The Sharp End of the Knife

Recently, I heard someone say, "you have to live life in order to make art and not the other way around".

I stumbled upon Better - A Surgeon's Notes on Performance by Atul Gawande in the public library and took it home, curious. Could I learn something about being a musician, about life, by looking over a doctor's shoulder?

Now, raise your hand those of you who have ever compared your musician's job to that of a doctor. As in, "when we make mistakes, no-one dies".


We all want to be better at our job, regardless of what we do. Although performing music on a stage feels dangerous to some, it's not. And being a doctor is a job where the stakes are especially high. That's why it's fascinating to find out how a surgeon approaches improvement.

Gawande writes about "three core requirements for success in medicine - or in any endeavor that involves risk and responsibility".

Diligence, the first of them, is the necessity of giving sufficient attention to detail to avoid mistakes and overcome obstacles. Paying attention to detail is "central to performance and fiendishly hard" - nothing one can just do.

"We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other."

The second challenge for a medical professional is to do right - in the human and ethical sense. Gawande touches on several uncomfortable questions, those that are complex to answer but important to reflect upon.

The third requirement is "ingenuity - thinking anew". For Gawande, ingenuity is a matter of character, and it arises from "deliberate, even obsessive, reflection on failure and a constant searching for new solutions".

"Having a machine is not the cure; understanding the ordinary, mundane details that must go right for each particular problem is."

"We are used to thinking that a doctor's ability depends mainly on science and skill. The lesson (...) is that they may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and diligence and ingenuity can matter enormously."

To finish, he poses the question that applies to almost everyone nowadays - as a single individual one feels like a small part of the whole system. And especially in the healthcare industry, seemingly, no-one is "irreplaceable. So not surprisingly, in this work one begins to wonder: How do I really matter?"

Gawande answers with five practical suggestions for what he calls "Becoming a Positive Deviant".

1. Ask an unscripted question. He likes to ask his patient a question to get to know him as a human being, even if it's late, even if he has other patients to see. "Where did you grow up?" or "Did you watch last night's Red Sox game?", allowing a space for human connection beyond the usual interaction.

2. Don't complain. "Resist it. It's boring, it doesn't solve anything and it will get you down."

3. Count something. According to Gawande, one should be a scientist in this world, regardless of what you do. In the simplest terms, this means that one should count something. "If you count something you find interesting, you will learn something interesting."

4. Write something. Whether it's in your journal, a blog, a paper or a little poem - it helps to bring your thoughts into perspective, to see the bigger picture. "By offering your reflections to an audience, even a small one, you make yourself part of a larger world. (...) So choose your audience. Write something."

5. Change. Finally, he recommends to make oneself an early adopter - not to embrace every new trend that comes along, but to be open to recognize when you are failing and need to look for new solutions.

"The choices a doctor makes are necessarily imperfect but they alter people's lives. Because of that reality, it often seems safest to do what everyone else is doing - to be just another white-coated cog in the machine. But a doctor must not let that happen - nor should anyone who takes on risk and responsibility in society.

So find something new to try, something to change. Count how often you succeed and how often you fail. Write about it. Ask people what they think. See if you can keep the conversation going."

Maria Busqué is a coach for musical performance and a freelance harpsichord player based in Berlin. You can follow her on twitter, @maria_busque visit her HELLOSTAGE page or find out more about her work at www.mariabusque.net.

Author: Maria Busqué / edited by Nina HELLO STAGE
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