Once you start to ask patients about their priorities, you discover what they're living for. Once you uncover that, it helps you, as a doctor, decide what to fight for. And when we do that, we often end up identifying limits to the kind of care that people want. One's assumption is that these people are going to live shorter lives, but what we're doing is protecting quality of life. In doing so, you sometimes end up helping people live longer. Certainly, you help people live better days and with more purpose in their lives.

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.

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.

The Affordable Care Act also offered protections that allow for preexisting conditions, as people know, that you're provided coverage and you can maintain steady coverage. And that's an important part of being able to stay in care and do better over the long run.

Go back to the '30s, '40s, '50s, and it was the discovery of heroic interventions, the ability to cure people with penicillin or do an operation to stop disease that was what saved the day. Primary care physicians couldn't do all that much that really demonstrated a difference. The people who control and work with you to control your blood pressure, they're not rewarded for doing that or to be innovative about doing that. So, the result is half of Americans have uncontrolled high blood pressure, despite seeing clinicians.

Human interaction is the key force in overcoming resistance and speeding change.

Don’t let yourself be. Find something new to try, something to change. Count how often it succeeds and how often it doesn’t. Write about it. Ask a patient or a colleague what they think about it. See if you can keep the conversation going.