Atul Gawande: Complications

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I started reading Atul Gawande's 2002 book Complications: A Surgeon's Notes on an Imperfect Science a couple of days ago, and was surprised last night when I discovered that I'd already read one of the chapters, the one on medical mistakes, human factors engineering, and the grim business of morbidity and mortality conferences. This chapter already appeared in the now-ancient volume The Best American Science Writing 2000, a volume I doubly recommend now, not just because it's got great writing on interesting topics, but also because it's appropriately priced, meaning that you can get it used for four dollars, including postage.

His essay on medical mistakes and how the medical community deals with them made a huge impression on me back in 2001. The story opens with a situation in which he nearly killed an emergency room patient while attempting to intubate her, discusses some of the engineering solutions to mistakes made by anesthetists, and wraps up with a visit to the weekly Morbidity and Mortality Conference (M & M) at his (teaching) hospital, where cases are discussed, blame taken and assigned, and the community creates a safe environment for doctors (and presumably, other staff) to accept the blame for their mistakes, generally without further repercussions.

Lately I've been thinking a lot about how churches, networks of churches, and denominations deal with mistakes, malfeasance, and general bad behavior, and I wonder if the M & M approach would be at all helpful. Fortunately for hospitals, doctors rarely intentionally kill patients. Unfortunately for churches, pastors and other leaders sometimes do things either that they know they shouldn't, or believe they're entitled to do anyway. So as much as I'd love to see the sort of blame-taking Gawande describes adapted for church use, I'm not holding my breath.

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