Better,+A+Surgeon's+Notes+on+Performance+by+Theresa+Skokna

Journal #1
Pages 1-69

The first 69 pages of the book author, Atul gets right into the main importances that come with being a doctor. He begins by explaining the importance of diligence. ''The sections of this book examine three core requirements for sucess in medicine—or in any endeavor that involves risk and responsibilty. The first is diligence, the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles''(p 8) He goes onto explain how many expect it to be easy and not a major virtue, yet it is central to performance and very hard.He shows this through many exmples in the book. Mr. Gawande speaks on behalf of another major thing: washing your hands. Especially for doctors going from patient to the next, room to room, it is unbeleiveable how easily germs,virus', etc. are spread. Many doctors need to start taking it more seriously now, because from many doctors not doing the appropraite hand washing system for doctors, new virus' are being passed to patients who don't make it out alive. Atul went over the casualties of war. How important it is we get more doctors, nurses, and helping services over to war sights. Ones that know exactly what they are doing providing the best for our men and loved ones.

The following video shows the large affect doctors put on their patients, not washing their hands as said to. This includes, doctors, nurses, therapists in hospitals, and any other staff members: http://youtu.be/RhQdHUsGPNU
 * very interesting!*

The first ¼ of this book has really made me think. Since it is all about the real world and real stories, I can barely put it down in words. It is so interesting to hear about even one day a doctor walks through—and those amazing patients they have. Being a doctor obviously seems like a lot of hard work and determination. Yet in the long run you seem to grow as a person and help others to reach their goals in life, even if that means living over the age of 20.

· ''One story about the wounded soldiers in Iraq and Afghanistan · Circulators role in the surgery room · National immunization days · China, India, Bhutan, Pakistan, Bangladesh, Thailand, Vietnam, and Burma—have national immunization days · Procedure doctors go through when washing hands

=
Being a doctor is ever more challenging than just studying for years. There is so much more to it that many of us don’t know of, simply because we aren’t experiencing it. For example, the amount of malpractice that goes on in the medical field. Malpractice is improper or negligent treatment of a patient, resulting in injury, damage, or loss. Another issue that Dawande touches is persons being naked while having checkups. Patients have tried suing doctors for inappropriately touching where one shouldn’t be. Even when at times it is for necessary reasons and not a reason of sexual means. The argument raised is: should doctors have an attending supervision in the room while specific checkups go on? While some say it makes the patients more uncomfortable with the more people in the room, also some may have a supervisor come in for certain procedures, while others don’t believe in having them. Apart from coming more from the patients view, another question comes to mind for doctors. That is what are they doing all of this for? At Atul explains, “Doctors aren’t supposed to be in it for the, and the more concerned a doctor becomes about money the more suspicious people become about the care being provided” Adding some humor, “That’s why the good doctors on TV hospital dramas drive old cars and live in ramshackle apartments, while the other bad doctors wear bespoke suits” Gawande cracks (p.114). Every day is totally different from the next as a doctor. From one patient to the next are situations doctors enjoy gladly taking care of. While of course there are the patients who feel like they need to walk out with something more than…living. =====

=
So far this book is so overwhelming. In the way that is a fun challenge. Since it relates all to the medical field there are some terms I am unsure of, but I simply look up definitions as I read teaching me more every page I turn. There’s so much behind close doors about doctors I never knew. It’s very enjoyable to be able to see behind them. Not many books can grab my attention, but I am happy to say that this one surely does! =====

