Learning from Medicine

I just finished reading Better, by Atul Gawande. It is an inspiring book about how the medical community continually seeks better outcomes for its patients. The book is organized around three principles - diligence, ethics, and ingenuity - which are explored in a series of essays. The book is filled with parallels to practicing a musical instrument, and for this reason I highly recommend it to any musician.

Gawande discusses the existence of a bell curve in medical outcomes, something the medical profession is loath to admit. Some doctors are consistently better at keeping their patients alive and healthy. He interviews and observes one doctor in action. This man has helped patients with cystic fibrosis live close to 20 years longer than the national average. Astonishingly, even as the national life expectancy for patients with CF has increased, this doctor has increased the life expectancy of his patients by even more. In interviewing this doctor, Gawande finds a man who has a single goal (keeping the lung capacity of patients with CF from diminishing) that he pursues in unique and creative ways with each patient. This doctor’s most important quality is his willingness to acknowledge failure. Anytime a patient misses a treatment, the doctor considers it a collective failure of the patient and the doctor. There is no leniency of the sort that is generally afforded human beings. His responsibility is to keep his patients alive and every missed treatment reduces the chances that they will live a long and healthy life. “We’ve failed,” he says to his patient. “It’s important to acknowledge when we’ve failed.”

It’s extremely easy to blame external factors when we don’t perform as expected. But, people who are at the far right of the bell curve are less lenient of their own failings than people who are merely average. The doctor’s calm acknowledgement of failure can be instructive for musicians. It contrasts with the anguished and destructive self-criticism that some musicians engage in and the excuses that other musicians make (a bad reed, difficult travel, etc). Recognizing failure is important for developing musicians.

Another lesson of the book is that extraordinary results require extraordinary organization. Gawande writes at length about the logistics involved in administering polio vaccines to 4.2 million children in southern India in a mere 4 days. This was not accomplished solely by ambition, but by careful planning and incredible diligence. The parallel with music is clear. Accomplishment in music depends on developing strategies for making progress, a meticulous attention to how these plans are carried out, and regular evaluation. The work is not glamorous, but it is necessary to achieve impressive results.

It was also impressive to read about the wide range of competencies of surgeons in India. The absence of many specialists meant that general surgeons often performed the work of a gastroenterologist, neurologist, and otolaryngologist in a single day. The willingness of these general surgeons to research and try operations that they had never before conducted in order to save lives is admirable. Gawande writes about an important daily ritual practiced by the surgeons he knew in India: “Each day I was there, the surgeons found time between cases to take a brief late-afternoon break at a café across the street from the hospital. For 15 or 30 minutes, they drank chai and swapped stories about their cases of the day – what they had done and how. Just this interaction seemed to prod them to aim higher than merely getting through the day.” Talking with fellow musicians is a valuable way to share knowledge and provide impetus to improve. I studied at two music schools, but only in one did students regularly discuss their practicing, ask one another for tips, and openly share their struggles. This sort of environment is indispensable for the developing musician. It reminds me of a quote from my favorite Italian economist, Luigi Zingales. “If I could, I would work in the United States and live in Italy,” he says.  He talks about all of the important traditions in Italy, such as eating every dinner together as a family, and explains how they transfer knowledge from the older to the younger generation. Talking about what you are doing is an indispensable resource for musicians.

After reading Better, I was relieved to be practicing music, a profession where no one dies when we play a note that is out of tune. A memorable quote from the book reminds me of the luxury of music: “Excellence came from seeing, on a daily basis, the difference between being 99.5% successful and 99.95% successful. Medicine’s distinction is that lives are lost in those slim margins.”

The book was inspiring throughout. It is filled with quotes that deserve to pasted on every music stand.  In his conclusion, Gawande writes: “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.”