Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.

When we, doctors, ask patients what their priorities are if time is short, what we do is we use what is available to us - whether it's geriatric care or palliative care or hospice care - to make sure they're living the kind of life that they want to live.

What is the alternative to understanding the complexity of the world?

I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle.

We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets - and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork.

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.