Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.— Atul Gawande
The most empowering Atul Gawande quotes that are little-known but priceless
Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.
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.
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.
We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets - and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.
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.
At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.
This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.
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.
I said there are at least two kinds of satisfaction, however, and the other has nothing to do with skill. It comes from human connection. It comes from making others happy, understanding them, loving them.
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.
We yearn for frictionless, technological solutions.
But people talking to people is still the way norms and standards change.
Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.
Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork.
Writing lets you step back and think through a problem.
Even the angriest rant forces the writer to achieve a degree of thoughtfulness.
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.
Our ideas of what our priorities are shift as we come face-to-face with some of the struggles.
I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.
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.
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.
You want to ensure people can do it right 99 percent of time.
When we have to fire one of our surgical trainees, it is never because they dont have the physical skills but because they dont have the moral skills - to practise and admit failure.
I learned about a lot of things in medical school, but mortality wasn't one of them.
What is the alternative to understanding the complexity of the world?
These are folks that keep people out of hospitals, out of emergency rooms, out of nursing homes. And not only that, they help people achieve more fulfilling lives.
We recruit for attitude and train for skill.
[In medicine,] we have trained, hired and rewarded people to be cowboys, but it's pit crews that we need.
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.
Are doctors who make mistakes villains? No, because then we all are.
We now have 30 percent, for example, of Medicare patients who are seeing doctors who are rewarded for doing this kind of work, like high blood pressure control. So, the Affordable Care Act has pushed this direction down the road.
Human interaction is the key force in overcoming resistance and speeding change.
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.
When we lived in a society where we had large families that lived together, especially in agricultural societies like my grandfather and father grew up in, the result is you always had family around to take care of you.
Man is fallible, but maybe men are less so.
If the conversation people think is coming is the 'death panel' conversation, that's a total failure.
Coaching done well may be the most effective intervention designed for human performance.
Life is choices, and they are relentless.
No sooner have you made one choice than another is upon you.
If we took away the ability to put defibrillators in people in their last years, people would be shouting in the streets.
Don’t let yourself be. Find something new to try, something to change. Count how often it succeeds and how often it doesn’t. Write about it. Ask a patient or a colleague what they think about it. See if you can keep the conversation going.
When [disease] can't be stopped, that's where we become lost.
Sometimes we can offer a cure, sometimes only a salve, sometimes not even that.
But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.
Over time I learned that there are two very different satisfactions that you can have in your life. One is the satisfaction of becoming skilled at something. It almost doesn't matter what the terrain is. There is a deep, soul-feeding resonance in mastery itself, whether in teaching, writing a complicated software program, coaching a baseball team, or marshalling a group of people to start a new business.
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.
What about regular professionals, who just want to do what they do as well as they can?
In every industrialized nation, the movement to reform health care has begun with stories about cruelty.
Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.
You may not control life's circumstances, but getting to be the author of your life means getting to control what you do with them.
My biggest fear, that 27 percent of Americans under 65 have an existing health condition that, without the protections of the Affordable Care Act, would mean they would - could be automatically excluded from insurance coverage. Before the ACA, they wouldn't have been able to get insurance coverage on the individual market, you know, if you're a freelancer or if you had a small business or the like.
The evidence is that people who enter hospice don't have shorter lives.
In many cases they are longer.
We look for medicine to be an orderly field of knowledge and procedure.
But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.
The Affordable Care Act also offered protections that allow for preexisting conditions, as people know, that you're provided coverage and you can maintain steady coverage. And that's an important part of being able to stay in care and do better over the long run.