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.

What is the alternative to understanding the complexity of the world?

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.

In many ways, the effort to study philosophy was my rebellion away from medicine. I'm the son of two Indian immigrant physicians, so the natural path for me would have been to become a doctor. I ended up doing the master's degree at Oxford in politics, philosophy, and economics while already having a seat in medical school. I was keeping that as my escape hatch. But my hope was that I might become a philosopher or something else entirely.

The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer.

When we, doctors, ask patients what their priorities are if time is short, what we do is we use what is available to us - whether it's geriatric care or palliative care or hospice care - to make sure they're living the kind of life that they want to live.

I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.