Chapter summaries for Better by Atule Gawande

Topics: Doctor, Patient, Physician Pages: 7 (2795 words) Published: October 14, 2013

Biology Enriched
Extra Credit Better: A Surgeon’s Notes on Performance

Chapter 1: On Washing Hands
Mr. Gawande starts his literature on washing hands. He introduces two friends a microbiologist and an infectious disease specialist. Both work hard and diligently against the spread of diseases just like Semmelweis who is mentioned in the chapter. Something I learned, that not many realize, is that each year two million people acquire an infection while they are in the hospital. Mainly because the clinicians only wash their hands one-third to one-half as many times as they should. Semmelweis, mentioned earlier, concluded in 1847 that doctors themselves were to blame for childbed fever, which was the leading cause of maternal death in childbirth. The best solutions are apparently the sanitizing gels that have only recently caught on in the U.S. Then there was an initiative to make the sanitizing easier for all. The engineer Perreiah came up with solutions that gave the staff more time which was revolutionary in itself but the format worked only under his supervision. After he left it all went down the drain, so, Lloyd a surgeon who had helped Perreiah decided to do more research and was excited when he encountered the positive deviance idea, the idea of building on people’s capabilities instead of trying to change them. The idea worked and even got funding for ten more hospitals across the country. At the end of the chapter Dr.Gawande ponders upon the idea of how many he has infected because of his lack of cleansing. Chapter 2: The Mop-Up

This chapter starts off with the difficulty of diligence. Yet there are some who have managed to deliver that expectation on an incredible scale. The task of distributing polio vaccines to millions of people, many in rural areas, was evidently a long and complicated task. The WHO had a team of only hundreds and had to teach the necessary vaccination procedures to the volunteers and local representatives, people who went door to door in all of these areas. Their target for the introduction of the vaccine was 90%.It was definitely complicated to try to keep the supplies in a constant outpour when there were only so many. For example, the vaccines needed to stay on ice to be effective. Something that seemed counterproductive and bothersome was the lack of information in some places. For example, some villagers didn’t even know the vaccines were coming that day so they had been missed and others blinded by their ignorance didn’t want to vaccine their children. One such case led to a woman who refused the vaccines for her child but later went on to regret it when her own daughter’s legs lay limply aside. Gawande traveled with a Pankaj who made rounds checking on the progress of the volunteers and making corrections as necessary. The diligence in reporting gave the WHO the necessary information to learn from that mop-up. The commitment to accumulating meaningful data and the commitment to studying and learning from that data is just as important as the actual process of vaccination itself. Chapter 3: Casualties of War

Casualties of War, covers the efforts of battlefield surgeons in Iraq and Afghanistan to save as many wounded in the wars as possible. A Forward Surgical Team (FST) can set up all their equipment in the combat zones in less than 60 minutes. The travel time of a seriously wounded soldier from the frontlines back to the US averages 4 days; in Vietnam, it occurred in an average of 45 days, which as any doctor knows every second is crucial. The focus of the FSTs is "damage control, not definitive repair." The wounded are then sent on to a temporary treatment facility immediately; if their injuries are serious they are then sent back to the US within a few days. The goal is for each level of treatment to give the patient the best chance for survival and then trust the next step in the chain to do its part to carry on the treatment. Gawande relates the...
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