Atul Gawande Quotes & Sayings

How we seek to spend our time may depend on how much time we perceive ourselves to have. — Atul Gawande

People die only once. They have no experience to draw on. — Atul Gawande

You would think that this would be whether the entrepreneur's idea is actually a good one. 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. — Atul Gawande

Medicine's focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet - and this is the painful paradox - we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It's been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs. — Atul Gawande

human beings fail the way all complex systems fail: randomly and gradually. — Atul Gawande

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. — Atul Gawande

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. — Atul Gawande

I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle. — Atul Gawande

We'd come to the same fork in the road I have seen scores of patients come to, the same place I'd seen Alice Hobson come to. We were up against the unfixable. But we were desperate to believe that we weren't up against the unmanageable. Yet short of calling 911 the next time trouble hit, and letting the logic and momentum of medical solutions take over, what were we to do? Between the three of us we had 120 years of experience in medicine, but it seemed a mystery. It turned out to be an education. — Atul Gawande

This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong. — Atul Gawande

When [disease] can't be stopped, that's where we become lost. — Atul Gawande

Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunset. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained? — Atul Gawande

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. If our genes explain less than we imagined, the classical wear-and-tear model may explain more than we knew. — Atul Gawande

It is not death that the very old tell me they fear. It is what happens short of death - losing their hearing, their memory, their best friends, their way of life. As Felix put it to me, "Old age is a continuous series of losses." Philip Roth put it more bitterly in his novel Everyman: "Old age is not a battle. Old age is a massacre. — Atul Gawande

The battle of being mortal is the battle to maintain the integrity of one's life - to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. — Atul Gawande

Courage, Laches responds, "is a certain endurance of the soul. — Atul Gawande

This place where half of us will typically spend a year or more of our lives was never truly made for us. — Atul Gawande

Medical professionals concentrate on repair of health, not sustenance of the soul. Yet — Atul Gawande

People 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

Much of our work today has entered its own B-17 phase. Substantial parts of what software designers, financial managers, firefighters, police officers, lawyers, and most certainly clinicians do are now too complex for them to carry out reliably from memory alone. Multiple fields, in other words, have become too much airplane for one person to fly. Yet it is far from obvious that something as simple as a checklist could be of substantial help. — Atul Gawande

But the fact that, by 2012, one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success. It is a measure of failure. Our ultimate goal, after all, is not a good death but a good life to the very end. The Dutch have been slower than others to develop palliative care programs that might provide for it. One reason, perhaps, is that their system of assisted death may have reinforced beliefs that reducing suffering and improving lives through other means is not feasible when one becomes debilitated or seriously ill. — Atul Gawande

She visited a nursing home nearby. 'It was actually one of the nicer ones,' she said. 'It was clean.' But it was a nursing home. 'You had the people in their wheelchairs all slumped over and lined up in the corridors. It was horrible.' It was the sort of place, she said, that her father feared more than anything. 'He did not want his life reduced to a bed, a dresser, a tiny TV, and half of a room with the curtain between him and someone else.'
But, she said, as she walked out of the place she thought, 'This is what I have to do.' Awful as it seemed, it was where she had to put him.
Why, I asked? — Atul Gawande

The No. 2 pencils had been handed out. The timer had been started. But we had not even registered that the test had begun. — Atul Gawande

We now live in the era of the super-specialist - of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn't. — Atul Gawande

Not the difference between treating and doing nothing, she explained. The difference was in the priorities. In ordinary medicine, the goal is to extend life. We'll sacrifice the quality of your existence now - by performing surgery, providing chemotherapy, putting you in intensive care - for the chance of gaining time later. Hospice deploys nurses, doctors, chaplains, and social workers to help people with a fatal illness have the fullest possible lives right now - — Atul Gawande

If I became just a brain in a jar - as long as I can communicate back and forth with people, that would be okay with me. — Atul Gawande

This simple but profound service - to grasp a fading man's need for everyday comforts, for companionship, for help achieving his modest aims - is the thing that is still so devastatingly lacking more than a century later. It was what Alice Hobson needed but could not find. And it was what Lou Sanders's daughter, through four increasingly exhausting years, discovered she could no longer give all by herself. But with the concept of assisted living, Keren Brown Wilson had managed to embed that vital help in a home. — Atul Gawande

