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" My vantage point on the world is the operating room where I see my patients. "

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" 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. "

" George Orwell is a pinnacle writer, for his combination of moral insight and literary writing. "

" The writing I love has something memorable in it - an image, a smell. It's the connection between the moment and the whole concept, weaving the micro together with the macro so that it has a hold on people - that's writing. "

" The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care. "

" No one looks at your hands to see how much they shake when you are interviewed to be a surgeon. The physical skills required are no greater than for writing cursive script. If an operation requires so much skill only a few surgeons can do it, you modify the operation to make it simpler. "

" Expertise is the mantra of modern medicine. "

" 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. "

" If I get hit by a bus tomorrow, my patients will not even be postponed. Another surgeon would step in and take over. The reason to do research and writing is that it at least makes me feel not entirely replaceable. If I didn't write, I don't know if I would do surgery. "

" 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. "

" People say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money. "

" I write because it's my way of finding cool ideas, thinking through hard problems and things I don't understand, and getting better at something. "

" When I do an operation, it's half a dozen people. When it goes beautifully, it's like a symphony, with everybody playing their part. "

" Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. "

" The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front. "

" You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they don't have the physical skills but because they don't have the moral skills - to practise and admit failure. "

" In every industrialized nation, the movement to reform health care has begun with stories about cruelty. "

" I was never born to write. I was taught to write. And I am still being taught to write. "

" 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. "

" Our great struggle in medicine these days is not just with ignorance and uncertainty. It's also with complexity: how much you have to make sure you have in your head and think about. There are a thousand ways things can go wrong. "

" As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems. "

Working Together

" Oliver Sacks remains my hero to this day. He was one of the first medical writers I read. The other was Lewis Thomas, who is no longer alive but is just heroic to me. "

" I have always believed that there is nothing greater than a life in rock n' roll - it has to be good rock n' roll - and I still think it is true. "

" I believe that one version of the good in life can be defined by the moments I sometimes had playing tennis as a sixteen-year-old. You'd be out on the court and for an hour, two hours, sometimes an entire roasting hot day, and every single thing you hit would go in. Hit that ball as hard as you wanted, wherever you wanted, and it went in. "

" 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. "