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Atul Gawande

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25 years ago surgeons used to be generalists. Now recognize that specializationis key - doing the same narrowset of procedures over and over again. Leads to faster, cheaper operations, with a far better success rate. And probably don't need fully trained doctors - just need training in one specific area.

"Intuition" often leads us astray - causes more mistakes than it prevents. First we are too easily influenced by suggestion, recent experience, distractions, and the way info is framed. And second, we are not goodatconsidering multiple factors - we tend to give some variables too much weight and wrongly ignore others.

A good computer program consistently gives each factor correct weight.

Breast cancer patients do best in specialized cancer centres, where they have a cancer surgein, an oncologist, a radiation therapist, a plastic surgeon, a social worker and a nutritionist who see breast cancer day in and day out.

Doctors are human, and humans make mistakes. James Reason in Human Error suggests that bc our brain is tuned to act intuitively - to sift quickly through all info that is constantly bombarding us - without wasting time analysing every situation anew.

But fatal errors are rarely due to one event. Almost always end result of a cascad eof mistakes. So need to examine and fix the process, rather than blame the individual at end of the chain.

The specialty of anesthesiology did this in 2 steps. First got an engineer named Jeffrey Cooper to analyse all errors that occurred during operations. He identified 359 of them. Ellison Perce, head of American Society of An. got manufacturers to standardize all machines so that dials all turned in same direction, locks stopped controls being accidentally set to bad combinations. Sensors added to alert when tubes in wrong place or came out during surgery. And finally, added regular training on a robot mannequin to simulate every cockup situation, to train anesthetologists same way airline pilots are trained.

Doctors/surgeons, but also pilots, judges, upper management guys can go bad. "Behavioural sentinel events" - persistent, poor anger mangement or abusive behaviour; bizarre or erratic behaviour; trangression of professional boundaries; or a disproportional number of lawsuits or complaints.

But what you are seeing is not sociopaths but struggling human beings.

Despite fewer and fewer people doing manual labour, back pain complaints have become a virtual epidemic. And most have no obvious structural defect that shows up on xrays or scans.

The first documented autopsy done in the Americas was done for religious reasons. Twin girls were born alive but conjoined in the Dominican Republic in 1533. A priest had baptised them as 2 separate souls. When they died eight days later there was a controversy as to whether he was right to have done so. A post mortem established 2 complete sets of internal organs, so it was decidedthat 2 souls had lived and died.

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