Katelyn Long

Assignment #1
FYS/Stahr
September 12, 2014
Diligent Details
Medicine is essential in the development of a society. Without medicine, a society can
only advance so far and achieve so much, before there is a detrimental downfall to the health of
its members. As the world has evolved, medicine has continued to change and grow into the
entity it is today. As a surgeon and an author, Atul Gawande uses diligence, doing right, and
ingenuity as his argument for success. These three components, along with positive deviance,
have lead to a revolutionized medical system. Continuing to implement this system, especially
diligence, will only further medicine.
In the book, Better, Atul Gawande states, This is a book about performance in
medicine (8). Medicine is like a theatrical performance, there is much preparation and practice
put into play before the show even starts. The author lists three essential elements to medical
performance, diligence, doing right, and ingenuity. Gawande defines diligence as, the necessity
of giving sufficient attention to detail to avoid error and prevail against obstacles (8). The main
example the author gives is as simple as consistent washing of hands. Whereas doing right is
not literally defined, perhaps because the author wanted each reader to interpret and define it
individually.

The author chooses to let the audience take a peak at doctors issues like

malpractice and salary. Lastly, the author defines ingenuity as, thinking anew (8). There are
many examples of ingenuity throughout the book, one of the most applicable being revamping

the mammogram procedure. Each of these three attributes plays a role in the show of medicine,
on both the domestic and international stages. These elements are subject to Gawandes claim
that they always need to be advancing, refining, and improving (8). Because the medical show
continues on, there is a never a final product. Something can always be tweaked or adapted for a
better performance. Throughout detailed observation, doctors and medical personnel have been
able to revise procedures and policies to create a safer and more productive environment for their
patients.
A doctor is required to embody many attributes and skills for their profession. The most
important characteristic of a doctor is diligence, which is shown in dealing with patients every
day. It is the close attention to detail, perseverance through obstacles, and the willingness to go
above and beyond to achieve ones goal. Gawande defines it later in the book as, the constant
and earnest effort to accomplish what is undertaken (29). Because drive and determination is so
vital to success in medicine, an argument can be made that diligence is the most important of all
of Gawandes three necessary characteristics. Without diligence, the other characteristics would
not be nearly as functional.

Better includes many examples of doctors and medical staff

practicing diligent behavior or the lack thereof and how this has resulted in success or failure.
This is seen in the stories about Cystic Fibrosis and the Apgar Score, and the ideas about positive
deviance being a useful tool for change.
One important example in the text stemmed from the chapter about Cystic Fibrosis.
Throughout the story of Janelle, a teenage girl with Cystic Fibrosis, and her doctor, Warren
Warwick, the readers see a prime example of diligence displayed by Warwick. After many
months of treatment, Janelle went back to Dr. Warwick for a checkup and consultation. Janelles
lung function measurements had previously been reading 109 percent and then dropped to 90

percent (220). A healthy individual normally reads at 100 percent. To most doctors that drop
would not have been much of a concern, 90 percent still sounds extremely healthy, especially
when given her genetic circumstances. However, Warren Warwick saw the drop and began his
investigation into the life of Janelle. To him that drop was significant, it was a big deal, even if
the patient did not see it the same way. Warwick began asking his patient questions about her
daily routine, new events happening in her life, really dissecting the problem at hand. After his
continuous pushing and digging Dr. Warwick found the root of the problem and immediately set
out to fix it. Even when the patient was unresponsive to the concerns he voiced, he was
persistent in his case.
Although some may argue that Warwick overstepped his bounds, he felt it was a
necessary investigation. Dr. Warwick explained to Janelle the difference between a daily .5
percent chance of getting sick versus a .05 percent chance, over a year its a difference between
83 percent and 16 percent, a significant difference. Warwick came up with ideas that were easy
for Janelle to follow and that interested her enough to commit to them, like secretly taking her
meds at school and going home for a breathing treatment before she goes to work. Dr. Warwick
spoke to Janelle in a way where she understood the seriousness of the situation, and he was able
to convince Janelle to take an offensive stance against her illness. Gawande describes this
encounter by saying this, was the core of Warwicks worldview. He believed that excellence
came from seeing, on a daily basis, the difference between being 99.5 percent successful and
99.95 percent successful (222). The medical field needs more doctors like Warwick, doctors
that want the very best for their patients, and does everything in his or her power to attain
complete success in the treatment of their patients. Dr. Warwicks success goes hand in hand
with the diligence he displays every day.

Another example of diligence comes from a woman named Virginia Apgar. She was an
anesthesiologist who saw some problems in the child birthing procedure and developed a method
to counteract these issues. Doctor Apgar created a score to compare to newly born infants to
determine their health and prognosis to live. Infants are checked at one minute and then again at
five minutes, so the doctors have an incentive to keep making an effort to revive the child. This
score created a system of comparison rather than one of the doctors opinion. Gawande says the
Apgar Score, rates babies on a scale of one to ten. An infant gets two points if it was pink all
over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and
two if its heart rate was over a hundred (186-187). This score helps level the playing field for
all infants and it ensures that the doctors and nurses are truly inspecting the babies overall
health. This score revolutionized the birthing process and became an incredible motivator for
hospitals and doctors. Doctor Apgars diligence and intuition have helped saved many infants
lives. She not only paid attention to the little details regarding a newborns health, but she also
pushed through stereotypes and prejudices to ensure positive change in the medical field.
Accompanied by diligence, one way to achieve change is through a method entitled
positive deviance. Positive deviance is going against the norm in attempt to make a positive
change. Gawande mentions five steps to become a positive deviant: ask an unscripted question,
dont complain, count something, write something, and change (251-256).

Both Warren

Warwick and Virginia Apgar use positive deviance in their respective fields to be a catalyst for
change. Warren Warwick used positive deviance when dealing with Janelle. Warwick asked
questions, did not allow complaining, counted Janelles lung measurements, wrote out a plan,
and created a change in his patients life. Virginia Apgar asked questions about the rising
number of infant deaths, did not complain about her position in the medical field, counted the

vital signs, wrote out her score, and changed the newborn success percentage. These examples
of positive deviance go hand in hand with the diligent traits of both doctors mentioned.
As Gawande has illustrated, diligence is the key to making a positive impact on the
medical community. The key to success is diligence. Although doing right and ingenuity are also
important in the medical field, diligence is a basic principle of both of them. Doctors must be
diligent when making big decisions, learning new techniques, and in small, day to day
interactions. Throughout it all, diligence must be present for optimal performance and
accomplishment. The smallest observations can make the biggest difference in the life of a
patient.

Works Cited
Gawande, Atul. Better. New York: Picador, 2007. Print.

Word Count: 1395