Blog by Sumana Harihareswara, Changeset founder
Atul Gawande, "Better"
Hi, reader. I wrote this in 2011 and it's now more than five years old. So it may be very out of date; the world, and I, have changed a lot since I wrote it! I'm keeping this up for historical archive purposes, but the me of today may 100% disagree with what I said then. I rarely edit posts after publishing them, but if I do, I usually leave a note in italics to mark the edit and the reason. If this post is particularly offensive or breaches someone's privacy, please contact me.
I keep recommending in-person that people read Atul Gawande's Better: A Surgeon's Notes on Performance, so I ought to write about it too. I describe it, tongue-in-cheek, as a secular self-help book. Gawande, Michael Lewis, Malcolm Gladwell, This American Life, my ex-boss -- who else gets lyrical about process improvement?
"Process improvement" is such a dry term for it. As Gawande puts it, success and improvement require diligence, ethics, and ingenuity. Mom points out that these match up against three old-school Hindu virtues:
Diligence = karma
Doing Right = dharma
Ingenuity = atma
That last might seem strange except for Gawande's definition. From the introduction:
...ingenuity -- thinking anew. Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflections on failure and a constant searching for new solutions.
This book enraptured me, in my late twenties, thinking about capability and courage, the way I didn't even realize science fiction, procedurals, and competence porn enraptured me as a teen. This is the opposite of ER. As I've mentioned in terms of systems thinking and interpersonal responsibility, I used to think that medicine was about heroics, not hygiene -- godlike individuals with huge responsibilities, not teams, not scientists who are good at changing their minds.
And as I get older, I understand diligence and perseverance better, and have a greater capability for them. I appreciate food or software or prose more when I've tried my hand at making it; I appreciate consistency, stamina, grit more when I've seen them from the inside.
Atul means "a lot" or "very," my mother says. I read aloud several portions of Better to my mother. I read aloud his commencement address on becoming a positive deviant. The book version is better than the speech he spoke.
The published word is a declaration of membership in that community, and also of concern to contribute something meaningful to it.
And I read aloud to her the incidents Gawande observes so vividly, the moments one person tries to persuade another. A doctor and a patient, a vaccinator and a resister. Mom says the prose is so beautiful it reminds her of Kannada. I liked every case study in Better, but the ones that stick with me described a Karnatakan polio vaccination drive and two cystic fibrosis clinics. They marry "How can I provide for this right thing to be always done?" with Trollope-level interpersonal power struggles.
In a job interview the other day, after the interviewer praised me for a moment of candor, I said, "I'm not an engineer, but I have an engineer's honesty, I hope." What's that Lincoln line that Obama quoted? I am not bound to win, but I am bound to be true. (Clever playing with "bound," there.) The joke I make about my Indian parents is that it would have been okay for me to turn into a doctor, because a doctor is an engineer of the body. Conversely, then, if engineers are like doctors, then who am I to them? A hospital administrator, a lab director, a nurse, a paramedic, a journal editor, a public health officer, a research assistant, a med school counselor, and Michael Crichton?