Agency

Yesterday I read Better: A Surgeon's Notes on Performance, by Atul Gawande. It was an excellent book, especially after The Spirit Catches You and You Fall Down. Both address problems in healthcare, but whereas Spirit is anecdotal and a little touchy-feely, Better provides facts to back up its claims. Most importantly, Better focuses on how doctors and nurses can improve things. Mainly, it seems, by giving themselves agency.

Agency is a funny sort of word. I first heard it in my first semester of college, in a class about Shakespearean comedies. I think it was the lecture about Much Ado about Nothing (great play, fantastic movie starring Kenneth Branagh, Emma Thompson, and Denzel Washington). It refers to the power to effect change. So, Hero ("Leonato's short daughter") has no agency in the events of the play. Instead of, say, Merchant's Portia, who does things like cross-dress as a lawyer, Hero allows things to be done to her.

Literary digressions are fun!

But the main point is that agency, and a belief in one's own agency, is important. It underlies the ethical principle of autonomy. There's a lot of energy focused on the patient's autonomy, as there should be. For example, the Lees in Spirit lost autonomy in part because of their inability to communicate with the physicians. In many ways, the book is as much about their struggle to be subjects as it is about Lia's battle with epilepsy.

But there is also the autonomy of the physician. This seems to be gaining ground nowadays, with physician discontent with the insurance system in this country and with government/administrator involvement in how their practices are to be run. Better's kind of unique in that it addresses the autonomy of physicians, surgeons, and nurses to make choices about their practice of medicine. One chapter, which I personally found the most fascinating, deals with medical practitioners assisting in lethal execution, and their ethical and personal dilemmas about how far to go.

It's a great book, even better than Complications, his first. Go read it.