Better: A Surgeon's Notes on Performance

by Atul Gawande

WHAT DOES IT take to be good at something in which failure is so easy, so effortless?

The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality.

“I didn’t really have anything else going on anyway,” one demurred when I spoke to her. When you make an effort, you find sometimes you are not the only one willing to do so.

organizations are fond of grand-sounding pledges to rid the planet of this or that menace. They nearly always fail, however.

U.S. homicide rates, for example, have dropped in recent years to levels unseen since the mid-1960s. Yet aggravated assaults, particularly with firearms, have more than tripled during that period. A key mitigating factor appears to be the trauma care provided: more people may be getting shot, but doctors are saving even more of them. Mortality from gun assaults has fallen from 16 percent in 1964 to 5 percent today.

It’s precisely because of our enormous success that people are bound to wonder what went wrong when we fail.

the hardest part of being a doctor, I have found, is to know what you have power over and what you don’t.

Many talk about the border between what we can do and what we can’t as if it were a bright line drawn across the hospital bed.

Perhaps we could spare this fruitless spending—if only we knew when people’s last six months would be.

So maybe we should never hold back, never stop pushing. In the face of uncertainty, what could be safer? It doesn’t take long to realize, however, that the rule is neither viable nor humane.

In the end, no guidelines can tell us what we have power over and what we don’t.

“We’ve failed, Janelle,” he said. “It’s important to acknowledge when we’ve failed.”

Everyone knows that averageness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child’s pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.