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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

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One Of The Reasons

Atul Gawande

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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.

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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.

The Big Thing That's Happened Is, In The Time Since The Affordable Care Act Has Been Going On, Our Medical Science Has Been Advancing. We Have Now Genomic Data. We Have The Power Of Big Data About What Your Living Patterns Are, What's Happening In Your Body. Even Your Smartphone Can Collect Data About Your Walking Or Your Pulse Or Other Things That Could Be Incredibly Meaningful In Being Able To Predict Whether You Have Disease Coming In The Future And Help Avert Those Problems.

We Recruit For Attitude And Train For Skill.

I Chose Surgery Because I Thought That Perhaps This Would Make Me More Like The Kind Of Person I Wanted To Be.

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.

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.

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.

If The Conversation People Think Is Coming Is The 'death Panel' Conversation, That's A Total Failure.

There Are Times When You Have Sharp Elbows, And People Are Trying To Muscle You Out Of Certain Meetings - Because Then People Could Leak To The Press That You Had A Role In Certain Decisions. I, At Twenty-six, Was Very Impatient And Didn't Know How To Keep My Powder Dry. I Was Running A Team Of Seventy-five People When I Had Never Been A Boss. I Was The Worst Boss Ever.

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.

Just Using A Checklist Requires [doctors] To Embrace Different Values From Ones We've Had, Like Humility, Discipline, Teamwork.

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 May Not Control Life's Circumstances, But Getting To Be The Author Of Your Life Means Getting To Control What You Do With Them.

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.

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.

Arriving At An Acceptance Of One's Mortality Is A Process, Not An Epiphany.

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The Definition Of What It Means To Be Dying Has Changed Radically. We Are Able To Extend People's Lives Considerably, Including Sometimes, Good Days.

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No Travel Ban Or Quarantine Will Seal A Country Completely. Even If Travel Could Be Reduced By Eighty Per Cent-itself A Feat-models Predict That New Transmissions Would Be Delayed Only A Few Weeks. Worse, It Would Only Drive An Increase In The Number Of Cases At The Source. Health-care Workers Who Have Fallen Ill Would Not Be Able To Get Out For Treatment, And The International Health Personnel Needed To Quell The Outbreak Would No Longer Be Able To Go In.

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Expertise Is The Mantra Of Modern Medicine.

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