecdotes and inspiring people. As with Gladwell, the reader has a nagging suspicion that not all the proper logical lines are being drawn between the anecdotes and the argument he's trying to make, but he's certainly a pleasure to read.
In his book Better, his grand idea is no less than the systematic improvement of health care: how to better the art of making people better. His most substantive suggestion for doing so comes in a chapter called "The Score," which discusses the genesis and use of Apgar scores, a way of measuring a newborn baby's health on a 0-10 scale. In his telling, this simple numerical measure, introduced in the 1960s, had a radical and near-immediate effect: doctors tried to increase the scores of babies in their care, and neonatology was greatly improved. In general, Gawande appears to favor the notion of medicine as a science, rather than an art: while proficiency in an art cannot be systematically taught and improved, science can be taught and improved on the basis of hypothesis and data. (From the other end, David Watts is a doctor and poet who treats his calling as an art. His fine book of essays The Orange Wire Problem, rating: 79, demonstrates the holistic approach he takes with caring for his patients.) Gawande would like hospitals to open up their records and share their success with the public, so that they can learn from one another and the public can learn as much as possible from them.
But how much can health truly be improved by attaching a 0-10 score to everything? It's an attractively simple idea -- albeit one that few doctors would care for -- but it seems more like a cosmetic fix than a panacea. He discusses the tremendous difficulty of getting data. Losses are more than embarrassing, they're shameful. Because of the prevalence of malpractice suits, anyone in the business of health care has to scrupulously avoid anything resembling an admission of wrongdoing -- including opening the records of treating patients. Yet open records are precisely what lead to the competition in other industries that produces progress.
Medical research and technological improvements are still occurring at a breakneck pace, but few have access to the top of the line. The best way to improve health care on a grand scale, he argues convincingly, is to look at getting the most bang for your buck, rather than relying on future technology.
The ongoing debate about health care insurance reform shows both how tricky and how vital these questions are. While Gawande leaves the reader with frustratingly few satisfying answers, he presents the terms as lucidly as anyone can.
Rating: 84
Cross-posted on Remingtonstein.