another book review

Better: A Surgeon's Notes on Performance by Atul Gawande

My review

rating: 5 of 5 stars
This is a great book. From it's title, I thought it was about how doctors figure out how to make their patients better. But instead, it is about how the medical profession makes itself and its performance better. Gawande classifies the methods he sees in several ways. First, there is diligence, doing right, and ingenuity. He explores these ideals while discussing the campaign to get doctors and nurses to wash their hands in hospitals, improving the field of obstetrics, saving the lives of more and more wounded soldiers, and improving life expectancy for people with cystic fibrosis. He emphasizes that improvement is possible, even with the tools and techniques we already have. We have to use them diligently, every day. It's not easy. At the end of the book, he has 5 suggestions for improving performance and generally making a difference in one's career. His audience is typically medical students, but these suggestions work for everyone:



1. Ask an unscripted question. In other words, get to know the people you are working with. They will mean more to you, and you will work with them better. It's just good for society, too.



2. Don't complain. Complaining drags us all down. I love to complain, so this is a hard one for me. But I also know that negative energy is infectious, and kill energy and creativity. But positive energy is also infectious. Neither he nor I am encouraging people to be chipper and annoying - just don't drag everybody down. Change the subject if necessary.



3. Count something. That I can do! Gawande's point is, find a question that interests you in your profession, and observe it. In order to improve performance, you need information on current performance, and also information on why current performance is what it is. So count something. Then give me the data and I will analyze it for you.



4. Write something. Gawande says you should show your writing to other people, write for an audience. I think that you can learn a lot about yourself and your profession through writing, even if no one else sees it. It helps to clarify thoughts.



5. Change. Don't be afraid to make changes when they are necessary.



Here is a quote that I like from the book, the essence of the book in one paragraph:



"Arriving at meaningful solutions is an inevitably slow and difficult process. Nonetheless, what I saw was: better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try."



Gawande is a good writer, and his essays are interesting individually. Despite what I might have indicated here, he does not preach. He provides examples and offers up the lessons he learned from them. And he writes about really interesting topics. In addition to the ones mentioned above, he writes about doctors who participate in executions, trying to innoculate 4.2 million children in 3 days in India with a polio vaccine, the difficult question of patients' dress (or lack thereof) during medical examinations, doctors' income, and the extreme and pedestrian steps that some surgeons must take every day to treat patients in public medical clinics in India. Interesting stuff, well-written, reads quickly.


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The Purfuit of Happineff

I just finished reading a book on happiness/unhappiness around the world, The Geography of Bliss by Eric Weiner. Weiner is a grump who wants to know who the happy people are and where they live, and why they are happy. What is happiness? So he studied up on Happiness Studies, and went to a bunch of different countries that are well-known to be either very happy or very unhappy. The happy countries were the Netherlands, Switzerland, Iceland, Thailand, and Bhutan. The unhappy one was Moldova, a very unhappy place. India and Qatar were mixed, but India seemed happier than Qatar. Great Britain was fairly unhappy, although they are beginning to think about trying to be happy, to the dismay of many people. America is not the unhappiest country, but not near the top of the happy spectrum. I hope I haven't forgotten any.

Weiner's conclusion is that happiness is multifaceted. A certain amount of money is involved, but it isn't much. Human connections are necessary, and trust. Envy is the enemy to happiness. That all makes sense. After that, you're on your own. That's what he found, anyway. That makes sense, too. Different people find different things that bring them happiness. Most people in the happy countries do not spend time wondering about happiness, perhaps because they are too busy being happy. If you've got it, you don't miss it or wonder where it is.

One thing that Weiner doesn't address is the temporal aspect of happiness, or the essence of happiness. He wrote about what makes people happy, but not about what it is to be happy. Is it joy? If so, is it constant joy? Or do scattered joyous moments equate to overall happiness? Is a person's happiness level their average state of being, and if so, is that necessarily where they are on the happiness meter during the majority of their life (or day, or week, or hour), or can it be the average of extreme joy and extreme misery? Is not hating your life the same as being happy? I think I am fairly happy, although there are many things I would like to change about my life. It could be better. But it is what it is, for now. (I think that was a message from one of the happy countries, actually.) But it's not constant or even frequent joy.

Another question: Why should we expect to be happy? In America, we are told that we must be happy, and that if we are not happy, then it must be our own fault. But I don't think that it is the human norm to be happy, not actively, consciously happy. I also don't think it's the human norm to be actively miserable. I think that in general, people just go along and do what they have to do to get by, and if they are happy, that's great, and if they are not, well, then, that's the way it is because they don't have any choice in the matter. Granted, I am thinking of serfs and subsistence farmers and all, but most people in the world have been at that level of society and have had little choice in their lives. (The Bhutanese, pretty happy people but they don't admit to it, have had little choice in their lives until now, when they are getting democracy by decree of the king; they don't want it, but they all voted because the king told them to. I don't think they really get this democracy thing.) It is all Thomas Jefferson's fault, this fixation on happiness that Americans have. Not that he promised us out and out happiness. He just promised the right to pursue happiness. With that right, then if we are not happy, then it must be our own damn fault. Jerk. Also, the American public is too stupid to distinguish between the right to pursue happiness and happiness itself. We feel so entitled to everything. If we are not happy, then it must be the government's fault that we are not happy. The government owes us!

So, it's either our own fault that we are unhappy, or it's the government's fault that we are unhappy. The book implies that it is both, in the sense that some countries are generally happy because of the system of government, and others are happy because of the cultural and societal attitude, which of course defines the government, as well. It could be our ancestor's fault, if it is all genetic. Or perhaps happiness is just a modern marketing ploy, and it really means nothing. I think that part of it is that, and that the choices that we make will not necessarily lead to either happiness or unhappiness. They may lead to comfort or discomfort, but not necessarily change our happiness level. (Happiness researchers agree.) On the other hand, some choices are definitely better than others. If only they were easy to identify.

This book did not address anything like depression or PTSD or the effects of war or trauma or other bad things. Weiner has spent time in Iraq and other places that have been going through horrible times, and he purposely avoided these places and issues for this book. He himself is not a happy person, which is why he was curious about it. He seems to be a little happier after writing the book (certainly after getting it done). One thing he says at the end: many people find it more important to have full and meaningful lives rather than empty and happy lives. The implication is that having full, meaningful, and happy lives may not be an option - so you may not get to pick. In which case, perhaps we should just stop worrying about it, and get on with our lives.

So there are lots of contradictions here, and in the interest of my happiness and yours, dear reader, I am not going to try to smooth them all out. I liked this book, and I recommend it.