Atul Gawande Quotes

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

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

We are not omniscient or all-powerful. Even enhanced by technology, our physical and mental powers are limited.

You know, 97 percent of the time, if you come into a hospital, everything goes well. But three percent of the time, we have major complications.

My vantage point on the world is the operating room where I see my patients.

In my grandfather's premodern world, how he wanted to live was his choice, and the family's role was to make it possible.

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

Michael Jordan always had to wear University of North Carolina boxer shorts under his Chicago Bulls uniform.

assisted living isn't really built for the sake of older people so much as for the sake of their children.

human beings fail the way all complex systems fail: randomly and gradually.

This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.

What is the alternative to understanding the complexity of the world?

We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.

Culture has tremendous inertia," he said. "That's why it's culture. It works because it lasts. Culture strangles innovation in the crib.

Even children are permitted to take more risks than the elderly.

Effort does matter; diligence and attention to the minutest details can save you.

The third requirement for success is ingenuity - thinking

If there is a credo in practical medicine, it is that the important thing is to be sensible.

Medicine was just another a tool you could try, no different from a healing ritual or a family remedy and no more effective.

The companies' most effective tactic, however, was simply to put out the goods and let surgeons play.

One has to decide whether one's fears or one's hopes are what should matter most.

It's easy to hide in a statement. It's hard to hide between statements," Cook said.

Neuroscientists have found that the prospect of making money stimulates the same primitive reward circuits in the brain that cocaine does.

But scientific advances have turned the processes of aging and dying into medical experiences,

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

That's how a doctor earns money, she told me. It's a war with insurance, every step of the way.

Their attitude seemed to result from incomprehension rather than cruelty, but as Tolstoy would have said, what's the difference in the end?

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.

As a person's end draws near, there comes a moment when responsibility shifts to someone else to decide what to do.

Was once on trauma duty when a young man about twenty years old was rolled in, shot in the buttock.

When [disease] can't be stopped, that's where we become lost.

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.

The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.

Percent of medical students take no course in geriatrics,

Mainstream doctors are turned off by geriatrics, and that's because they do not have the faculties to cope with the Old Crock," Felix Silverstone,

It seemed as if, once aging led to debility, it was impossible for anyone to be happy. *

And in stories, endings matter.

You may not control life's circumstances, but getting to be the author of your life means getting to control what you do with them.

How we seek to spend our time may depend on how much time we perceive ourselves to have.

Research has found that loss of bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels.

This place where half of us will typically spend a year or more of our lives was never truly made for us.

LOU SANDERS WAS on his way to joining the infantilized and catatonic denizens belted into the wheelchairs of a North Andover nursing home

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination.

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

Josiah Royce wrote a book with the title The Philosophy of Loyalty.

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

People die only once. They have no experience to draw on.

But the dismal finances of geriatrics are only a symptom of a deeper reality: people have not insisted on a change in priorities.

All human beings err, but they err frequently and in predictable, patterned ways.

Do what is right, and do it now.

Believe that the difference in death rates can be traced to the fundamental human need for a reason to live.

We need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon.

We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So

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

If the conversation people think is coming is the 'death panel' conversation, that's a total failure.

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.

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

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

Your chances of avoiding the nursing home are directly related to the number of children you have,

Living is a kind of skill. The calm and wisdom of old age are achieved over time.

That the chance to shape one's story is essential to sustaining meaning in life;

When the prevailing fantasy is that we can be ageless, the geriatrician's uncomfortable demand is that we accept we are not.

need to understand how much you're willing to go through to have a shot at being alive and what level of being alive is tolerable to you.

Man is fallible, but maybe men are less so.

We Have Medicalized Aging, and That Experiment Is Failing Us

Whatever the limits and travails we face, we want to retain the autonomy - the freedom - to be the authors of our lives.

They provided assisted living, but no one seemed to think it was their job to actually assist him with living

New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment.

accepted stoically, without fear or self-pity or hope for anything

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

This is normal. Although the processes can be slowed - diet and physical activity can make a difference - they cannot be stopped.

Wisdom is prudent strength.

I write because it's my way of finding cool ideas, thinking through hard problems and things I don't understand, and getting better at something.

George Orwell is a pinnacle writer, for his combination of moral insight and literary writing.

Each year, about 350,000 Americans fall and break a hip. Of those, 40 percent end up in a nursing home, and 20 percent are never able to walk again.

A young doctor is not so young nowadays; you typically don't start in independent practice until your midthirties. We

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front.

If end-of-life discussions were an experimental drug, the FDA would approve it.

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

In the face of the unknown - the always nagging uncertainty about whether, under complex circumstances, things will really be okay -

As we age, it's as if the calcium seeps out of our skeletons and into our tissues.

Instead they choose to accept their fallibilities. They recognised the simplicity and power of using a checklist.

And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained? In

Under conditions of complexity, not only are checklists a help, they are required for success.

As medical progress has extended our lives, the result has been what's called the "rectangularization" of survival.

When I do an operation, it's half a dozen people. When it goes beautifully, it's like a symphony, with everybody playing their part.

Her arm. Her face sagged. Her speech slurred. Although

The No. 2 pencils had been handed out. The timer had been started. But we had not even registered that the test had begun.

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.

Our ultimate goal, after all, is not a good death but a good life to the very end.

The simpler way to say it is that perspective matters.

The lesson seems almost Zen: you live longer only when you stop trying to live longer.

The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average?

The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness.

Whereas today people often understate their age to census takers, studies of past censuses have revealed that they used to overstate it.

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

I was willing to be rejected. That's what allows you to be a good salesperson. You have to be willing to be rejected.

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

The job of doctors is to supply up-to-date knowledge and skills. The job of patients is to supply the decisions.

The purpose of medical schooling was to teach how to save lives, not how to tend to their demise.