I just finished reading Better by Atul Gawande, a book examining improvements in medicine, and the stories he tells are fascinating. Military doctors who lowered death rates among injured soldiers from 25-30% in the Korean and Vietnam Wars to 10% in the current war in Iraq. Doctors and volunteers in India responsible for administering polio vaccines to millions of kids in rural areas in 3 days. Doctors who incessantly worked towards lowering in-hospital infections, simply by finding ways to get medical workers to wash their hands. A doctor who almost single handedly increased the life expectancy of children with cystic fibrosis from 3 to 40 and beyond. He shows how fields advance because certain people make a conscious effort to do better.

While I'd encourage anyone to read the book, he finishes with a list of 5 things he came up with to answer the question "How do I really matter?", which I thought were interesting and worth discussing. They are:

• Ask an unscripted question -- For Gawande, this is a way of adding a human touch to his relationships with coworkers and patients, by asking questions that go beyond the bare necessity. "This is not a forty-six-year-old male with a right inguinal hernia. This is a forty-six-year-old former mortician who hated the funeral business with a right inguinal hernia." But more generally, I think this is also a good idea because it encourages us to break the routine, try something different, and snap out of group-think.


• Don't complain -- Gawande argues that complaining merely fosters negativity, without offering any solutions. That's certainly true, and complaining should be avoided for that purpose alone, but it's not easy to just "not complain". I worked in an environment where people complained a lot. It then occurred to me that people complain when there's no avenue for remedy. So if people are complaining, it's not just an indication that things are broken, but things are so broken that people don't even know how to fix it. That's double bad.


• Count something -- He asserts that all doctors should be scientists, and therefore should count something, i.e. do research. Earlier in the book, he also talks about the Apgar score, which for the firs time quantified the state of new born infants, which then lead to quantifiable improvements in their care and thus survival rate. It's a common theme throughout the book. The first step towards improvement is to know how you're doing, then measure whether or not things are getting better or worse. Metrics are vital for that purpose.


• Write something -- Writing, in short, is a way to contribute to a larger corpus of knowledge, which the medical (and any other field) is based on. Even small ideas and data, cumulatively, could lead to large changes. In my chosen profession (software engineering), an equivalent alternative would be to contribute to Open Source projects, or release code. Writing is also a great way to organize thoughts, or look at things from a different perspective. Even as a developer, I spend a decent amount of time writing documentation, which often gives me new ideas, or allows me to find inconsistencies and unnecessary complexity in my code or design.


• Change -- In short, he says be an early adopter. Or at least be open to change. A necessary condition to adopting new ideas or trying new things, of course, is the ability to take risks. In some ways, creating an environment or mentality where risk is not only assumed, but tolerated, is the hard part. It's way too easy to be crippled by unnecessary fear of risk.