American - Scientist | November 5, 1965 -
George Orwell is a pinnacle writer, for his combination of moral insight and literary writing.
Atul Gawande
WritingMoralInsightCombination
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.
WritingHandsYouLooksSkillSee
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.
FailureTimeFirePeopleYouMoral
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.
CommunityHealthMedicalWorldCare
Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.
PoorFixFirstPositionBe The First
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.
HealthGreatAmericanSystemCost
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.
HealthGreatServicePeopleCare
In every industrialized nation, the movement to reform health care has begun with stories about cruelty.
HealthCareCrueltyNationMovement
This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.
CareRealityPointHarmHealAny
We now live in the era of the super-specialist - of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn't.
LiveTimePracticeBetterNowEra
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.
FailureHealthPeopleCarePressure
Our health-care morass is like the problems of global warming and the national debt - the kind of vast policy failure that is far easier to get into than to get out of. Americans say that they want leaders who will take on these problems.
FailureProblemsSayWantKindDebt
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