Atul Gawande Quotes

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

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 naïve.

human beings need loyalty. It does not necessarily produce happiness, and can even be painful, but we all require devotion to something more than ourselves for our lives to be endurable. Without it, we have only our desires to guide us, and they are fleeting, capricious, and insatiable. They provide, ultimately, only torment.

Surgeons, as a group, adhere to a curious egalitarianism. They believe in practice, not talent. People often assume that you have to have great hands to become a surgeon, but it’s not true. When I interviewed to get into surgery programs, no one made me sew or take a dexterity test or checked if my hands were steady. You do not even need all ten fingers to be accepted. To be sure, talent helps. Professors say every two or three years they’ll see someone truly gifted come through a program — someone who picks up complex manual skills unusually quickly, sees the operative field as a whole, notices trouble before it happens. Nonetheless, attending surgeons say that what’s most important to them is finding people who are conscientious, industrious, and boneheaded enough to stick at practicing this one difficult thing day and night for years on end. As one professor of surgery put it to me, given a choice between a Ph.D. who had painstakingly cloned a gene and a talented sculptor, he’d pick the Ph.D. every time. Sure, he said, he’d bet on the sculptor being more physically talented; but he’d bet on the Ph.D. being less “flaky.” And in the end that matters more. Skill, surgeons believe, can be taught; tenacity cannot.

The simpler way to say it is that perspective matters.

Medicine’s ground state is uncertainty. And wisdom — for both patients and doctors — is defined by how one copes with it.

checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a kind of cognitive net. They catch mental flaws inherent in all of us — flaws of memory and attention and thoroughness. And because they do, they raise wide, unexpected possibilities.

The philosophy is that you push the power of decision making out to the periphery and away from the center. You give people the room to adapt, based on their experience and expertise. All you ask is that they talk to one another and take responsibility. That is what works.

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

The striking thing is that WHO doesn't really have the authority to do any of this. It can't tell governments what to do. It hires no vaccinators, distributes no vaccine. It is a small Geneva bureaucracy run by several hundred international delegates whose annual votes tell the organization what to do but not how to do it.…The only substantial resource that WHO has cultivated is information and expertise.

Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.

So Pabrai added the following checkpoint to his list: when analysing a company, stop and confirm that you’ve asked yourself whether the revenues might be overstated or understated due to boom or bust conditions.

Assisted living is far harder than assisted death, but its possibilities are far greater, as well.

Indeed, the scientific effort to improve performance in medicine — an effort that at present gets only a miniscule portion of scientific budgets — can arguably save more lives in the next decade than bench science, more lives than research on the genome, stem cell therapy, cancer vaccines, and all the other laboratory work we hear about in the news.

My third answer for becoming a positive deviant: Count something. Regardless of what one ultimately does in medicine — or outside medicine, for that matter — one should be a scientist in the world....If you count something you find interesting, you will learn something interesting.