DuncanI just finished Better: A Surgeon's Notes on Performance by Atul Gawande, mentioned by James Sogi. The five points the author makes at the end of the book are good recommendations. These are: Ask unscripted questions, Don't complain, Count Something, Write Something, Change. The balance of the book is also very good. His theme is ways to improve performance in various fields, but specifically medicine. Diligence, ingenuity and doing right (sounds ethics) are the pillars of his approach. These are all good ideas, but the interesting part of the book is in the details and the examples he presents.

He starts with with diligence, and presents a case of infections in hospitals. Each year 2 million patients acquire and infection like Staph or Enterococcus while in the hospital. Ninety thousand will die of the infection. I found this staggering. The main cause of this is the doctors themselves through patient contact and not executing a very simple procedure, washing their hands. There are reasons for this, time being the biggest. To properly wash ones hands it takes about a minute. If a doctor sees 30 patients in an hours, that is 30 minutes an hour just washing hands. The best hospitals have come up with solutions for this, including antiseptic jells, greater use of gloves, greater awareness of the problem, better access to washing areas. But it comes ultimately back to the doctors to be diligent in such a simple area. It reminds me of the Coach Wooden's simple advice to players about how to tie their shoes before games.

Another chapter focuses on the eradication of Polio. This is a great success story, but diligence continues. When a half dozen cases are found in places like India, the World Health Organization and others, mobilize a staff to inoculate 4 million children. It takes them 3 days. There are great costs, but millions of children have been spared the horrors of polio through this diligence.

The chapter on ingenuity discusses the comparative advances in specific areas of disease prevention. I found the chapter on cystic fibrosis compelling. Using a rating system patients can identify the best hospitals for treatment. The top hospital nationally is in Minneapolis and has survival/longevity rates well above their peers. They achieve this by designing, testing and implementing aggressive treatments well before peers accept this as the standard. The director here invented tools like a duel stereo stethoscope to better identify lung sounds and a mechanized chest-thumping vest to allow better clearing of fluids. The entire treatment regime is carefully monitored and adapted to patients. It shows results. Life expectancy with CF nationally is around 33 years, at Minneapolis it is 47.

The chapters on doing good (ethics) deal in the gray areas of medicine. He looks at issues like compensation, involvement in state executions, and where to draw the line on fighting for an apparently terminal patient. I would recommend the book to all. There are definitely ideas to improve trading, but also the book is a glimpse into the medical field and the challenges they face as they try to improve and save lives.

Arman Agdaian remarks:

How to get better? In order to get better in anything you have to be humbled and punished many times over to never repeat the same mistakes. In my years of brokering and trading in the commodity markets, I will be the first to admit, I have learned you have to be willing to be wrong to be right. Life is about the sweet and the sour. How do you know how sweet something is if you never been soured?





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