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.

No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.

In every industrialized nation, the movement to reform health care has begun with stories about cruelty.

You know, 97 percent of the time, if you come into a hospital, everything goes well. But three percent of the time, we have major complications.

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.

Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle.