Atul Gawande

Based on Wikipedia: Atul Gawande

The Surgeon Who Tried to Fix Everything

Here's a question that shouldn't be hard to answer: Before you go into surgery, does everyone in the operating room know your name? Do they know which side of your body they're operating on? Has anyone checked if you're allergic to the anesthesia they're about to pump into your veins?

For most of medical history, the answer was: maybe, maybe not.

Atul Gawande found this unacceptable. And then he did something about it—he convinced hospitals around the world to use a checklist. A simple, unglamorous checklist. The kind of thing pilots use before takeoff. It worked. Deaths dropped. Complications plummeted. It turns out that surgery, like flying a plane, has too many steps for any human brain to reliably remember them all.

But the checklist is just one chapter in a life that reads like someone trying to solve every problem in American healthcare, one at a time, through sheer force of intelligence and persistence.

From Athens to Everywhere

Gawande was born in Brooklyn in 1965, but he grew up in Athens, Ohio—not the ancient Greek city of philosophers, but a small college town in Appalachian Ohio. Both of his parents were doctors who had immigrated from Maharashtra, India, where Marathi is spoken. So medicine wasn't just a career option; it was the family business.

His academic path looks almost comically overachieving. Stanford for a degree in biology and political science. Then Oxford as a Rhodes Scholar, where he studied Philosophy, Politics, and Economics—the famous PPE program that has produced more British prime ministers than any other degree. Then Harvard Medical School. Then a Master of Public Health, also from Harvard. Then a surgical residency at Brigham and Women's Hospital in Boston, one of the most competitive training programs in the country.

But here's what makes Gawande unusual: he kept getting distracted from medicine by politics, and distracted from politics by medicine.

The Political Surgeon

As an undergraduate, Gawande volunteered for Gary Hart's presidential campaign. If you don't remember Gary Hart, he was the charismatic Colorado senator who was the frontrunner for the 1988 Democratic nomination until a scandal involving a yacht named "Monkey Business" ended his career. Gawande picked interesting causes, if not always winning ones.

After Stanford, he worked on Al Gore's 1988 presidential campaign. Gore lost the nomination to Michael Dukakis, who then lost the general election to George H.W. Bush. Gawande went to work for a Tennessee congressman named Jim Cooper, helping develop "managed competition" healthcare proposals. If that phrase sounds familiar, it's because it became one of the intellectual foundations for healthcare reform debates that would consume American politics for the next three decades.

Then something remarkable happened. Gawande started medical school in 1990, but two years later, he left to join Bill Clinton's presidential campaign as a healthcare advisor. He was twenty-six years old, hadn't finished medical school, and was helping design how America might provide healthcare to its citizens.

When Clinton won, Gawande became a senior advisor at the Department of Health and Human Services. He directed one of the three committees working on Clinton's ambitious healthcare reform plan, supervising seventy-five people and defining what benefits Americans would receive and what employers would be required to provide.

The Clinton healthcare plan failed spectacularly. It was attacked from all sides, became a political disaster, and helped Republicans win control of Congress in 1994. Gawande later reflected on this period with characteristic honesty, saying "what I'm good at is not the same as what people who are good at leading agencies or running for office are really good at."

So he went back to medical school.

The Writer Emerges

During his surgical residency—a grueling period when young doctors work hundred-hour weeks, sleep in hospital call rooms, and slowly learn how to cut into human bodies without killing people—Gawande started writing.

His friend Jacob Weisberg had become the editor of Slate, the online magazine that was one of the first serious journalistic publications on the internet. Weisberg asked if Gawande would contribute some pieces. Soon, Gawande was also writing for The New Yorker, and by 1998, he had become a staff writer there—while still completing his surgical training.

Think about that for a moment. Surgical residency is designed to consume your entire life. The New Yorker publishes some of the most carefully crafted long-form journalism in America. Gawande was doing both.

His early writing tackled uncomfortable subjects. In January 1998, he published a piece in Slate about abortion that argued the debate shouldn't focus on specific medical techniques—like the so-called "partial-birth abortion" that had become a political flashpoint—but rather on the deeper question of when a fetus becomes a conscious, perceiving being. It was the kind of article designed to make everyone uncomfortable, which is usually a sign that someone is thinking clearly about a hard problem.

