We recruit for attitude and train for skill.

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 dont have the physical skills but because they dont have the moral skills - to practise and admit failure.

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.

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

Our ideas of what our priorities are shift as we come face-to-face with some of the struggles.

This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.

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.