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. Atul Gawande More Quotes by Atul Gawande More Quotes From Atul Gawande What is needed, however, isn't just that people working together be nice to each other. It is discipline. Discipline is hard--harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at. Atul Gawande discipline nice skills Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength. Atul Gawande prudent faces Human interaction is the key force in overcoming resistance and speeding change. Atul Gawande resistance keys overcoming 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 doctors team practice 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 understanding skills two 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 medicine opportunity way 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 medical school thinking 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. Atul Gawande one-day practice way I learned about a lot of things in medical school, but mortality wasn't one of them. Atul Gawande mortality medical school One of the reasons people might be fallible, why we might fail to do what we try to do isignorance, that we have a limited understanding of the laws of the world - the physical laws that govern the world and of all the particulars of the world upon which those laws work. And then there's ineptitude, meaning that the knowledge is available, but individuals fail to apply it correctly. The third source is "necessary fallibility." That is, we're never going to be omniscient, there is some knowledge that we will simply never achieve, and there are limits to what we will be able to do. Atul Gawande understanding trying people 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 writing trying thinking Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork. Atul Gawande motivation inspiration teamwork We have medicalized aging, and that experiment is failing us. Atul Gawande aging experiments failing We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change. Atul Gawande talking people way 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 blood people fall What about regular professionals, who just want to do what they do as well as they can? Atul Gawande wells want People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as "the constant and earnest effort to accomplish what is undertaken."... Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior. Atul Gawande accomplishment expectations people The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer. Atul Gawande hospice cases people I talked to over two hundred patients and family members about their experiences with aging, serious illnesses, and the big unfixables. But I also spoke with scores of physicians, and especially geriatricians, palliative care doctors, hospice nurses, and nursing home workers. The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people's priorities are, besides just living longer, is to simply ask. And we don't ask. Atul Gawande nursing nurse home We recruit for attitude and train for skill. Atul Gawande recruit skills attitude
