Writing lets you step back and think through a problem. Even the angriest rant forces the writer to achieve a degree of thoughtfulness.

There are times when you have sharp elbows, and people are trying to muscle you out of certain meetings - because then people could leak to the press that you had a role in certain decisions. I, at twenty-six, was very impatient and didn't know how to keep my powder dry. I was running a team of seventy-five people when I had never been a boss. I was the worst boss ever.

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.

Just look at the list of who the lowest-paid people are. Pediatricians are at the bottom. You would also look at internists. You would look at psychiatrists. You would look at family physicians, HIV specialists. People who take care of chronic illnesses by seeing people carefully over time, those are the people who get the least money. The people who have the most are people like orthopedic surgeons, interventional cardiologists. And my point isn't that there is something wrong with heroism.

Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work - whether in healthcare, education, climate change, making a pathway out of poverty - is the great task of our generation as a whole.

You can't make a recipe for something as complicated as surgery. Instead, you can make a recipe for how to have a team that's prepared for the unexpected.

As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.