01c. 1965 ADBetterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one's life is bound up in others' and in science and in the messy, complicated connection between the two It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.Atul Gawande / quote ↗
02c. 1965 ADIn 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.Atul Gawande / quote ↗
03c. 1965 ADWhen our time is limited and we are uncertain about how best to serve our priorities, we are forced to deal with the fact that both the experiencing self and the remembering self matter. We do not want to endure long pain and short pleasure. Yet certain pleasures can make enduring suffering worthwhile. The peaks are important, and so is the ending.Atul Gawande / quote ↗
05c. 1965 ADWhat is troubling is not just being average but settling for it. Everyone knows that average-ness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child's pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.Atul Gawande / quote ↗
06c. 1965 AD[We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?Atul Gawande / quote ↗
07c. 1965 ADAt least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality- the courage to seek out the truth of what is to be feared and what is to be hoped. But even more daunting is the second kind of courage - the courage to act on the truth we find.Atul Gawande / quote ↗
08c. 1965 ADLife is choices, and they are relentless. No sooner have you made one choice than another is upon you.Atul Gawande / quote ↗
09c. 1965 ADThere is a saying about surgeons, meant as a reproof: "Sometimes wrong; never in doubt." But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off - or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn't, of course. But still he cut.Atul Gawande / quote ↗
10c. 1965 ADThe core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.Atul Gawande / quote ↗
11c. 1965 ADThe simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn't, someone who understood that the damage is greatest if all you do is fight to the bitter end.Atul Gawande / quote ↗
12c. 1965 ADWe want progress in medicine to be clear and unequivocal, but of course it rarely is. Every new treatment has gaping unknowns - for both patients and society - and it can be hard to decide what do do about them.Atul Gawande / quote ↗
13c. 1965 ADIf there is a credo in practical medicine, it is that the important thing is to be sensible.Atul Gawande / quote ↗
14c. 1965 ADThe 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.Atul Gawande / quote ↗
15c. 1965 ADAre doctors who make mistakes villains? No, because then we all are.Atul Gawande / quote ↗
16c. 1965 ADThe striking thing is that WHO doesn't really have the authority to do any of this. It can't tell governments what to do. It hires no vaccinators, distributes no vaccine. It is a small Geneva bureaucracy run by several hundred international delegates whose annual votes tell the organization what to do but not how to do it.…The only substantial resource that WHO has cultivated is information and expertise.Atul Gawande / quote ↗
17c. 1965 ADHealth care confronts us with a difficult test. We have never corrected failure in something so deeply embedded in people's lives and in the economy without the pressure of an outright crisis.Atul Gawande / quote ↗
18c. 1965 ADOur health-care morass is like the problems of global warming and the national debt - the kind of vast policy failure that is far easier to get into than to get out of. Americans say that they want leaders who will take on these problems.Atul Gawande / quote ↗
19c. 1965 ADThe history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front.Atul Gawande / quote ↗
20c. 1965 ADPeople say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money.Atul Gawande / quote ↗
21c. 1965 ADEvery country in the world is battling the rising cost of health care. No community anywhere has demonstrably lowered its health-care costs (not just slowed their rate of increase) by improving medical services. They've lowered costs only by cutting or rationing them.Atul Gawande / quote ↗
22c. 1965 ADOliver Sacks remains my hero to this day. He was one of the first medical writers I read. The other was Lewis Thomas, who is no longer alive but is just heroic to me.Atul Gawande / quote ↗
23c. 1965 ADNo 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.Atul Gawande / quote ↗
24c. 1965 ADCost is the spectre haunting health reform. For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage.Atul Gawande / quote ↗
