How to be a ‘positive deviant’

I’ve just finished reading Atul Gawande’s 2007 book Better: a surgeon’s notes on performance. I’ve been meaning to read it ever since it came out! It’s fantastic, and I’ve highlighted many sections of it on my Kindle.

The afterword has a particularly interesting section, the structure of which Gawande takes from Paul Auster’s essay ‘Gotham Handbook’:

I get to lecture to the students at our medical school on occasion. For one lecture, I decided to try to figure out an answer to this question, both for them and for myself. I came up with five—five suggestions for how one might make a worthy difference, for how one might become, in other words, a positive deviant. This is what I told them.

My first suggestion came from a favorite essay by Paul Auster: Ask an unscripted question.

My second suggestion was: Don’t complain.

Ours is a team sport, but with two key differences from the kinds with lighted scoreboards: the stakes are people’s lives and we have no coaches. The latter is no minor matter. Doctors are expected to coach themselves. We have no one but ourselves to lift us through the struggles. But we’re not good at it.

My third answer for becoming a positive deviant: Count something.

If you count something you find interesting, you will learn something interesting.

My fourth suggestion was: Write something.

Most of all, by offering your reflections to an audience, even a small one, you make yourself part of a larger world. Put a few thoughts on a topic in just a newsletter, and you find yourself wondering nervously: Will people notice it? What will they think? Did I say something dumb? An audience is a community. The published word is a declaration of membership in that community and also of a willingness to contribute something meaningful to it.

My suggestion number five… was: Change.

Nonetheless, make yourself an early adopter. Look for the opportunity to change. I am not saying you should embrace every new trend that comes along. But be willing to recognize the inadequacies in what you do and to seek out solutions. As successful as medicine is, it remains replete with uncertainties and failure. This is what makes it human, at times painful, and also so worthwhile.

There’s also a great section where Gawande reflects on the fact that all of us are on a bell curve, often without realising it:

The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average? If we took all the surgeons at my level of experience, compared our results, and discovered that I am one of the worst, the answer would be easy: I’d turn in my scalpel. But what if I were a B–? Working as I do in a city that’s mobbed with surgeons, how could I justify putting patients under the knife? I could tell myself, Someone’s got to be average. If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right?

Except, of course, there is. What is troubling is not just being average but settling for it. Everyone knows that average-ness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child’s pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.

It’s a great book. I highly recommend you read it.

(a note to those Kindle users frustrated with the restrictions around copy/paste with Kindle Cloud Reader— I’ve found ACRExtensions is a JS bookmarklet that works well!)