Top 113 Quotes & Sayings by Atul Gawande
Explore popular quotes and sayings by an American scientist Atul Gawande.
Last updated on April 13, 2025.
To become a doctor, you spend so much time in the tunnels of preparation - head down, trying not to screw up, trying to make it from one day to the next - that it is a shock to find yourself at the other end, with someone shaking your hand and asking how much money you want to make.
Expertise is the mantra of modern medicine.
The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front.
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.
Oliver 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.
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.
Health 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.
No one looks at your hands to see how much they shake when you are interviewed to be a surgeon. The physical skills required are no greater than for writing cursive script. If an operation requires so much skill only a few surgeons can do it, you modify the operation to make it simpler.
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.
You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they don't have the physical skills but because they don't have the moral skills - to practise and admit failure.
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.
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.
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.
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination.
Most people are squeamish about saying how much they earn, but in medicine the situation seems especially fraught. Doctors aren't supposed to be in it for the money, and the more concerned a doctor seems to be about making money the more suspicious people become about the care being provided.
When I do an operation, it's half a dozen people. When it goes beautifully, it's like a symphony, with everybody playing their part.
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.
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.
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.
I was never born to write. I was taught to write. And I am still being taught to write.
My vantage point on the world is the operating room where I see my patients.
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.
I have always believed that there is nothing greater than a life in rock n' roll - it has to be good rock n' roll - and I still think it is true.
The damage that the human body can survive these days is as awesome as it is horrible: crushing, burning, bombing, a burst blood vessel in the brain, a ruptured colon, a massive heart attack, rampaging infection. These conditions had once been uniformly fatal.
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.
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.
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.
The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care.
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.
This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.
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.
In every industrialized nation, the movement to reform health care has begun with stories about cruelty.
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.
Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.
Human beings are social creatures. We are social not just in the trivial sense that we like company, and not just in the obvious sense that we each depend on others. We are social in a more elemental way: simply to exist as a normal human being requires interaction with other people.
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.
The writing I love has something memorable in it - an image, a smell. It's the connection between the moment and the whole concept, weaving the micro together with the macro so that it has a hold on people - that's writing.
George Orwell is a pinnacle writer, for his combination of moral insight and literary writing.
Our great struggle in medicine these days is not just with ignorance and uncertainty. It's also with complexity: how much you have to make sure you have in your head and think about. There are a thousand ways things can go wrong.
Once you start to ask patients about their priorities, you discover what they're living for. Once you uncover that, it helps you, as a doctor, decide what to fight for. And when we do that, we often end up identifying limits to the kind of care that people want. One's assumption is that these people are going to live shorter lives, but what we're doing is protecting quality of life. In doing so, you sometimes end up helping people live longer. Certainly, you help people live better days and with more purpose in their lives.
Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.
You may not control life's circumstances, but getting to be the author of your life means getting to control what you do with them.
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.
Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.
We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.
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 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.
Developing a skill is painful, though. It is difficult. And that's part of the satisfaction. You will only find meaning in what you struggle with. What you struggle to get good at next may not seem the exact right thing for you at first. With time and effort, however, you will discover new possibilities in yourself-an ability to solve problems, for instance, or to communicate, or to create beauty.
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.
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.
My own son has a congenital heart condition, where his life was saved by a cardiac surgeon stepping in at 11 days of life to save his life. But he is now 21 years old because of constant monitoring and working with him with a primary care physician. that's the only reason now that he's getting to live a long and healthy life. That's what we're not rewarding. They don't have the kind of resources and commitment that we are giving to people like me. I have millions of dollars of equipment available to me when I go to work every day in an operating room.
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.
Arriving at an acceptance of one's mortality is a process, not an epiphany.
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.
Coaching done well may be the most effective intervention designed for human performance.
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.
The battle of being mortal is the battle to maintain the integrity of one's life.
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.
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.
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
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