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. - Atul Gawande

sometime over the last several decades — and it is only over the last several decades — science has filled in enough knowledge to make ineptitude as much our struggle as ignorance.

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

Consider the case of La Crosse, Wisconsin. Its elderly residents have unusually low end-of-life hospital costs. During their last six months, according to Medicare data, they spend half as many days in the hospital as the national average, and there’s no sign that doctors or patients are halting care prematurely. Despite average rates of obesity and smoking, their life expectancy outpaces the national mean by a year.