• Adewale Kukoyi

Book review: Complications by Atul Gawande

Eighteen years later, Atul Gawande’s ‘Complications: A Surgeon’s Notes on an Imperfect Science’ remains a timeless memoir. The 228-page novel gives us an insight into life as a surgeon and how it is to practice Medicine ‘over’ the knife. Amidst the technological advancements that are synonymous with the medical field, the book reminds us of the fundamental human element to the profession. As Gawande puts it, the inspiration for this book arose from his intense eight-year surgical residency programme where he stumbled across numerous cases that reminded him that Medicine is a strange, remarkable and sometimes disturbing business. 

The book is a collection of cases and subsequent essays structured in three parts: Fallibility, Mystery and Uncertainty. Each element acts as a central theme and takes us on a journey through the lens of Gawande, a young surgical resident navigating his way through his career. 

The ‘Fallibility’ section of his account shows us the dilemmas of the learning curve and how often in Medicine, training can be more free-flowing rather than structured. As the name of the chapter suggests, we also learn more about the occurrence of mistakes (or malpractice, whichever way you look at it) and even how a profession like ours reflects on potentially fatal errors in “Morbidity and Mortality” meetings. It is truly an eye-opening and captivating way to begin the book and also questions whether automation of procedures and treatments through the use of machine learning and AI is an effective way of improving healthcare - a question still extensively debated today. 

The ‘Mystery’ chapter delves deeper into the limitations and imperfections of medical science when applied to healing. A simple case of chronic back pain can appear very simple superficially but becomes even more of a puzzle when further unravelled. This mystery of a patient becomes a variable to factor in but ultimately decisions still have to be made. We must ask: Do we continue with referring the issue to different specialities, or do we begin to interrogate the patient’s story? In Gawande’s case, he decides to do both. 

Finally, and arguably the most crucial section of the novel is ‘Uncertainty’. Even if doctors limited their errors and understood all possible scientific processes occurring in a patient (I wish), there will always be that element of uncertainty. Uncertainty, whether it was the right diagnosis or right procedure, will arise; hence Medicine can never be perfect.

I implore you to give ‘Complications’ a read even if you were never considering surgery. It is a relevant read for all medical students alike as well as the lay individual.