Atul Gawande on the Secrets of a Puzzle-Filled Career

; Atul Gawande, MD, MPH

| Disclosures | December 06, 2013

Mesmerized by the OR

Dr. Topol: Then you went back and finished med school. You also were at Harvard School of Public Health and got a degree there as well. And then you did your surgical residency. You're obviously an accomplished surgeon, but when did you get into the writing side?

Dr. Gawande: I never thought surgery was going to be what I was going to do. I went through medical school thinking that I would so something like internal medicine, combine a career where I have a clinic on the side but mostly do public policy, trying to understand how you make health systems better. Then I got into an operating room and I fell in love with it and it was a real problem.

Dr. Topol: You were mesmerized by the operating room?

Dr. Gawande: Weirdly enough, I thought surgeons were like politicians. Surgeons are grappling with having limited information and knowledge, imperfect science, but have a necessity to act in the face of both imperfection in their own abilities and imperfect knowledge in the world. I saw a lot of the same incredible range of characters and people [in politics and the operating room]. I have sometimes said that my favorite New Yorker cartoon, because it described me, was a picture of a headstone in which the inscription read, "He kept his options open." I was the guy who kept his options open.

I wanted to be more like surgeons and more like the politicians I admired who could make decisions, live with the consequences, and learn from the consequences.

Becoming a Writer

Dr. Topol: You got transfixed by surgery but you also got into writing.

Dr. Gawande: I diverted myself. When I was practicing surgery I had no ability to keep my work in policy going. A friend of mine started an Internet magazine, But in 1996 no one was writing for an Internet magazine, so he would ask his friends, "Would you write something for me?" I demurred for a while but then I realized that it was an opportunity to stay involved in writing about policy. And that's what I started doing. You'd call it a blog today, but every couple of weeks I'd have a new article and I'd start learning. My first articles were terrible.

But it was beautiful because I could learn on the job, and just like doing 30 gallbladder surgeries in a row, I did 30 columns in a row but with fantastic editors, people like [founder] Michael Kinsley, Jacob Weisberg, and a couple of other folks who are just fantastic, who would tell me, "This is what you're doing well, and this is what you're not doing well. Work on this." I remember a series of columns where I'd work on how to make it more visual. How do I not put the boring stuff up front but be able to convey the ideas? How do you tell a story? And so, gradually over that time, I learned how to do at least short-form work.

Dr. Topol: You got pretty good at that. Now, when did the New Yorker discover you?

Dr. Gawande: By the end of that period I was getting, like, 300,000 hits for a given article. One of the people following along was a New Yorker editor who asked if I would like to try something longer for them. So, in 1998, I wrote my first piece for the New Yorker. I really enjoyed it, even though it was incredibly painful. It went through 22 revisions and then had to go through their grueling fact-checking process.

Dr. Topol: A little tougher than Slate.

Dr. Gawande: Yes. I thought, "Hey, this will take 2 months [to get published]." It ended up being almost a year before that final piece was something they were happy with. But I learned a ton and then I wrote 3 articles that year. After the 3 articles they asked if I'd switch over and join the staff. I was in my third-year residency at that point.

They worked it out so that I could both do surgery and write, and it was fantastic. It was amazing to have that foot in the door.

Dr. Topol: Was that a life changer for you?

Dr. Gawande: Absolutely. There have been multiple life changers along the way. I've gotten really, really lucky. The life changers have been where I've gotten to be paired with people who could open up my perception of what you could do as a doctor, what was possible for you, and then offer a helping hand to say that this is how you do it well. The New Yorker has really been about my relationship with my editor there, a guy named Henry Finder, who is just tremendous. He's just a tremendous brain, sharpens your thinking and gets you understanding how to write better and better.

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  1. Gawande A. The cost conundrum: what a Texas town can teach us about health care. The New Yorker. June 1, 2009. Accessed November 26, 2013.

  2. Gawande A. Big med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care? New Yorker. August 13, 2012. Accessed November 26, 2013.

  3. Gawande A. The hot spotters: Can we lower medical costs by giving the neediest patients better care? New Yorker. January 24, 2011. Accessed November 26, 2013.

  4. Gawande A. The itch: Its mysterious power may be a clue to a new theory about brains and bodies. New Yorker. June 30, 2008. Accessed November 26, 2013.

  5. Lifebox. Saving lives through safer surgery. Accessed November 26, 2013.

Authors and Disclosures


Eric J. Topol, MD

Director, Scripps Translational Science Institute; Chief Academic Officer, Scripps Health; Professor of Genomics, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape

Disclosure: Eric J. Topol, MD, has disclosed the following relevant financial relationships:
Serve[d] as a director, officer, partner, employee, advisor, consultant, or trustee for: AltheaDX; Biological Dynamics; Cypher Genomics [Co-founder]; Dexcom; Genapsys; Gilead Sciences, Inc.; Portola Pharmaceuticals; Quest Diagnostics; Sotera Wireless; Volcano
Received research grant from: National Institutes of Health; Qualcomm Foundation

Atul Gawande, MD, MPH

Director, Ariadne Labs; Professor, Department of Health Policy and Management, Harvard School of Public Health; General and Endocrine Surgeon, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

Disclosure: Atul A. Gawande, MD, MPH, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Brigham and Women’s Hospital; Harvard School of Public Health; Lifebox Foundation
Serve(d) as a speaker or a member of a speakers bureau for: National Hospice & Palliative Care Organization; PeaceHealth; Intermountain Health Care; ABT Assoc; Partners Healthcare; Amer Soc of Anesthesiologists; American College of Surgeons; Leading Age; Carolinas Healthcare; University of Albany; American Society of Healthcare Engineers; University of California at San Francisco; National Council for Community Behavioral Healthcare; Goodwin Procter; Royal Bank of Scotland; Society of Neurological Surgeons; Agency for Healthcare Research and Quality; Institute of Medicine; Boston Children’s Hospital; Pricewaterhouse Coopers; International Society for Quality in Health Care; Press Ganey; Chicago Humanities Festival
Received income in an amount equal to or greater than $250 from: Henry Holt; Picador USA; Conde Nast Inc.; Harper Collins; Pearson Publishing; Houghton Mifflin; McGraw Hill; Harvard Business School Press; Profile Books Ltd.; New England Journal of Medicine; Penguin Books/India; Sosoh Publishing; Commonwealth Publishing Co.; China Renmin University Press; Lua de Papel; Antoni Bosch Editor; Asa Editore; Editorial Diagonal del Grup62/Edicone; Verlasgruppe Random House GmbH; Uitgeverij Nieuwezjds; Baronet; Znak; Humanitas; Giulio Einaudi Editore S.p.A.; Sextante; Book21; Gramedia Pustaka Utama; Shinyusha Co. Ltd.; Domingo Publishing; Cheers Publishing Co; Mehta Publishing House; Misuzu Shobo; Codecs; First News-TriViet Publishing Co.; Cengage Learning; Internazionale Magazine; Eriko Yamauchi; CBS Television; Public Broadcasting Service; TNT Network; Fresenius
Received research grant from: Blue Cross Blue Shield; Boston Consulting Group; EMC; The Gates Foundation; The World Health Organization; The Branta Foundation; Harvard Risk Management Foundation; MacArthur Foundation; New Zealand Government; The Rx Foundation; Agency for Healthcare Research & Quality; Health Research & Educational Trust

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