· What are doctor's motivations?
Journal #3 Pages 130-200

In Dawande's book he explains doctoring issues or topics by sharing part of his past or someone else's for you to understand better. Throughout the book he explains many interesting things I had never knew nor thought of about doctors. One thing I never thought about, were the doctors working in death chambers. Attul further explains how there are people actually out there who are willing to participate in the punishments.One of them killed a mother of three during a convenience-store robbery and then, while away, shot a man who was standing at his car...I do not have a strong conviction about the death penalty, but i don't feel anything negative about it for such people eithar...and morally if you think about the animal behavior of some of these people.. Dr. A explained about ultimately deciding to participate in death chamber killings. Atul further talks about the most latest form of punishment, lethal injection. Another issue is fighting. When a doctor could most likely help the patient if he tried hard and had determination, but not all doctors do. Years ago, when babies were born premature, doctors would just assume they werent going to make it and put the child off to the side till it died. Till now, doctors began trying to take care of the premature babies, with several being able to survive. Dr. Attul further explains the stages of a baby being born. Many mothers want to have specific births (ie. Natural). The amount of mothers wanting cesarean sections is growing fast. Many find it easier after they have done it once and a lot less to go through. Yet it is important to do what your doctor thinks is best given the specific circumstances of your baby's placement.

This section of the book, checkpoint 3, I finished in no time. It was the most attention grabbing for me.Specifically when Attul spoke about the doctors working in death chambers and what they must do specifically. These days we have so many books on girls and boys, vampires and wolves, but what about doctors. Its a useful topic that is more interesting then many imagine. I am excited to finish the rest of the book and read a paragraph that makes my jaw drop again.

· Cesarean deliveries · Doctors Salary working in Death Chambers (**Could they be doing it for the money?)** · Research more on Home Births · Somehow she let me put all my regrets behind me. (**From his several past experiences has become this honest and sincere doctor: Special Events in his life)** · Why are gas chambers no longer used as a form of punishment

Journal #4 Page 201-257

As the book began narrowing down, Atul spoke a lot on performance. Such as how “Nonetheless, for a given patient, there are wide, meaningful differences among centers and a few are simply better than the rest”(p.206). If we were to use a bell curve someone would be average. Is there shame in being one of the averages? “When the stakes are our lives and lives of our children, we want no one to settle for average” (p. 230). Which is why each doctor must keep working harder than the day before, to give their patients the best outcomes they can give. There are many things doctors can’t control, such as the overwhelming amount of patients, poverty, lack of supplies, etc. Yet where they do have control –their skills, for example – these doctors should seek for betterment. One area they have sought for betterment, was with cystic fibrosis. It wasn't too long ago one would not live much longer after they were born. With the hard work of several doctors, many with cystic fibrosis are living long, much happier lives. The last chapter of this book is a chapter I think everyone should read. The name of the chapter: Suggestions for becoming a positive deviant. A deviant being something or someone better than the norm. Atul gives five suggestions, not demands, which he has used and continues to. The first one being: Ask an unscripted question. Just by knowing a tiny bit more about someone you can learn something interesting or helpful. “If you ask a question, the machine begins to feel less like a machine” said Mr. Gawande. His second suggestion: Don’t complain. We must resist it. Complaining is simply boring, doesn’t solve anything, and it’ll get you down. This doesn’t mean we must be sunny about everything, yet be prepared to talk about something else, even if that means the weather. The third suggestion: Count something. While Atul was a resident, it was the number of patients who an instrument forgotten inside them during surgery he counted. He learned that it was the patients who had to undergo emergency operations or procedures that this accident happened to. Mr. Gawande says, “ If you count something you find interesting, you will learn something interesting”. His fourth suggestion was: Write something. Whether you write five paragraphs or a small journal, just write. It must not achieve perfection, only a small observation about your world. We all must choose an audience and simply write. His last suggestion: Change. Try to make yourself an early adaptor and look for the opportunity to change. He explains, “I am not saying you should embrace every new trend that comes along. But be willing to recognize the inadequacies in what you do and to seek out solutions”. (p 238) I can honestly say a book has never been so mind opening. Going into this I wasn’t reading it because I wanted to become a doctor, yet it was something I didn’t know much about and thought it would be helpful. Which is why I am so glad I did decide to open up this book. I have learned some of the positive and negatives of being a doctor. Not only that, but helpful tips anyone or I can use in their life. This book is great for those who are open to learning something new. It is not an average teenage book about love and vampires, but I promise you it’ll get you thinking. I am very glad I chose this book and grateful for being introduced to it by my library staff at school. · Cystic Fibrosis · His suggestions for people · Atul t raveling to India · What field of doctors usually work well together · Cystic Fibrosis in foreign countries