Quotes from Better, by Atul Gawande

- ‘The third requirement for success is ingenuity – thinking anew. Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not [sic] paper over, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.’ (9)
- ‘Making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their [sic] hands.’ (21)
- ‘After a century of effort, the only successful attempt at eradication of a global disease has been the battle against smallpox – a mammoth undertaking that was, just the same, decidedly simpler than the campaign against polio. Smallpox, with its distinctive blisters and vesicles, could be readily and quickly identified; the moment a case appeared, a team could be dispatched to immunize everyone the victim might have come into contact. That strategy, known as ‘ring immunization’, eradicated the disease by 1979.’ (32)
- ‘The only leader in the West who took [Albert Sabin] up on the idea [of mass polio vaccinations] was Fidel Castro. In 1962, Castro’s Committee for the Defense of the Revolution organized 82,366 local committees to carry out a succession of weeklong house-to-house national immunization campaigns using the Sabin vaccine. In 1963, only one case of polio occurred in Cuba .’ (36)
- ‘Mortality from gun assaults has fallen from 16 percent in 1964 to 5 percent today.’ (52)
- ‘Although more US soldiers have been wounded in combat in the current way than in the Revolutionary War, the War of 1812, and the Spanish-American War combined, and more than in the first four years of military involvement in Vietnam, we have had substantially fewer deaths. Just 10 percent of wounded American soldiers have died [ Vietnam : 24%; WWII: 30%].’ (53)
- ‘Once the soldiers began wearing [bulletproof vests] more consistently, the percentage killed on the battlefield dropped instantly.’ (56)
- ‘They had available to them two Combat Support Hospitals (or CSHs – or ‘CaSHes’ – as they call them) in four locations for that next level of care. These are 248-bed hospitals typically with six operating tables, some specialty surgery services, and radiology and laboratory facilities. Mobile hospitals as well, they arrive in modular units by air, tractor trailer, or ship and can be fully functional in twenty-four to forty-eight hours.’ (59)
- ‘In 2005, the United States spent more than two trillion dollars – one-sixth of all the money we have – on health care.’ (126)
- ‘The AMA clarified the ban [against physician participation in executions] in its 1992 Code of Medical Ethics. Article 2.06 states, ‘A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution,’ although an individual physician’s opinion about capital punishment remains ‘the personal moral decision of the individual.’ The code further stipulates that unacceptable participation includes prescribing or administering medications as part of the execution procedure, monitoring vital signs, rendering technical advice, selecting injection sites, starting or supervising placement of intravenous lines, or simply being present.’ (135)
- ‘The American Nurses Association (ANA) has adopted a similar prohibition. Only the national pharmacists’ society, the American Pharmaceutical Association, permits involvement.’ (135)
- ‘To fix medicine, [Don] Berwick maintained, we need to do two things: measure ourselves and be more open about what we are doing. We should be routinely comparing the performance of doctors and hospitals, looking at everything from surgical complication rates to how often a drug ordered for a patient is delivered correctly and on time. And, he insisted, hospitals should give patients total access to the information.’ (214)
- ‘[At the best CF center] before patients went home, the doctors gave them a written summary of their visit and a complete copy of their record, something that I had never thought to do in my own practice.’ (218)
- ‘[ Warwick ] believed that excellence came from seeing, on a daily basis, the difference between 99.5 perfect successful and being 99.95 percent successful.’ (222)
- ‘[In an Indian regional hospital] there was, I soon realized, noting especially exotic about the troubles most people came to the surgeons with, and this in itself was revealing. In the cottage hospital outside my father’s village, half the patients were admitted for diseases we do not often see in the West – waterborne diarrhea, tuberculosis, malaria – but it is unusual for them to die from such illness.’ (238)
- ‘People continue to get cholera and amoebiasis, but they recover. And then they face what we face – gallbladder problems, cancer, hernias, car-crash injuries. The number one cause of death inIndia is now coronary artery disease, not respiratory infections of diarrheal illness.’ (238)
- ‘More than one doctor told me that it was easier to get a new MRI machine than to maintain basic supplies and hygiene.’ (242)
- Gawande’s rules: 1. ‘Ask an unscripted question.’ 2. ‘Don’t complain.’ 3. ‘Count something.’ 4. ‘Write something.’ 5. ‘Change.’

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