Quotes from Atul Gawande

No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.

A resident has a distinctive vantage on medicine. You are an insider, seeing everything and a part of everything; yet at the same time you see it anew.

Feeling pity for him, I stopped to browse and was stunned to discover what he had on offer. He

It did not take long here to realize that some had come just to be seen

All the same I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death. I am less worried about the abuse of these powers than I am about dependence on them.

Training in most fields is longer and more intense than ever. People spend years of sixty-, seventy-, eighty-hour weeks building their base of knowledge and experience before going out into practice on their own—whether they are doctors or professors or lawyers or engineers. They have sought to perfect themselves. It is not clear how we could produce substantially more expertise than we already have. Yet our failures remain frequent. They persist despite remarkable individual ability. *

This was one place where I knew I had found something worthy of awe.

The discussions were sparsely attended and mostly went over my head:

As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did.

You felt the need to say hello. Indeed, it seemed impolite not to do so.

What's the shortest time you've seen and the longest time you've seen for people who took no treatment? Three months was the shortest, she said, three years the longest. And with treatment? She got mumbly. Finally she said that the longest might not have been that much more than three years. But with treatment, the average should shift toward the longer end.

Yet, in the course of fifty cases, some teams managed to halve their operating time while others failed to improve at all. Practice, it turned out, did not necessarily make perfect.

Hospice deploys nurses, doctors, chaplains, and social workers to help people with a fatal illness have the fullest possible lives right now—much as nursing home reformers deploy staff to help people with severe disabilities. In terminal illness that means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as feasible, or getting out with family once in a while—

Oh yes, he said. In a fire, the metal can plasticize—lose its stiffness and bend like spaghetti. This was why the World Trade Center buildings collapsed

You see it in the 36 percent increase between 2004 and 2007 in lawsuits against attorneys for legal mistakes—the most common being simple administrative errors, like missed calendar dates and clerical screwups, as well as errors in applying the law. You see it in flawed software design, in foreign intelligence failures, in our tottering banks—in fact, in almost any endeavor requiring mastery of complexity and of large amounts of knowledge. Such

In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating. How

A team at Cedars-Sinai Hospital in Los Angeles had actually gotten far enough along to begin human trials of a temporary, bioengineered liver.

I was impressed that he had learned to tolerate the winters.

THE CHOICES DON'T stop, however. Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

Alice insisted the accelerator had got stuck. She thought of herself as a good driver and hated the idea that anyone would think that the problem was her age. The body's decline creeps like a vine. Day to day, the changes can be imperceptible. You adapt. Then something happens that finally makes it clear that things are no longer the same. The falls didn't do it. The car accident didn't do it. Instead, it was a scam that did. Not long after the car accident, Alice

No matter how accomplished, surgeons trying something new got worse before they got better, and the learning curve proved longer, and affected by a far more complicated range of factors, than anyone had realized. It's all stark confirmation that you can't train novices without compromising patient care.

I told him of how, almost thirty years before, my parents had narrowed their choices of where to take up practice to either Athens, Ohio, or Hancock, Michigan, in the upper peninsula.

We know less and less about our patients but more and more about our science.

Do we ever say that we need them to agree to it anyway? I've never seen it. Given the stakes, who in their right mind would agree to be practiced upon?