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Better: a surgeon's notes on performance

An usual book about how using what we know about humanity can improve the way we deliver healthcare

An usual book about how using what we know about humanity can improve the way we deliver healthcare

I really enjoyed this book written by someone who is both a surgeon and a writer. He explores some of the dilemmas and controversies of practising medicine.

He starts with an interesting discussion about the reasons why, despite all the evidence about infection risk, we have not succeeded in persuading health professionals to wash their hands.

He makes the point that the culture of sterility in operating theatres is such that failure to observe proper procedure would cause outrage; why the difference in other parts of medicine?

He uses examples of what ideas have and have not worked and proposes the model of positive deviance – that is, building on the capabilities people already have.

This was used with great success by a hospital in Pittsburgh. By working with staff and using their ideas they managed to drop the MRSA infection rate to zero.

He devotes a chapter to the WHO polio eradication scheme.

As an organisation the WHO has no legal powers, but for example in India covers a population of 1 billion with only 250 physicians.

His description of the attention to detail during one outbreak makes one feel as if one were there. His admiration for the participants and the process comes clearly through, but he also plays devils advocate by wondering if more benefit would have been achieved if the same money had been spent on sanitation or basic medical care.

Processes are discussed again in his reflection on medical care in Iraq.

Battlefield care has been transformed by ordinary doctors. Again attention to detail led to simple changes, so for example wound rates were cut by enforcing the wearing of protective vests.

Once the ‘golden five minutes' for survival had been identified, doctors attitudes to standard procedures needed to change so they could learn to simply stabilise casualties to stop them dying and move them on rather than sort all their problems.

Battlefield to USA transfer times have thus dropped from 45 days in Vietnam to four days in Iraq.

I could go on; he interviews doctors who help the US execution process and explores their often belief-driven motivation, and explores the progress made in the care of patients with cystic fibrosis and questions the current climate of litigation.

The common theme to all the chapters is how do we use what happens in our ordinary working lives to do a better job both for our patients and ourselves.

He suggests five key features - learn about individuals, don't moan, count something, write something and be prepared to change.

The book is so well written that he may inspire some to do just that.

I for one might go back to my surgery and ask for staff input into handwashing, rather than just sticking notices above the sinks.

Rating: 4.5/5

Dr Clare Etherington

Better - a surgeon's notes on performance

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