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Expertise is the mantra of modern medicine.
Atul Gawande
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Atul Gawande
Age: 59
Born: 1965
Born: May 11
Journalist
Medical Writer
Professor
Researcher
Surgeon
Brooklyn
New York
Atul A Gawande
Atul Gawande
Mantra
Mantras
Expertise
Medicine
Modern
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Having great components is not enough, and yet we've been obsessed in medicine with components. We want the best drugs, the best technologies, the best specialists, but we don't think too much about how it all comes together.
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We have medicalized aging, and that experiment is failing us.
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You can't make a recipe for something as complicated as surgery. Instead, you can make a recipe for how to have a team that's prepared for the unexpected.
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Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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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.
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The possibilities and probabilities are all we have to work with in medicine, though. What we are drawn to in this imperfect science, what we in fact covet in our way, is the alterable moment-the fragile but crystalline opportunity for one's know-how, ability, or just gut instinct to change the course of another's life for the better.
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People who reach certain levels of frailty, more important than getting their mammogram, more important than getting their blood pressure tweaked, they're at high risk of falling. If they fall and break their hip, they not only die sooner, they die miserably.
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Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.
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Man is fallible, but maybe men are less so.
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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.
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This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.
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Human interaction is the key force in overcoming resistance and speeding change.
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No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not.
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Arriving at an acceptance of one's mortality is a process, not an epiphany.
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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.
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I learned about a lot of things in medical school, but mortality wasn't one of them.
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As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.
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We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.
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We recruit for attitude and train for skill.
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What about regular professionals, who just want to do what they do as well as they can?
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