I haven’t even made it all of the way through the book yet, but I’m riveted by Atul Gawande’s Complications: A Surgeon’s Note on an Imperfect Science. Though the author is a human physician, I think anyone here in the veterinary field would find much in the book that would have you nodding as I was, so engrossed during my after-work pedicure splurge that I failed to notice the tech painting my toenails a distinct fluorescent orange instead of the demure pink I had put aside. It was worth it.
Those of you not in the field at all would like it too, I think. It’s one of the more honest assessments I have read on the practice of medicine in a long time. Among the assertions:
1. Good doctors are not the most talented, but the most tenacious. Talent only gets you so far, but practice- overandoverandover- is what makes you excel.
2. Yep, having newbies work on you stinks and they do mess up quite a bit more. Therefore it sometimes behooves doctors to tap dance around the reality of who, exactly, will be slicing you up later on that day.
3. Cookbook medicine is not a bad thing.
Number three is a hugely contentious point in the field of veterinary medicine. Vets, proud of their reputation as stubborn and independent, invariably bristle at the suggestion that strict adherence to protocol improves outcomes. After all, we come from the James Herriot/MacGyver worldview of medicine, where in the throes of a 2 am emergency you might have to deliver a calf with only a funnel, a Slinky, and a moldy orange at your disposal. We like the romantic idea of solemnly looking at a pet, diagnosing an abscessed tooth based on good ol’ intuition and know-how, and saving the day with our wit and creativity.
Clients who subscribe to this vision also contribute to the problem. At least once a week- no, make that once a day- I have someone complain about the need to perform diagnostics in order to, well, make a diagnosis. “Ol’ Doc Johnson down the street can diagnose a bad heart from across the room!” they’ll puff, “and he does it for $5 and a jar of jam!” Ol’ Doc Johnson is retired, sadly. And probably missed a heck of a lot of things with his x-ray vision and his bottle of Vetalog, unless he secretly had one of those cool Star Trek TNG diagnosis gadgets that Dr. Crusher used. (Uh oh, I just outed myself as a major nerd. Ignore that.)
We all want to think we’re smart, and that is how we got where we are. Because our gigantic brains are so gifted and amazing that, like a brainy blimp, the sheer antigravitational force of our genius lifted us by our cranium and plopped us into our office, perfect and infallible from day one. The mystique of the medical profession doesn’t do much to dispel that myth, truth be told. But the real truth is, repetition and hard work makes the man, usually despite our ego, not because of it. Despite the hard to shake belief that protocols and standardization squash one’s ability to perform medical works of art and magnificence, the evidence has shown consistently that following the routine the same way over and over improves your outcomes.
I remember doing a rotation in surgery my senior year with a resident from Australia. I don’t know that anyone would call him a genius, truth be told, including himself. While I retracted for him, he’d turn on AC/DC and tell me about his prior career as a mechanic and his love of brawling. I’m pretty sure he never made it through War and Peace. What he did do, however, was practice his technique for hours on end at home, practicing maneuvers with a Dremel and a dowel. His work, like that of all great doctors, was systematic and meticulous, and his outcomes were excellent.
On the other hand, there was a girl in my graduating class who was by her own admission, a card carrying Mensa genius. She didn’t study. She had a near-perfect GPA. She never had to try hard to succeed at anything- until she graduated. I heard that she quit veterinary medicine, her passion since childhood, not 2 years after graduation because she couldn’t stand the pressure of imperfection and making mistakes. What a shame, because I’m sure she was great.
I wonder how often that happens. We’re all scared to admit our fallibility to ourselves, let alone others- which is why I was so intrigued to read this book where the doctor admits it to the whole world.