Atul Gawande Quotes

Those of us in medicine don’t help, for we often regard the patient on the downhill as uninteresting unless he or she has a discrete problem we can fix.

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

Steps to become a positive deviant:
1. Ask unscripted questions
2. Don't complain
3. Count something that interests you
4. Write something... Anything
5. Change yourself. Change something

What is needed, however, isn't just that people working together be nice to each other. It is discipline.
Discipline is hard — harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

Consider the fact that we care deeply about what happens to the world after we die. If self-interests were the primary source of meaning in life, then it wouldn’t matter to people if an hour after their death everyone they know were to be wiped from the face of the earth. Yet, it matters greatly to most people. We feel that such an occurrence would make our lives meaningless. The only way death is not meaningless is to see yourself as part of something greater; a family, a community, a society. If you don’t, mortality is only a horror, but if you do, it is not. Loyalty, said Royce, solves the paradox of our ordinary existence, by showing us outside of ourselves the cause which is to be served, and inside of ourselves, the will which delights to do this service, and is not thwarted, but enriched and expressed in such service… Above the level of self-actualization in Maslow’s hierarchy of needs, they suggest the existence in people of a transcendent desire to see and help other beings achieve their potential.
As our time winds down, we all seek comfort in simple pleasures; companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the awards of achieving and accumulating and more interested in the rewards of simply being. Yet, while we may feel less ambitious, we also have become concerned for our legacy, and we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.

In the end, people don’t view their life as merely the average of all of 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 may be empty. A seemingly diffic

We want autonomy for ourselves and safety for those we love.

...we all require devotion to something more than ourselves for our lives to be endurable.

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.

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

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.

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

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.

There was a succession of roommates, never chosen with her input and all with cognitive impairments. Some were quiet. One kept her up at night. She felt incarcerated, like she was in prison for being old.

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

"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."