Complications Quotes

“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.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“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.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“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, Complications: A Surgeon's Notes on an Imperfect Science

“There is a saying about surgeons, meant as a reproof: "Sometimes wrong; never in doubt." But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off - or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn't, of course. But still he cut.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“We want perfection without practice. Yet everyone is harmed if no one is trained for the future.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“There have now been many studies of elite performers—international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth—and the biggest difference researchers find between them and lesser performers is the cumulative amount of deliberate practice they’ve had. Indeed, the most important talent may be the talent for practice itself.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Pain is a symphony - a complex response that includes not just a distinct sensation but also motor activity, a change in emotion, a focusing of attention, a brand-new memory.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“In psychology, there's something called the broken-leg problem. A statistical formula may be highly successful in predicting whether or not a person will go to a movie in the next week. But someone who knows that this person is laid up with a broken leg will beat the formula. No formula can take into account the infinite range of such exceptional events.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“The important question isn't how to keep bad physicians from harming patient; it's how to keep good physicians from harming patients. Medical malpractice suits are a remarkably ineffective remedy.
(In reference to a Harvard Medical Practice Study)... fewer than 2 percent of the patients who had received substandard care ever filed suit. Conversely, only a small minority among patients who did sue had in fact been victims of negligent care. And a patient's likelihood of winning a suit depended primarily on how poor his or her outcome was, regardless of whether that outcome was caused by disease or unavoidable risks of care. The deeper problem with medical malpractice is that by demonizing errors they prevent doctors from acknowledging & discussing them publicly. The tort system makes adversaries of patient & physician, and pushes each other to offer a heavily slanted version of events.
”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“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, Complications: A Surgeon's Notes on an Imperfect Science

“we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“not only do all human beings err, but they err frequently and in predictable, patterned ways.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Even worse than losing self-confidence, though, is reacting defensively. There are surgeons who will see faults everywhere except in themselves. They have no questions and no fears about their abilities. As a result, they learn nothing from their mistakes and know nothing of their limitations. As one surgeon told me, it is a rare but alarming thing to meet a surgeon without fear. “If you’re not a little afraid when you operate,” he said, “you’re bound to do a patient a grave disservice.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Surgeons, as a group, adhere to a curious egalitarianism. They believe in practice, not talent. People often assume that you have to have great hands to become a surgeon, but it’s not true. When I interviewed to get into surgery programs, no one made me sew or take a dexterity test or checked if my hands were steady. You do not even need all ten fingers to be accepted. To be sure, talent helps. Professors say every two or three years they’ll see someone truly gifted come through a program—someone who picks up complex manual skills unusually quickly, sees the operative field as a whole, notices trouble before it happens. Nonetheless, attending surgeons say that what’s most important to them is finding people who are conscientious, industrious, and boneheaded enough to stick at practicing this one difficult thing day and night for years on end. As one professor of surgery put it to me, given a choice between a Ph.D. who had painstakingly cloned a gene and a talented sculptor, he’d pick the Ph.D. every time. Sure, he said, he’d bet on the sculptor being more physically talented; but he’d bet on the Ph.D. being less “flaky.” And in the end that matters more. Skill, surgeons believe, can be taught; tenacity cannot.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“We are a species that evolved to survive starvation, not resist abundance”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“It is a reality of medicine that choosing to not do something—to not order a test, to not give an antibiotic, to not take a patient to the operating room—is far harder than choosing to do it.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“One wants to know whether, in the end, her troubles were physical or psychological. But it is a question as impossible to answer as whether a blush is physical or mental—or, for that matter, whether a person is. Everyone is both, inseparable even by a surgeon’s blade.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“all human beings err, but they err frequently and in predictable, patterned ways.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“If there is a credo in practical medicine, it is that the important thing is to be sensible.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“We want progress in medicine to be clear and unequivocal, but of course it rarely is. Every new treatment has gaping unknowns - for both patients and society - and it can be hard to decide what do do about them.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Western medicine is dominated by a single imperative—the quest for machinelike perfection in the delivery of care.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“In medicine, we have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm for supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seems to help. But there is still no getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of colon. No matter how many protections we put in place, on average these cases go less well with a novice then with someone experienced.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Medicine’s ground state is uncertainty. And wisdom—for both patients and doctors—is defined by how one copes with it. This”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“During the Second World War, for example, Lieutenant Colonel Henry K. Beecher conducted a classic study of men with serious battlefield injuries. In the Cartesian view, the degree of injury ought to determine the degree of pain, rather like a dial controlling volume. Yet 58 percent of the men—men with compound fractures, gunshot wounds, torn limbs—reported only slight pain or no pain at all. Just 27 percent of the men felt enough pain to request pain medication, although such wounds routinely require narcotics in civilians. Clearly, something that was going on in their minds—Beecher thought they were overjoyed to have escaped alive from the battlefield—counteracted the signals sent by their injuries. Pain was becoming recognized as far more complex than a one-way transmission from injury to “ouch.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“A resident has a distinctive vantage on medicine. You are an insider, seeing everything and a part of everything; yet at the same time you see it anew.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“Some I am fortunate to still keep up with. Others I was never given the chance to know as well as I wish I could have. All of them have taught me more than any could know.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science

“what he has found is a stubborn, overwhelming, and embarrassing degree of inconsistency in what we do.”
― Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science