So today, with our average life span in much of the world climbing past eighty years, we are already oddities living well beyond our appointed time. — Atul Gawande

In one study, old people assigned to a geriatrics team stayed independent for far longer, and were admitted to the hospital less. — Atul Gawande

Even our brains shrink: at the age of thirty, the brain is a three-pound organ that barely fits inside the skull; by our seventies, gray-matter loss leaves almost an inch of spare room. — Atul Gawande

An audience is a community. The published word is a declaration of membership in that community and also of a willingness to contribute something meaningful to it.
So choose your audience. Write something. — Atul Gawande

I was learning. In medicine, we have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually — Atul Gawande

Block has a list of questions that she aims to cover with sick patients in the time before decisions have to be made: What do they understand their prognosis to be, what are their concerns about what lies ahead, what kinds of trade-offs are they willing to make, how do they want to spend their time if their health worsens, who do they want to make decisions if they can't? A decade — Atul Gawande

HOW DID WE wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives? — Atul Gawande

Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice. — Atul Gawande

Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future. Understanding — Atul Gawande

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. — Atul Gawande

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. — Atul Gawande

Instead they choose to accept their fallibilities. They recognised the simplicity and power of using a checklist. — Atul Gawande

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. — Atul Gawande

This is normal. Although the processes can be slowed - diet and physical activity can make a difference - they cannot be stopped. — Atul Gawande

The job of doctors is to supply up-to-date knowledge and skills. The job of patients is to supply the decisions. — Atul Gawande

To maintain the same volume of blood flow through our narrowed and stiffened blood vessels, the heart has to generate increased pressure. As a result, more than half of us develop hypertension by the age of sixty-five. — Atul Gawande

I believe that one version of the good in life can be defined by the moments I sometimes had playing tennis as a sixteen-year-old. You'd be out on the court and for an hour, two hours, sometimes an entire roasting hot day, and every single thing you hit would go in. Hit that ball as hard as you wanted, wherever you wanted, and it went in. — Atul Gawande

In my grandfather's premodern world, how he wanted to live was his choice, and the family's role was to make it possible. — Atul Gawande

As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in this world
to make choices and sustain connections to others according to their own priorities. In modern society, we have come to assume that debility and dependence rule out such autonomy. — Atul Gawande

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. — Atul Gawande

Arriving at an acceptance of one's mortality is a process, not an epiphany. — Atul Gawande

We 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

We are running up against the difficulty of maintaining a coherent philosophical distinction between giving people the right to stop external or artificial processes that prolong their lives and giving them the right to stop the natural, internal processes that do so — Atul Gawande

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. — Atul Gawande

I asked Thomas what his special technique for sales was as a kid. He said he didn't have any. It was simply that "I was willing to be rejected. That's what allows you to be a good salesperson. You have to be willing to be rejected." It — Atul Gawande

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. — Atul Gawande

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. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers. — Atul Gawande

No, the more familiar and widely dangerous issue is a kind of silent disengagement, the consequence of specialized technicians sticking narrowly to their domains. "That's not my problem" is possibly the worst thing people can think, whether they are starting an operation, taxiing an airplane full of passengers down a runway, or building a thousand-foot-tall skyscraper. — Atul Gawande

Our 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

For all but our most recent history, death was a common, ever-present possibility. It didn't matter whether you were five or fifty. Every day was a roll of the dice. — Atul Gawande

Medicine was just another a tool you could try, no different from a healing ritual or a family remedy and no more effective. — Atul Gawande

The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer. — Atul Gawande

I think we are faced in medicine with the reality that we have to be willing to talk about our failures and think hard about them, even despite the malpractice system. I mean, there are things that we can do to make that system better. — Atul Gawande

they have priorities beyond merely being safe and living longer; that the chance to shape one's story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone's lives. Inevitably, — Atul Gawande

If I get hit by a bus tomorrow, my patients will not even be postponed. Another surgeon would step in and take over. The reason to do research and writing is that it at least makes me feel not entirely replaceable. If I didn't write, I don't know if I would do surgery. — Atul Gawande

