Western medicine is dominated by a single imperative — the quest for machinelike perfection in the delivery of care. - Atul Gawande

You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific — matters of how casual you should be, how formal, how reticent, how forthright. Also: how apologetic, how self-confident, how money-minded.

To become a doctor, you spend so much time in the tunnels of preparation — head down, trying not to screw up, just going from one day to the next — that it is a shock to find yourself at the other end, with someone shaking your hand and offering you a job. But the day comes.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice — pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.