In 1925, at the glorious, brutal height of roaring ’20s excess, Sinclair Lewis introduced a new kind of protagonist to the American literary imagination: the tortured, truth-seeking medical hero. He named this hero (who he insisted was not actually a hero) Dr. Martin Arrowsmith, and gave him his own novel, Arrowsmith, the story of the young doctor’s struggle to navigate the competing forces of idealism and greed, curing and commercialism. Written with characteristic flashes of satire, the book captured the excruciating contradictions of its era’s medical moment–the promise of life-saving treatments for pneumonia and plague mixed with the consuming pressures of business–and won its author a Pulitzer Prize. Lewis turned down the award–as a satirist and social critic, he felt he could not in good conscience (or any conscience, really) accept a prize intended to honor the book that best presented “the wholesome atmosphere of American life, and the highest standard of American manners and manhood.” But he left a lingering portrait of an era in which the Gospel of Ford, with its tenets of commerce and competition, first began to overtake the sacred disciplines of science and medicine.
Eight decades later, a group of prominent doctor-writers–among them Sherwin Nuland, Jerome Groopman and Atul Gawande–has resurrected Lewis’s fascination with the truth-seeking physician and ushered in a new era of medical criticism. Today’s doctor-authors tell vivid stories of the contradiction between the doctors they had once dreamed of being and the ones they have since become–the very contradiction that plagued Lewis’s hero. But unlike Arrowsmith, their stories touch only lightly on the themes of greed and commercialism, and speak not at all of issues like HMOs or universal healthcare (subjects Lewis might have spun into glistening satirical threads). Instead, they focus on the threat posed to medicine by the modern medical industry’s cult of technology, emphasis on action and obsession with quick-fix procedures. In the face of a fast-paced, algorithm-obsessed medical culture, they ask how a doctor can go about the business–or is it the art?–of doctoring. How does a physician heal rather than just treat?
Atul Gawande, the Harvard-trained surgeon, writer and medical golden boy, thinks he has the answer. He certainly has the résumé, and media savvy, to make other people think he has the answer. At 41, Gawande is a general surgeon at the respected Brigham and Women’s Hospital in Boston, an assistant professor at Harvard Medical School, a staff writer for The New Yorker and a regular contributor to The New England Journal of Medicine. He is also a former Rhodes scholar and 2006 MacArthur fellow–or “genius”–who, like his colleague Malcolm Gladwell, has managed to parlay his success and savoir-faire into demi-celebrity status. His books and articles have a tendency to feel less like dialogues between peers or with interested patients than guides for other MDs, how-to tracts advising them on how they too “might make a worthy difference.”
His latest thoughts on making a difference–which he also refers to as achieving “success in medicine”–are laid out in his new book, Better: A Surgeon’s Notes on Performance. As the title suggests, Better is about what it takes to become a “better” clinician–to go beyond the purely doctorly skills that make a physician competent (skills like “canny diagnosis, technical prowess, and some ability to empathize”) to the skills that make a physician outstanding. Gawande has identified three of these magical skills, or the “core requirements” necessary “for success in medicine–or in any endeavor that involves risk and responsibility.” They are “diligence,” “doing right” and “ingenuity,” and he dedicates his book to teasing them apart in chapters on everything from the life-saving importance of hand-washing (vigilance) to the ethics of participating in prison executions (doing right–or, in this case, not doing right) to the creation of the Apgar score for assessing the health of newborn babies (ingenuity).