Training Badge
Submitted by tcomeau on


I read Atul Gawande's [i]Better: A Surgeon's Notes On Performance[/i] last night. It's written from a medical perspective, and talks about many of the things that are wrong with medical delivery today, but it is really about performance. I recommend it for anybody who cares about their own performance.

The book started as a series of essays, some of which I've read before. There are three sections, and each has a theme around improved performance.

[i]Diligence[/i] is about how to do something well, and it boils down to just that: be diligent. Planning things, making sure the plan is complete, and executing the plan; washing your hands every time; tracking your own performance and being honest about failures.

[i]Doing Right[/i] is about understanding what will improve your performance, and then actually doing it. The Right Thing isn't always obvious, and deciding on right conduct can require serious soul searching. Having decided on the right thing, however, means accepting the obligation to do right.

[i]Ingenuity[/i] is about metrics, of all things, and about finding good metrics and applying them to your work, and about finding innovative ways to improve performance.

In an afterword Gawande makes five [i]Suggestions for Becoming a Positive Deviant[/i].
1. "Ask an unscripted question." Ask about things that matter to the other person, and actually listen to the answer. This may make other people seem more like real people, and less like machines.
2. "Don't complain. ... It's boring, it doesn't solve anything, and it will get you down."
3. "Count something. a scientist in the world." Some metrics are better than others, but some metric is better than no metrics.
4. "Write something." This is the same advice Cliff Stoll gives everybody. Publish something, somewhere, in the hope of contributing to a larger world.
5. "Change." This doesn't mean chasing every fad, it means recognizing that you are not doing everything you might as well as you might, and you need to try new solutions.

Despite being 250+ pages, I found it a very fast read. It is at times inspiring, at times disheartening and occasionally terrifying, but [i]Better[/i] is well worth the read.


todds's picture

This is a great book and I just wanted to second the recommendation.

Atul Gawande is a staff writer for The New Yorker and his first book, "Complications", was a New York Times bestseller and a finalist for the National Book Award. He writes about the difficulties facing medicine, and he has a great vantage point as a general surgeon at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. His new book, "Better" is about the quest to improve the status quo, and in medicine, this translates directly into saved lives.

Great stuff.

mptully's picture

I am reading Complications at the moment, and thoroughly enjoying it.

What I love is his way of writing, of explaining complicated medical procedures in simple language. As an ex-hospital pharmacist I understand a lot of it anyway, but as an academic and writer I so appreciate the effort that is involved in simply explaining the complex. I have a lot to learn!


thaGUma's picture

Thanks for the endorsement tc. Another book for my shelf. I am not an avid reader and am buying more than I read because of this site but this book sounds good and the Amazon exerpt is extremely engaging.


AManagerTool's picture

I also enjoyed it. Definitely, a good read. Business advice was pretty much common sense...if your a regular consumer of business advice. However, it did color it from the perspective of the medical industry which made it interesting. I liked getting the doctor's viewpoint on things and hearing that they are actually human. They have all the problems that every other group of people have. It's just that with their problems, people actually can die. It's not just about profit and loss statements.

jgfellow's picture

I assign my new folks two chapters out of "Better." But those two chapters ("Mop-up" and "The Bell Curve") sum up the relationship between attention-to-detail and quality-of-performance.

My folks do complex predictive modeling. Along the way, there are hundreds of opportunities to degrade the quality of the model by failing to notice a mistaken definition or funny input data. I hope that, by reading Gawande, the modelers will be inspired to give their work that one extra review that makes difference between "not obviously wrong" and "super work."

misstenacity's picture

I was a fanatic of the "Drama in Real Life" stories in Reader's Digest as a kid/adolescent (yes, this was about as interesting as reading got for me at 10 with limited library access, that and our school's READ Magazine ( - Gen X'ers, all bond together, now! 8) ).

I adored "Complications", so I will definitely pick up "Better". I have a further recommendation in that medical vein - [url=]Phantoms in the Brain[/url], by V. S. Ramachandran.