What is the alternative to understanding the complexity of the world? — Atul Gawande

If there is a credo in practical medicine, it is that the important thing is to be sensible. — Atul Gawande

Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields - from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us. That — Atul Gawande

The third requirement for success is ingenuity - thinking — Atul Gawande

It is unsettling to find how little it takes to defeat success in medicine. You come as a professional equipped with expertise and technology. You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific
matters of how casual you should be, how formal, how reticent, how forthright. Also: how apologetic, how self-confident, how money-minded. 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 each interaction is negotiated can determine whether a doctor is trusted, whether a patient is heard, whether the right diagnosis is made, the right treatment given. But in this realm there are no perfect formulas. — Atul Gawande

We don't like checklists. They can be painstaking. They're not much fun. But I don't think the issue here is mere laziness. There's something deeper, more visceral going on when people walk away not only from saving lives but from making money. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating. — Atul Gawande

In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die. — Atul Gawande

They provided assisted living, but no one seemed to think it was their job to actually assist him with living — Atul Gawande

There have now been many studies of elite performers - international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth - and the biggest difference researchers find between them and lesser performers is the cumulative amount of deliberate practice they've had. Indeed, the most important talent may be the talent for practice itself. — Atul Gawande

I learned about a lot of things in medical school, but mortality wasn't one of them. — Atul Gawande

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength. — Atul Gawande

There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not. Universal health-care coverage belongs to the first category: you can pick one of several possible solutions, pass a bill, and (allowing for some tinkering around the edges) it will happen. — Atul Gawande

Sometime over the last several decades - and it is only over the last several decades - science has filled in enough knowledge to make ineptitude as much our struggle as ignorance. — Atul Gawande

But it's not only the breadth and quantity of knowledge that has made medicine complicated. It is also the execution - the practical matter of what knowledge requires clinicians to do. — Atul Gawande

For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute — Atul Gawande

I write because it's my way of finding cool ideas, thinking through hard problems and things I don't understand, and getting better at something. — Atul Gawande

Research has found that loss of bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels. — Atul Gawande

There 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

Living is a kind of skill. The calm and wisdom of old age are achieved over time. — Atul Gawande

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline. — Atul Gawande

Few societies have come to grips with the new demography. We cling to the notion of retirement at sixty-five - a reasonable notion when those over sixty-five were a tiny percentage of the population but increasingly untenable as they approach 20 percent. People are putting aside less in savings for old age now than they have at any time since the Great Depression. More than half of the very old now live without a spouse and we have fewer children than ever before, yet we give virtually no thought to how we will live out our later years alone. — Atul Gawande

In a fire, the metal can plasticize - lose its stiffness and bend like spaghetti. This was why the World Trade Center buildings collapsed, — Atul Gawande

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? The — Atul Gawande

One has to decide whether one's fears or one's hopes are what should matter most. — Atul Gawande

In the end, people don't view their life as merely the average of all its moments - which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life maybe empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves. — Atul Gawande

Coaching done well may be the most effective intervention designed for human performance. — Atul Gawande

The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. — Atul Gawande

As Montaigne wrote, observing late-sixteenth-century life, To die of age is a rare, singular, and extraordinary death, and so much less natural than others: it is the last and extremest kind of dying. — Atul Gawande

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

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. — Atul Gawande

Measurements of people's minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves. Unlike your experiencing self - which is absorbed in the moment - your remembering self is attempting to recognize not only the peaks of joy and valleys of misery but also how the story works out as a whole. — Atul Gawande

The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don't. — Atul Gawande

The 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

Modernization did not demote the elderly. It demoted the family. It gave people - the young and the old - a way of life with more liberty and control, including the liberty to be less beholden to other generations. The veneration of elders may be gone, but not because it has been replaced by veneration of youth. It's been replaced by veneration of the independent self. * * * — Atul Gawande

It's easy to hide in a statement. It's hard to hide between statements," Cook said. — Atul Gawande

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. — Atul Gawande

Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers. I wrote this book in — Atul Gawande

If end-of-life discussions were an experimental drug, the FDA would approve it. — Atul Gawande