If We Took Away The Ability To

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.

I Talked To Over Two Hundred Patients And Family Members About Their Experiences With Aging, Serious Illnesses, And The Big Unfixables. But I Also Spoke With Scores Of Physicians, And Especially Geriatricians, Palliative Care Doctors, Hospice Nurses, And Nursing Home Workers. The Biggest Thing I Found Was That When These Clinicians Were At Their Best, They Were Recognizing That People Had Priorities Besides Merely Living Longer. The Most Important And Reliable Way That We Can Understand What People's Priorities Are, Besides Just Living Longer, Is To Simply Ask. And We Don't Ask.

We Recruit For Attitude And Train For Skill.

People Underestimate The Importance Of Dilligence As A Virtue. No Doubt It Has Something To Do With How Supremely Mundane It Seems. It Is Defined As "the Constant And Earnest Effort To Accomplish What Is Undertaken."... Understood, However, As The Prerequisite Of Great Accomplishment, Diligence Stands As One Of The Most Difficult Challenges Facing Any Group Of People Who Take On Tasks Of Risk And Consequence. It Sets A High, Seemingly Impossible, Expectation For Performance And Human Behavior.

Having Great Components Is Not Enough, And Yet We've Been Obsessed In Medicine With Components. We Want The Best Drugs, The Best Technologies, The Best Specialists, But We Don't Think Too Much About How It All Comes Together.