Sports psychologist Jared Tendler shared a similar view in his book The Mental Game of Poker. With regards to learning, Gawande describes how we sometimes have to get worse before we can get better. To navigate society’s demands in surgery, according to Gawande, necessary learning in surgery is often hidden, whether by anaesthesia or plays in language. If ‘novices’ do not receive the opportunities to build experience, then there’ll be less experienced professionals in sum. But preferences at the individual level can create problems in the aggregate. When it comes to healthcare for themselves and their loved ones, people insist on ‘professionals’ over ‘novices’ (and fairly so). Gawande also observes how society demands ‘perfection without practice’. So one’s desire to continue with training and practice is critical to success. While we can teach skill, we cannot teach tenacity. Gawande suggests that people who are ‘conscientious, industrious and boneheaded’ enough to practice consistently, and dedicate themselves to the craft, are more likely to succeed in surgery. It’s for these reasons that Gawande believes in practice, rather than talent. Sometimes, these experiences must involve abject failures and occasional humiliations. Experience helps them to grapple with incomplete information, ambiguous science, and the limitation in their knowledge and ability.

He observes how surgeons develop their skills and confidence through experience. He was also amazed with the surgeon’s ability to use a scalpel with unwavering confidence. Gawande recalls as a young surgeon his early discomfort with jabbing needles into patients. The higher the stakes, the more necessary and prudent this becomes. In Gawande’s view, great surgeons will act decisively, but recognise the limitations of their science and skill.

The field brings its share of doubts, missteps, failures and surprises. It’s science mixed with habits, intuition and occasional guessing. For all its knowledge and procedures, medicine is an imperfect science, characterised by changing knowledge, incomplete information and fallible individuals. Gawande describes medicine as a messy field. In this post, we’ll review some of the messages that I took from Gawande’s work.

It contains a myriad of lessons, not only for those in healthcare, but for those in business as well. Complications is both an insightful and educational book. This includes Gawande’s reflections on the challenges and choices we face when making decisions under uncertainty. The book provides insight into the fallibilities, mysteries and uncertainties of medicine. Surgeon Atul Gawande (and now CEO of Haven Healthcare) compiled a collection of essays, written during his general residency, in his book Complications: A Surgeon’s Notes on an Imperfect Science.

Complications atul