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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

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The Possibilities And Probabilities

Atul Gawande

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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.

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What Is The Alternative To Understanding The Complexity Of The World?

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.

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.

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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.

We Yearn For Frictionless, Technological Solutions. But People Talking To People Is Still The Way Norms And Standards Change.

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.

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.

The Evidence Is That People Who Enter Hospice Don't Have Shorter Lives. In Many Cases They Are Longer.

Good Checklists, On The Other Hand Are Precise. They Are Efficient, To The Point, And Easy To Use Even In The Most Difficult Situations. They Do Not Try To Spell Out Everything--a Checklist Cannot Fly A Plane. Instead, They Provide Reminders Of Only The Most Critical And Important Steps--the Ones That Even The Highly Skilled Professional Using Them Could Miss. Good Checklists Are, Above All, Practical.

Difficult Situations

When We Lived In A Society Where We Had Large Families That Lived Together, Especially In Agricultural Societies Like My Grandfather And Father Grew Up In, The Result Is You Always Had Family Around To Take Care Of You.

In One Study, Old People Assigned To A Geriatrics Team Stayed Independent For Far Longer, And Were Admitted To The Hospital Less.

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.

What About Regular Professionals, Who Just Want To Do What They Do As Well As They Can?

My Biggest Fear, That 27 Percent Of Americans Under 65 Have An Existing Health Condition That, Without The Protections Of The Affordable Care Act, Would Mean They Would - Could Be Automatically Excluded From Insurance Coverage. Before The Aca, They Wouldn't Have Been Able To Get Insurance Coverage On The Individual Market, You Know, If You're A Freelancer Or If You Had A Small Business Or The Like.

Over Time I Learned That There Are Two Very Different Satisfactions That You Can Have In Your Life. One Is The Satisfaction Of Becoming Skilled At Something. It Almost Doesn't Matter What The Terrain Is. There Is A Deep, Soul-feeding Resonance In Mastery Itself, Whether In Teaching, Writing A Complicated Software Program, Coaching A Baseball Team, Or Marshalling A Group Of People To Start A New Business.

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.

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.

We Recruit For Attitude And Train For Skill.

If We Took Away The Ability To Put Defibrillators In People In Their Last Years, People Would Be Shouting In The Streets.

Coaching Done Well May Be The Most Effective Intervention Designed For Human Performance.

Expertise Is The Mantra Of Modern Medicine.

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.

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