Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.
I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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.
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.
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.
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.
Arriving at an acceptance of one’s mortality is a process, not an epiphany.
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.
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.
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.
We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.
Are doctors who make mistakes villains? No, because then we all are.
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.
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.
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.
The evidence is that people who enter hospice don’t have shorter lives. In many cases they are longer.
We Have Medicalized Aging, and That Experiment Is Failing Us.
Coaching done well may be the most effective intervention designed for human performance.
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.