Editor’s Notebook: Good Advice from a Surgeon and Writer


July / August 2005

Editor’s Notebook

Good Advice from a Surgeon and Writer

Atul Gawande, MD, MPH, is a surgeon and writer whose work focuses on understanding medical errors and improving the performance of physicians. He contributes a column called Notes of a Surgeon to the New England Journal of Medicine and articles on medical topics to The New Yorker, some of which have been published as a collection titled Complications: A Surgeon’s Notes on an Imperfect Science (Picador, 2003). Gawande combines compassion and intellectual curiosity with research and his daily experiences as a surgeon in simple, eloquent language. His essays are among the most interesting currently published in this field.

This year’s graduates of Harvard Medical School and Harvard School of Dental Medicine chose him as their commencement speaker. In his address (available at www.hms.harvard.edu/news/grad2005.html), he marveled at the number of professionals working in healthcare in this country: 819,000 physicians and surgeons, 2.4 million nurses, 388,000 medical assistants, 232,000 pharmacists, etc. They serve almost 3 million potential patients, usually working as teams in highly complex systems. Gawande asked the Harvard graduates, “So as you become a white coated cog in this machine, this remarkable and at the same time maddening factory of healthcare, how do you not disappear? How do you matter?”

His own answer to that question is to follow five rules for practicing medicine. Typical of Gawande, these rules apply to life well beyond healthcare.

Rule 1. Ask an unscripted question. Ours is a job of talking to strangers. Why not learn something from them?

Rule 2. Don’t whine. Resist it. It’s boring, and it will get you down.

Rule 3. Count something. If you count something interesting to you, you will find something interesting.

Rule 4. Write something. Try to put your name in print at least once a year, in something: a peer-reviewed article, blog, or volume of poetry.

Rule 5. Change. Be willing to recognize the inadequacies in what we do and to seek out solutions.

Collectively, these rules mirror time-honored advice to be fully “present” in all activities and relationships and to remain open to new ideas.

Predictably, rule 4, “Write something,” warms my heart. As he encourages the graduates to write, Gawande emphasizes the role of observation, “What you write does not need to achieve perfection. It only needs to add some small observation about our world.” While conveying even a small observation, the writer makes a connection to a larger community. “The published word is a declaration of membership in that community, and also of concern to contribute something meaningful to it.”

What better reason to write for PSQH than to join the growing community of healthcare professionals who seek to improve safety and quality? There are many ways to contribute: a brief letter-to-the-editor, an opinion column, a case study, or a feature article based on research. It’s a great way to “matter” and to resist being consumed by the “machine.”