Best 99 quotes of Atul Gawande on MyQuotes

A failure often does not have to be a failure at all. However, you have to be ready for it-will you admit when things go wrong? Will you take steps to set them right?-because the difference between triumph and defeat, you'll find, isn't about willingness to take risks. It's about mastery of rescue.

After readinf some essay on the nature of human fallibility, I was very aware that we are the recipients of a huge amount of discovery over the last century. Medicine exemplifies this. And that has transitioned us from a world in which people's lives were mostly governed by ignorance to one that's constrained by ineptitude. A century ago, we didn't know, for instance, what diseases afflicted us, what their nature really was, or what to do about them. And that has changed.

Are doctors who make mistakes villains? No, because then we all are.

Arriving at an acceptance of one's mortality is a process, not an epiphany.

As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.

Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

Coaching done well may be the most effective intervention designed for human performance.

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.

Don’t let yourself be. Find something new to try, something to change. Count how often it succeeds and how often it doesn’t. Write about it. Ask a patient or a colleague what they think about it. See if you can keep the conversation going.

Expertise is the mantra of modern medicine.

Go back to the '30s, '40s, '50s, and it was the discovery of heroic interventions, the ability to cure people with penicillin or do an operation to stop disease that was what saved the day. Primary care physicians couldn't do all that much that really demonstrated a difference. The people who control and work with you to control your blood pressure, they're not rewarded for doing that or to be innovative about doing that. So, the result is half of Americans have uncontrolled high blood pressure, despite seeing clinicians.

Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything--a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps--the ones that even the highly skilled professional using them could miss. Good checklists are, above all, practical.

Having great components is not enough, and yet we've been obsessed in medicine with components. We want the best drugs, the best technologies, the best specialists, but we don't think too much about how it all comes together.

Human interaction is the key force in overcoming resistance and speeding change.

I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.

If I became just a brain in a jar - as long as I can communicate back and forth with people, that would be okay with me.

If we took away the ability to put defibrillators in people in their last years, people would be shouting in the streets.

I learned about a lot of things in medical school, but mortality wasn't one of them.

In every industrialized nation, the movement to reform health care has begun with stories about cruelty.

In many ways, the effort to study philosophy was my rebellion away from medicine. I'm the son of two Indian immigrant physicians, so the natural path for me would have been to become a doctor. I ended up doing the master's degree at Oxford in politics, philosophy, and economics while already having a seat in medical school. I was keeping that as my escape hatch. But my hope was that I might become a philosopher or something else entirely.

In one study, old people assigned to a geriatrics team stayed independent for far longer, and were admitted to the hospital less.

In psychology, there's something called the broken-leg problem. A statistical formula may be highly successful in predicting whether or not a person will go to a movie in the next week. But someone who knows that this person is laid up with a broken leg will beat the formula. No formula can take into account the infinite range of such exceptional events.

In the end, people don't view their life as merely the average of all its moments-which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life maybe empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves.

I said there are at least two kinds of satisfaction, however, and the other has nothing to do with skill. It comes from human connection. It comes from making others happy, understanding them, loving them.

I talked to over two hundred patients and family members about their experiences with aging, serious illnesses, and the big unfixables. But I also spoke with scores of physicians, and especially geriatricians, palliative care doctors, hospice nurses, and nursing home workers. The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people's priorities are, besides just living longer, is to simply ask. And we don't ask.

I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle.

Just look at the list of who the lowest-paid people are. Pediatricians are at the bottom. You would also look at internists. You would look at psychiatrists. You would look at family physicians, HIV specialists. People who take care of chronic illnesses by seeing people carefully over time, those are the people who get the least money. The people who have the most are people like orthopedic surgeons, interventional cardiologists. And my point isn't that there is something wrong with heroism.

Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork.

Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work - whether in healthcare, education, climate change, making a pathway out of poverty - is the great task of our generation as a whole.

My biggest fear, that 27 percent of Americans under 65 have an existing health condition that, without the protections of the Affordable Care Act, would mean they would - could be automatically excluded from insurance coverage. Before the ACA, they wouldn't have been able to get insurance coverage on the individual market, you know, if you're a freelancer or if you had a small business or the like.

My own son has a congenital heart condition, where his life was saved by a cardiac surgeon stepping in at 11 days of life to save his life. But he is now 21 years old because of constant monitoring and working with him with a primary care physician. that's the only reason now that he's getting to live a long and healthy life. That's what we're not rewarding. They don't have the kind of resources and commitment that we are giving to people like me. I have millions of dollars of equipment available to me when I go to work every day in an operating room.

No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.

No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not.

No travel ban or quarantine will seal a country completely. Even if travel could be reduced by eighty per cent-itself a feat-models predict that new transmissions would be delayed only a few weeks. Worse, it would only drive an increase in the number of cases at the source. Health-care workers who have fallen ill would not be able to get out for treatment, and the international health personnel needed to quell the outbreak would no longer be able to go in.

Once you start to ask patients about their priorities, you discover what they're living for. Once you uncover that, it helps you, as a doctor, decide what to fight for. And when we do that, we often end up identifying limits to the kind of care that people want. One's assumption is that these people are going to live shorter lives, but what we're doing is protecting quality of life. In doing so, you sometimes end up helping people live longer. Certainly, you help people live better days and with more purpose in their lives.

One of the consequences of if the Affordable Care Act is repealed, is that all of us now are at risk of being a preexisting - of having a preexisting condition waiting to happen. Life, increasingly, is a preexisting condition waiting to happen, now that we have more and more of this data available.

Our ideas of what our priorities are shift as we come face-to-face with some of the struggles.

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.

Over time I learned that there are two very different satisfactions that you can have in your life. One is the satisfaction of becoming skilled at something. It almost doesn't matter what the terrain is. There is a deep, soul-feeding resonance in mastery itself, whether in teaching, writing a complicated software program, coaching a baseball team, or marshalling a group of people to start a new business.

People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as "the constant and earnest effort to accomplish what is undertaken."... Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior.

People who reach certain levels of frailty, more important than getting their mammogram, more important than getting their blood pressure tweaked, they're at high risk of falling. If they fall and break their hip, they not only die sooner, they die miserably.

Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.

Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.

The Affordable Care Act also offered protections that allow for preexisting conditions, as people know, that you're provided coverage and you can maintain steady coverage. And that's an important part of being able to stay in care and do better over the long run.

The big thing that's happened is, in the time since the Affordable Care Act has been going on, our medical science has been advancing. We have now genomic data. We have the power of big data about what your living patterns are, what's happening in your body. Even your smartphone can collect data about your walking or your pulse or other things that could be incredibly meaningful in being able to predict whether you have disease coming in the future and help avert those problems.

The definition of what it means to be dying has changed radically. We are able to extend people's lives considerably, including sometimes, good days.

The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer.