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.
Interpretation
Outsiders see the flaws in our institutions, but their lack of integration limits their ability to improve them.
This quote highlights the paradox of outsiders in society; while they may be able to identify the shortcomings and inefficiencies of social institutions, their outsider status often prevents them from effectively enacting change. Their distance from the established system makes it difficult for them to understand the complexities and nuances required for meaningful reform.
In practice
In a discussion on social reform, one might quote Gawande to highlight the importance of insider perspectives.
A failure often does not have to be a failure at all. However, you have to be ready for it-will you admit when things go wrong? Will you take steps to set them right?-because the difference between triumph and defeat, you'll find, isn't about willingness to take risks. It's about mastery of rescue.
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.
Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork.
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.
At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.
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.
We lead two lives, and the half of our soul is madness, and half heaven is lit by a black sun. I say I am a man, is the other that hides in me?
Then we shall... be able to take part in the discussion of the question of why it is that we and the universe exist. If we find the answer to that, it would be the ultimate triumph of human reason - for then we would know the mind of God.
The state is a force incarnate. Worse, it is the silly parading of force. It never seeks to prevail by persuasion. Whenever it thrusts its finger into anything it does so in the most unfriendly way. Its essence is command and compulsion.
Coastal sailing as long as it is perfectly safe and easy commands no magic. Overseas expeditions are invariably bound up with ceremonies and ritual. Man resorts to magic only where chance and circumstances are not fully controlled by knowledge.
But for me there is neither Monday nor Sunday: there are days which pass in disorder, and then, sudden lightning like this one. Nothing has changed and yet everything is different. I can't describe it, it's like the Nausea and yet it's just the opposite: at last an adventure happens to me and when I question myself I see that it happens that I am myself and that I am here; I am the one who splits in the night, I am as happy as the hero of a novel.
When my time to die comes an angel will be there to comfort me. He will give me peace and joy even at that most critical hour, and usher me into the presence of God, and I will dwell with the Lord forever. Thank God for the ministry of His blessed angels.
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