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

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.

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.

One of the reasons people might be fallible, why we might fail to do what we try to do isignorance, that we have a limited understanding of the laws of the world - the physical laws that govern the world and of all the particulars of the world upon which those laws work. And then there's ineptitude, meaning that the knowledge is available, but individuals fail to apply it correctly. The third source is "necessary fallibility." That is, we're never going to be omniscient, there is some knowledge that we will simply never achieve, and there are limits to what we will be able to do.

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.

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.