Atul Gawande Quotes

“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.”

— Atul Gawande

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.

— Atul Gawande

“How we seek to spend our time may depend on how much time we perceive ourselves to have.”

— Atul Gawande

“Betterment 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

“Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.”

— 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

Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

— Atul Gawande

“Pain is a symphony - a complex response that includes not just a distinct sensation but also motor activity, a change in emotion, a focusing of attention, a brand-new memory.”

— Atul Gawande

The important question isn't how to keep bad physicians from harming patient; it's how to keep good physicians from harming patients. Medical malpractice suits are a remarkably ineffective remedy.
(In reference to a Harvard Medical Practice Study) ... fewer than 2 percent of the patients who had received substandard care ever filed suit. Conversely, only a small minority among patients who did sue had in fact been victims of negligent care. And a patient's likelihood of winning a suit depended primarily on how poor his or her outcome was, regardless of whether that outcome was caused by disease or unavoidable risks of care. The deeper problem with medical malpractice is that by demonizing errors they prevent doctors from acknowledging & discussing them publicly. The tort system makes adversaries of patient & physician, and pushes each other to offer a heavily slanted version of events.

— 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

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

— Atul Gawande

“People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.”

— 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

“The 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

Terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression.

— Atul Gawande

“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.”

— Atul Gawande

“Introduction I learned about a lot of things in medical school, but mortality wasn't one of them. Although I was given a dry, leathery corpse to dissect in my first term, that was solely a way to learn about human anatomy. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point. The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise. The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy's classic novella.”

— 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

“Living is a kind of skill.”

— Atul Gawande

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

— Atul Gawande

“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.”

— Atul Gawande

You know, there's this phase of people's lives in which they can't really cope on their own, and we ought to find a way to make it manageable.

— Atul Gawande

“Even worse than losing self-confidence, though, is reacting defensively. There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations. As one surgeon told me, it is a rare but alarming thing to meet a surgeon without fear. "If you're not a little afraid when you operate," he said, "you're bound to do a patient a grave disservice.”

— Atul Gawande

“Technological society has forgotten what scholars call the "dying role" and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay.”

— Atul Gawande

“We need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon.”

— Atul Gawande

“What tormented Ivan Ilyich most," Tolstoy writes, "was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result." Ivan Ilyich has flashes of hope that maybe things will turn around, but as he grows weaker and more emaciated he knows what is happening. He lives in mounting anguish and fear of death. But death is not a subject that his doctors, friends, or family can countenance. That is what causes him his most profound pain.”

— Atul Gawande

“One American in seven has no coverage, and one in three younger than sixty-five will lose coverage at some point in the next two years. These are people who aren't poor or old enough to qualify for government programs but whose jobs aren't good enough to provide benefits either.”

— Atul Gawande

“Amount of freedom you have in your life is not the measure of the worth of your life. Just as safety is an empty and even self-defeating goal to live for, so ultimately is autonomy.”

— Atul Gawande

“In a sense, the advances of modern medicine have given us two revolutions: we've undergone a biological transformation of the course of our lives and also a cultural transformation of how we think about that course.”

— Atul Gawande

“Whereas today people often understate their age to census takers, studies of past censuses have revealed that they used to overstate it.”

— Atul Gawande

“In the past, surviving into old age was uncommon, and those who did survive served a special purpose as guardians of tradition, knowledge, and history.”

— Atul Gawande

“The third requirement for success is ingenuity-thinking”

— Atul Gawande

“New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment.”

— 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

“There was a succession of roommates, never chosen with her input and all with cognitive impairments. Some were quiet. One kept her up at night. She felt incarcerated, like she was in prison for being old. The”

— Atul Gawande

“The key word in her mind was home. Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don't. This loss of freedom was what people like Lou Sanders and Wilson's mother, Jessie, dreaded. Wilson”

— Atul Gawande

“When, as the researchers put it, "life's fragility is primed," people's goals and motives in their everyday lives shift completely. It's perspective, not age, that matters most. Tolstoy”

— 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

“Believe that the difference in death rates can be traced to the fundamental human need for a reason to live.”

— Atul Gawande

“As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.”

— Atul Gawande

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination.”

— Atul Gawande

“Every 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

“Cost 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

“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'm floating between multiple media. I really wish you could buy the hardcover book and it would come with the digital download and audible version. I spend stupid amounts of money because I'm usually buying my books in at least two formats.”

— 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

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

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

— Atul Gawande

If we took away the ability to put defibrillators in people in their last years, people would be shouting in the streets.

— Atul Gawande

“What is the alternative to understanding the complexity of the world?”

— Atul Gawande