Quotes from Atul Gawande

and he never considered the idea.

the real lesson is that under conditions of true complexity—where the knowledge required exceeds that of any individual and unpredictability reigns—efforts to dictate every step from the center will fail. People need room to act and adapt. Yet

It turns out that inheritance has surprisingly little influence on longevity. James Vaupel, of the Max Planck Institute for Demographic Research, in Rostock, Germany, notes that only 3 percent of how long you'll live, compared with the average, is explained by your parents' longevity; by contrast, up to 90 percent of how tall you are is explained by your parents' height. Even genetically identical twins vary widely in life span: the typical gap is more than fifteen years.

Discipline is hard—harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

because of the previous damage, it couldn't safely be done.

No one would have faulted him for doing either.

The Emanuels described a third type of doctor-patient relationship, which they called "interpretive." Here the doctor's role is to help patients determine what they want. Interpretive doctors ask, "What is most important to you? What are your worries?" Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.

When the patient complained of pain, Goodman refused to admit that anything needed to be done.

That fall, they moved in a greyhound named Target, a lapdog named Ginger, the four cats, and the birds. They threw out all their artificial plants and put live plants in every room. Staff members brought their kids to hang out after school; friends and family put in a garden at the back of the home and a playground for the kids. It was shock therapy.

They all believed that you didn't need to sacrifice your autonomy just because you needed help in your life. And I realized, in meeting these people, that they shared a very particular philosophical idea of what kind of autonomy mattered most in life.

Faulty memory and distraction are a particular danger in what engineers call all-or-none processes: whether running to the store to buy ingredients for a cake, preparing an airplane for takeoff, or evaluating a sick person in the hospital, if you miss just one key thing, you might as well not have made the effort at all. A

It may seem harsh to say, but if it was a sixty-year-old man I would've taken the leg without question." This was partly, I think, a purely emotional unwillingness to cut off the limb of a pretty twenty-three-year-old—the kind of sentimentalism that can get you in trouble.

and he couldn't endure the prospect of a longer operation.

But finding a good idea is apparently not all that hard. Finding an entrepreneur who can execute a good idea is a different matter entirely. One needs a person who can take an idea from proposal to reality, work the long hours, build a team, handle the pressures and setbacks, manage technical and people problems alike, and stick with the effort for years on end without getting distracted or going insane. Such people are rare and extremely hard to spot.

Whether insurance is provided by the government or by corporations, there is no reason to think that the battles—over the fees charged, the bills rejected, the preapproval contortions—will ever end.

Somewhere in my mind, I must have been aware of the possibility that

Studdert stood firm with his decision not to take more, but you could see he was uneasy about it.

The third requirement for success is ingenuity—thinking

her arm. Her face sagged. Her speech slurred. Although

Goodman insisted there was nothing to be done.

People who we had believed weren't able to speak started speaking," Thomas said. "People who had been completely withdrawn and nonambulatory started coming to the nurses' station and saying, 'I'll take the dog for a walk.

Surgery has, essentially, four big killers wherever it is done in the world: infection, bleeding, unsafe anesthesia, and what can only be called the unexpected. For the first three, science and experience have given us some straightforward and valuable preventive measures we think we consistently follow but don't. These misses are simple failures—perfect for a classic checklist.

He ignored the obvious on X rays.

He and Segal conferred and thought of one other thing they could try