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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.

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
Discipline
Teamwork
Results
Physicians
Courses
Doctors
Course
Matters
Values
Humility
Culture
Embrace
Penalized
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Service
Rewarded
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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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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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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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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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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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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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We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.
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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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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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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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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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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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What about regular professionals, who just want to do what they do as well as they can?
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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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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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Expertise is the mantra of modern medicine.
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Coaching done well may be the most effective intervention designed for human performance.
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We have medicalized aging, and that experiment is failing us.
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Are doctors who make mistakes villains? No, because then we all are.
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Arriving at an acceptance of one's mortality is a process, not an epiphany.
Atul Gawande