The possibilities and probabilities are all we have to work with in medicine, though. What we are drawn to in this imperfect science, what we in fact covet in our way, is the alterable moment-the fragile but crystalline opportunity for one's know-how, ability, or just gut instinct to change the course of another's life for the better.
Interpretation
Medicine is an imperfect science, and it relies on our skills and instincts to make a positive impact on lives.
In this quote, Atul Gawande emphasizes the inherent uncertainties in medicine, highlighting that although it operates within the realm of possibilities and probabilities, it is the 'alterable moment' that truly matters. This moment represents the opportunity for healthcare professionals to use their knowledge, skills, and intuition to make a meaningful difference in the lives of their patients, reflecting the delicate balance of science and the human touch in medical practice.
In practice
During a medical conference, a speaker might use this quote to emphasize the importance of skill and instinct in patient care.
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 cannot step aside and say that we have achieved our goal by inventing a new drug or a new way by which to treat presently incurable diseases, a new way to help those who suffer from malnutrition, or the creation of ideal balanced diets on a worldwide scale. We cannot rest till the way has been found, with our help, to bring our finest achievement to everyone.
AIDS is a plague - numerically, statistically and by any definition known to modern public health - though no one in authority has the guts to call it one.
Early detection is key," she said. "And if I hadn't found my lump early, I don't know what would have been. I am still here and I want to encourage women to do that on a regular basis.
Surgeon generals are appointed by presidents, but our work isn't about politics. Our highest duty to to the public. Our true guide is science. Our job is to speak the truth about public health, even when it's controversial or perceived as political.
To be without health insurance in this country means to be without access to medical care. But health is not a luxury, nor should it be the sole possession of a privileged few. We are all created b'tzelem elohim - in the image of God - and this makes each human life as precious as the next. By 'pricing out' a portion of this country's population from health care coverage, we mock the image of God and destroy the vessels of God's work.
Analysis helps patients put their unconscious procedural memories and actions into words and into context, so they can better understand them. In the process they plastically retranscribe these procedural memories, so that they become conscious explicit memories, sometimes for the first time, and patients no longer need to "relive" or "reenact" them, especially if they were traumatic.
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