Positive Deviants and Their Medical Contributions

Gawande (2007) shows the relations between doctors and patients as well as the medicine behind the scene; it is like a separate world that is unseen to a regular person. In this world the doctor does his best to make the patient feel better, to prescribe a better medication, to become a good doctor and even better. This word “better” is going through the book from the beginning up to the end. Gawande identifies three topics: “Diligence”, “Doing Right”, and “Ingenuity”. He tells the readers about the importance of simple health care procedures like washing hands in order to drop in the epidemic rate in the hospitals, about the doctors who worked on mopping-up the polio among the Indian population, and about those who strived to save the lives of American soldiers in Iraq. Comfort level for the patients and cultural requirements are also discussed as well as insurance systems and service pricelists. The most significant problems that are mentioned by Gawande are the suing the doctors for their malpractices, and whether or not doctors should participate in executions by lethal injection. At the end the readers can learn more about how become a good doctor, how accept the failures, reflect on failures and find new solutions – even through creativity – to avoid these failures in the future.

Gawande hit upon a very important idea that “But making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands” (p.21). By this statement Gawande means that often people think that medicine is only about diagnosis, but in fact the health of an every single person is consists of thousands of steps, such as following health care rules, fighting till the end, and being creative.

First of all, following health care rules can prevent serious illnesses and diseases. According to Gawande, “Bacterial counts on the hands range from five thousand to five million colony-forming units per square centimeter. […]. The worst place is under the fingernails” (p.17). Doctors examine a lot of patients each day and if they don’t wash their hands, don’t use sterile gloves and don’t sterilize the instruments, they can easily communicate infection from one patient to another. Gawande acknowledges his possible mistakes in this passage:

Until that moment, when I stood there looking at the sign on his door, it had not occurred to me that I might have given him that infection. But the truth is I may have. One of us certainly did (p. 28).

Due to doctors either are lazy to follow hand hygiene rules or just forget about them, millions of patients are infected in the hospitals and as a result many of them die. Such doctors and nurses can be easily sued for malpractice. However, they all should understand that this simple step of washing hands can save a lot of lives and drop in the epidemic rate in the hospitals. Thus, lives of millions of patients are literally in the doctors’ hands.

Another instance of following the health care rules to avoid serious diseases is to be vaccinated when you should to be. When the epidemic breaks out, scientists do their best to find the vaccine for this or that disease.  Gawande gives us an example of polio – the disease that strikes children under age five in India (p. 35).  A huge campaign for polio immunization was launched there. Thousands of vaccinators went from house to house to inoculate children. It was up to parents whether or not do this vaccination to their children. But they had to understand that this simple process of immunization could save the life of their children and stop the spreading of the disease. Unfortunately, not all people realized that and as a result a lot of children became paralyzed because of not taking the drop. Gawande describes the conversation between mother and the doctor:

The mother said that a health worker had come around with polio drops a few weeks before her daughter became sick. But she had heard from other villagers that children were getting fevers from the drops. So she refused the vaccination. A look of profound sadness now swept over her (p. 50).

In that way, it is very important to follow health care rules, because these are what help people to stay healthy, prevent diseases and avoid terrible results, such as death.

Still another example of thousands of small steps that make the path to the success is fight till the end. Due to the progress in medicine, there are big chances for soldiers to survive after getting injuries during the war such as gunshot wounds to the stomach, liver, chest and others. One of the main important things is whether or not doctors start the treatment on time and whether or not they fight till the end to save the soldiers’ lives. In the war every minute and even every second has its own value. That’s why time is one of the cruelest things during the war. Colonel Ronald Bellamy claimed, “Civilian surgeons talk of having a “Golden Hour” during which most trauma victims can be saved”. But there are also “Golden Five Minutes” for soldiers with blood loss (as citied in Gawande, p. 57). If during these minutes the urgent treatment has started, probably, the soldiers would live. Moreover, it is also important what kind of treatment is provided and whether or not doctors put their whole soul, all their desires to save the soldiers. Life is priceless, that’s why doctors have to do their best to pull soldiers out of the death.

People also ask doctors very often questions like “Should they put her through yet more of this? Or should they take her home and let her die?” But where is the border between what doctors can do and what they can’t do (p. 159)? According to Gawande, “the truth is we want doctors who fight” (p. 159). “Even when we don’t know that a patient can be completely normal and healthy, we want doctors to fight” (p. 160).  Such a great responsibility lies with doctors. They should definitely fight. Only this kind of behavior can lead the doctors to the success, even if they were not able to save someone’s life. We never know what the last attempt can do. Maybe the last desperate attempt can lead the patient to the recovery. That’s why it is so important to fight till the very end, especially when the patients, their friends and relatives believe in doctors’ help so much.

The most significant example of how thousands of small steps make the path to the success is doctors’ ingenuity. Ingenuity is not less important than doctors’ skills and professionalism. Only due to all these things together, these simple steps, doctors can be successful in what they do. “Nonetheless, what I saw was: better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try” (p. 246). Doctors don’t have to be afraid of being creative and should give a try to something they have invented, even if it seems so simple and primitive. Who knows maybe exactly this innovation will improve the quality of the medicine and will help to save people’s lives. Gawande gives us an example of this kind of simple idea. It is a measurement of a newborn’s physical condition that was invented by Virginia Apgar – the first woman who was admitted to the surgical residency at Columbia University College of Physicians and Surgeons (p.185). “The Apgar Score, as it became universally known, allowed nurses to rate the condition of babies at birth on a scale from zero to ten” (p. 187). This innovation amazed doctors. It allowed them to give an immediate feedback to what they did. According to Gawande “The score also changed the choices they made about how to do better” (p. 190).

To sum up all above, Gawande considers that the ultimate success consists not only of difficult diagnosis, but it is the result of cooperation between doctors and patients. Moreover thousands of steps are essential to the way to the success. Following health care tips, fighting up to the end and doctors’ ingenuity these are what can save millions of lives and lead to the doctors’ professional triumph. However, not only in the medical field these steps are very important. Our whole life should be based on single steps that will lead us to the height of our success.

Author: Ekaterina Nikitina


Gawande, A. (2007). Better: A surgeon’s notes on performance. New York: Picador.