Better: A Surgeon's Notes on Performance by Atul Gawande Profile, Metropolitan, HK$192 Few professions demand perfection every minute of every day. Still fewer can measure the cost of failure to achieve it in lives lost. It's unrealistic to expect perfection in any occupation, yet when it comes to medicine that' what we insist on. Medical writer Atul Gawande, a surgeon at Boston's Brigham and Women's Hospital, knows better than most that perfection is unattainable - but he believes 'better' is not. To that end, he offers Better: A Surgeon's Notes on Performance, a collection of essays exploring how doctors in the US and around the world have made getting better at their craft an integral part of their practice of medicine. The essays in Better are divided into three broad categories: 'Diligence', 'Doing right' and 'Ingenuity' - the three factors Gawande believes lead to better medicine. Diligence, he says, has to do with the art of paying attention to detail and how determination can make the most hopeless tasks possible. Something as simple as washing hands, which Gawande says doctors and nurses fail to do alarmingly often, could prevent outbreaks in hospitals that claim thousands of lives every year. Diligence also makes possible a campaign in India to inoculate millions of children in just a few days. 'Doing right' explores what happens when mistakes are made and how doctors interact with patients. Although Gawande investigates how doctors are financially compensated and the struggle to define proper doctor-patient relations, it's his essay on malpractice that will draw in most readers. Doctors candidly admit they sometimes make mistakes, but only rarely are patients compensated. Gawande proposes a worthy alternative to the current malpractice system, but, given that it would line fewer people's pockets, it's a pipe dream. By far the most interesting section is the examination of ingenuity. Readers will be surprised to learn, for example, that Caesarean sections are a standard surgical procedure because many doctors lack the talent to use older birthing methods. One unnerving essay says that most doctors and clinics, regardless of reputation, are merely average at delivering health care. In the final essay, Gawande sees doctors in India perform all manner of procedures that in the west would call for specialists. If Better shows us anything, it's that the greatest improvements in health care won't come as the results of new technologies and drugs, but from better using the resources that already exist. As Gawande points out, deaths due to breast cancer could be cut by a third if more women made use of screening mammography. In the end, Gawande argues, being better is simply a matter of finding someone who does it better and following their lead, or coming up with new and better ways of doing things. It's an approach that has earned a following in the business world, but one that's still resisted by many physicians for personal, ideological or institutional reasons. Gawande doesn't pretend to have all the answers - the issues are too large and complex for that. Medicine may be a science, but it's practised by human beings on other human beings. Because of that, we instinctively know that the work is difficult, and Better shows why. Gawande is rightly lauded as a fine surgeon and Better performs a service just as valuable. Thanks to him, we know how hard it really is to be better when lives are in your hands.