Five questions: Gawande on surgeons
Atul Gawande
Surgeons all make mistakes. What matters is how they react to them, says Harvard surgeon and New Yorker staff writer Atul Gawande, MD, who visited campus last week to deliver the Center for Biomedical Ethics' Jonathan J. King Lecture: “On the Ethics of Erring.” The inevitability of screwing up plays a prominent role in Gawande’s writing, especially in his 2002 bestseller “Complications: A Surgeon’s Notes on an Imperfect Science”(Picador). Gawande, 38, a Stanford University graduate, went to Harvard for medical school and finished his surgical residency at Brigham & Women’s Hospital in June 2003. Now on Harvard’s faculty, he practices surgery and identifies strategies to improve surgical care. He lives in Newton, Mass., with his wife and three children.
Gawande met with Medical Center Report’s Rosanne Spector before his lecture Oct. 12.
1. How do your fellow surgeons react to you writing about their mistakes?
GAWANDE: (Laughing) I’m careful. You HAVE to be careful.
No. 1, I ask everybody’s permission before I write about them. So people don’t get angry with me so much about that. People can get angry about the arguments I make, and disagree vehemently.
To my surprise people seem to sort of enjoy having me around. Other surgeons even come to me and say, Hey I’ve kind of had an interest in writing – can you take a look at this piece for me?
2. Is there something appealing about a career with high stakes and great risk of error?
GAWANDE: A large part of the reason I liked going into surgery was the high stakes. I liked the character of people who are forced to face situations where there is deep uncertainty, high stakes and a need to take action. And I liked the prospect of being trained to think in a way that would let me become more like those people.
3. Why did it take so long to reduce surgical residents' workloads from the typical 110 hours a week to the current maximum of 80? [Last year the agency regulating U.S. medical training capped residents’ work hours.]
GAWANDE: The answer is partly that surgeons honestly did not believe that being tired made any difference.
Even if you could show lots of evidence that truck drivers and pilots and other people are affected by fatigue, surgeons are congenitally disposed to believing that they're better in some way. And that’s a benighted kind of view. We’re as human as the next person and as subject to fatigue as others.
The more sophisticated concern that has been a source of worry all along, though, is what does it take to reduce the hours? I’d say most of us in surgery are worried about watching the primary ethic of responsibility get replaced by a shift-work mentality.
4. Why are people less interested in surgical careers than they used to be?
GAWANDE: This last cycle of applications in surgery everyone’s sort of breathing a big sigh of relief because the numbers are back up again. And I think it’s probably in response to what people did when the numbers dropped.
There were some clear reasons why people were shying away from general surgery in particular. One was the lifestyle. It’s tough training. And also the fact that surgery has never been good about cultivating its appeal to women.
The [change to an] 80-hour work week made it seem like a more reasonable life. You had people becoming much more sensitive to the fact that you can’t just make this a he-man kind of profession – that we need to be more encouraging for women to go into the field.
And then also you have an increasing rank of women who are powerhouses in surgery. That’s a dramatic cultural shift and makes a big difference in making it seem like this is also something that women can do.
5. Does writing about your work make it harder to do your job?
GAWANDE: It makes it far easier. I think I would have quit surgical residency if I hadn’t started writing.
Surgical training can definitely be a grind. And it can be hard to enjoy for long stretches unless you recognize that what you’re doing is really unbelievable.
The writing let me step back and sort of wonder about lots of questions like, How is it that 700,000 physicians who in the end are just ordinary people with ordinary problems manage to do something that’s extraordinary – as extraordinary as keep people well and help make them well. And I never would have been able to connect those two unless the writing was there.
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