Quotes from Atul Gawande

In the course of a normal lifetime, the muscles of the jaw lose about 40 percent of their mass and the bones of the mandible lose about 20 percent, becoming porous and weak. The ability

A good computer program consistently and automatically gives each factor its appropriate weight.

Even good doctors can go bad, and when they do, colleagues tend to be almost entirely unequipped to do anything about them.

I called Segal and filled him in.

Then comes what still seems surreal to me. You reach in, and instead of finding a tumor or some other abnormality, as surgeons usually do when we go into someone's belly, you find five tiny wiggling toes, a knee, a whole leg. And suddenly you realize you have a new human being struggling in your hands. You almost forget the mother on the table.

All the examples, I noticed, had a few attributes in common: They involved simple interventions—a vaccine, the removal of a pump handle. The effects were carefully measured. And the interventions proved to have widely transmissible benefits—what business types would term a large ROI (return on investment) or what Archimedes would have called, merely, leverage.

They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor's child but not the truck driver's. If choice cannot go to everyone, maybe it is better when it is not allowed at all.

He even put me in touch with former colleagues and patients. His only request was that I not use his real name.

In the end what he gave Eleanor and her father was mainly confidence, from what I could see.

two months before he left the hospital. Weak and debilitated, he lost his limousine business and his home

But experience brings a new role: I am expected to teach the procedure instead.

The medical officer's microplan was a sheaf of ragged paper, with marker-drawn maps and penciled-in tables. The first page said that he had recruited twenty-two teams of two vaccinators each to cover a population of 34,144 people. "How do you know this population estimate is right?" Pankaj asked. The officer replied that he'd done a house-to-house survey.

features that speak much more to what a middle-aged person desires for a parent than to what the parent does.

All involve risk, uncertainty, and complexity — and therefore steps that are worth committing to a checklist and testing in routine care. Good checklists could become as important as doctors and nurses as good stethoscopes (which, unlike checklist, have never been proved to make a difference in patient care). The hard question — still unanswered — is whether medical culture can seize the opportunity.

She misinterprets this as a question.

doctors can be stubborn about changing the way we do things.

But he agreed that it could not be ruled out.

I am still adjusting to this role.

Yet compassion and technology aren't necessarily incompatible; they can be mutually reinforcing.

Two-thirds of the terminal cancer patients in the Coping with Cancer study reported having had no discussion with their doctors about their goals for end-of-life care, despite being, on average, just four months from death. But the third who did have discussions were far less likely to undergo cardiopulmonary resuscitation or be put on a ventilator or end up in an intensive care unit. Most of them enrolled in hospice.

So what else was there but to biopsy?

It is all I can do not to take over. But she cannot learn without doing, I tell myself. I decide to let her have one more try.

And there is such a strategy—though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies. It is a checklist.

people reported more positive emotions as they aged.