If we shift as we age toward appreciating everyday pleasures and relationships rather than toward achieving, having, and getting, and if we find this more fulfilling, then why do we take so long to do it? Why do we wait until weβre old? The common view was that these lessons are hard to learn. Living is a kind of skill. The calm and wisdom of old age are achieved over time.
Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.
I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. Whatβs wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome thatβs vastly more probable. The trouble is that weβve built our medical system and culture around the long tail. Weβve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery ticketsβand have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.
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.
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.
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.
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.
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.
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.
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination.
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.
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.
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.
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.
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.
George Orwell is a pinnacle writer, for his combination of moral insight and literary writing.
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.
In every industrialized nation, the movement to reform health care has begun with stories about cruelty.
This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.
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.
