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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.
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
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More quotes by Atul Gawande
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.
Atul Gawande
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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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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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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You know, 97 percent of the time, if you come into a hospital, everything goes well. But three percent of the time, we have major complications.
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A failure often does not have to be a failure at all. However, you have to be ready for it-will you admit when things go wrong? Will you take steps to set them right?-because the difference between triumph and defeat, you'll find, isn't about willingness to take risks. It's about mastery of rescue.
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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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Arriving at an acceptance of one's mortality is a process, not an epiphany.
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One of the consequences of if the Affordable Care Act is repealed, is that all of us now are at risk of being a preexisting - of having a preexisting condition waiting to happen. Life, increasingly, is a preexisting condition waiting to happen, now that we have more and more of this data available.
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We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in.
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Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work - whether in healthcare, education, climate change, making a pathway out of poverty - is the great task of our generation as a whole.
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We have medicalized aging, and that experiment is failing us.
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Checklists turn out...to be among the basic tools of the quality and productivity revolution in aviation, engineering, construction - in virtually every field combining high risk and complexity. Checklists seem lowly and simplistic, but they help fill in for the gaps in our brains and between our brains.
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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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Are doctors who make mistakes villains? No, because then we all are.
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We recruit for attitude and train for skill.
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Expertise is the mantra of modern medicine.
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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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Writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness.
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When we, doctors, ask patients what their priorities are if time is short, what we do is we use what is available to us - whether it's geriatric care or palliative care or hospice care - to make sure they're living the kind of life that they want to live.
Atul Gawande