People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as "the constant and earnest effort to accomplish what is undertaken."... Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior.

Developing a skill is painful, though. It is difficult. And that's part of the satisfaction. You will only find meaning in what you struggle with. What you struggle to get good at next may not seem the exact right thing for you at first. With time and effort, however, you will discover new possibilities in yourself-an ability to solve problems, for instance, or to communicate, or to create beauty.

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.

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.

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.

No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not.

We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.