“Until that moment, when I stood there looking at the sign on his door, it had not occurred to me that I might have given him that infection. Only then did I realize we were on the floor of one of my own patients.

Yokoe pointed out that three of the eight rooms had bright yellow precaution signs because of patients inside with MRSA or VRE. In concluding he returns to this prism, concentrating on his own practice: Gawande spends time with the infection control team in his own hospital as he does so, he takes on their perspective, writing of doctors, supposed healers, as vectors for the transmission of disease. Most of his chapter on hand-washing could be described as conventional, albeit beautifully written: he examines the history of hand washing, the barriers which make ideal practice more difficult than it may sound and the partially successful interventions which have increased compliance but yielded only temporary results. Gawande shows an impressive willingness to examine his own conduct, success and failure. Gawande breaks great performance down into three elements: diligence, doing right and performance I’d like to highlight three related themes which are woven through the chapters and which I believe offer a model of practice as appropriate for teachers as much as they do for doctors. His underlying philosophy is what makes the book so compelling.

The topics on which Gawande focuses are intriguing, his writing is clear and well-researched, adding to his power I’m not sure any of this is the key to his importance however. In other chapters, he considers the counter-intuitive demands of battlefield medicine, the ethics of participation in execution as a doctor and the unanswerable dilemma of when to stop fighting for a patient’s survival. He explains the occasions when he and his peers breach these protocols and concludes by considering his own culpability for the spread of infection. In examining hand washing, for example, he begins with Semmelweiss’s pioneering attempts to convince his peers that this simple measure worked, then proceeds to consider the travails of his colleagues today, whose job is to ensure medical staff implement Semmelweiss’s nineteenth-century findings. Gawande’s meditations on medical practice span time and space and range from the general to the personal in their search for insight. This book is so good, its message so apposite for teachers, that I shall now break this rule. In my brief blogging career, I have eschewed comparisons between medicine and education too many seem hackneyed, simplistic or rhetorical. It’s Better, by Atul Gawande – a surgeon writing about how he and his profession can improve their performance. The book which best expresses how I aspire to improve my teaching has nothing to do with teaching.

Better by Atul Gawande