The McAllen Mystery

In June 2009, Gawande published an article in The New Yorker that would change American healthcare policy. It was called "The Cost Conundrum," and it asked a simple question: Why does healthcare in McAllen, Texas cost so much more than healthcare in El Paso, Texas?

McAllen is a border town in the Rio Grande Valley. It's not wealthy. Its residents aren't particularly sick. But Medicare was spending more per person there than almost anywhere else in the country—twice as much as El Paso, which is just down the road and has similar demographics.

Gawande flew to McAllen and started talking to doctors, hospital administrators, and patients. What he found was a culture of medicine that had become oriented around profit rather than patient care. Doctors ordered more tests, performed more procedures, and hospitalized more patients—not because patients needed these things, but because each test, procedure, and hospital stay generated revenue.

The contrast was the Mayo Clinic in Minnesota, where doctors are paid salaries rather than fees for each service they provide. At Mayo, there's no financial incentive to order an unnecessary MRI or perform surgery that might not help. The result: better outcomes at lower costs.

The article "made waves," as one medical journal put it. President Barack Obama was in the middle of his push to pass healthcare reform legislation, and the McAllen article became a touchstone. Senator Ron Wyden said the article "affected [Obama's] thinking dramatically." Obama showed it to a group of senators and effectively said, "This is what we've got to fix."

Charlie Munger, Warren Buffett's legendary business partner, read the article and was so impressed that he mailed Gawande a check for twenty thousand dollars as a thank-you. Gawande returned it. Munger sent a new check for forty thousand dollars. Gawande donated the money to the hospital where he'd trained.

The Checklist Revolution

Gawande's most influential idea came from an unlikely source: aviation.

In 1935, the United States Army Air Corps held a competition to select its next bomber. Boeing's Model 299 was the clear favorite—bigger, faster, and more capable than anything else. During its demonstration flight at Wright Field in Ohio, it crashed and burned, killing two crew members including the test pilot.

The investigation found nothing wrong with the plane. It was simply too complicated for one person to fly. There were too many steps to remember: adjust the wing flaps, set the fuel mixture, check the rudder lock, monitor the engine gauges. The pilot, an experienced aviator, had forgotten to release a new locking mechanism on the elevator controls.

The solution wasn't to find better pilots. It was to create a checklist. A simple list of steps to follow before takeoff, during flight, and during landing. With the checklist, Boeing's bomber became the B-17 Flying Fortress, one of the most successful aircraft in military history.

Gawande wondered: if checklists could prevent plane crashes, could they prevent surgical deaths?

He led the World Health Organization's initiative to create a surgical safety checklist. It was ridiculously simple. Before anesthesia, confirm the patient's identity and what operation they're having. Before the first incision, everyone introduces themselves by name and role. Before the patient leaves the operating room, count the sponges and instruments to make sure nothing was left inside.

The results were stunning. In a study of eight hospitals around the world, the checklist reduced deaths by 47 percent and complications by 36 percent. Not from any new technology or drug—just from making sure everyone did the basics.

The medical journal The Lancet called it "a tangible instrument to promote safety," but noted that the real value was "encouraging communication among teams and stimulating further reform to bring a culture of safety to the very centre of patients' care."

Gawande turned this work into his third book, The Checklist Manifesto, published in 2009. It became a New York Times bestseller and influenced thinking far beyond medicine—in construction, finance, and anywhere complex tasks require coordination among many people.

Four Books on Medicine's Hardest Questions

Gawande's books form a kind of progression through the fundamental challenges of being a doctor.

His first book, Complications: A Surgeon's Notes on an Imperfect Science (2002), collected revised versions of his Slate and New Yorker articles. It was a National Book Award finalist and established his reputation as a medical writer who could make surgery and its dilemmas vivid for general readers. The book is honest about how much doctors don't know, how often they make mistakes, and how medicine is as much art and judgment as science.

Better: A Surgeon's Notes on Performance (2007) explored what separates good doctors from great ones. Gawande identified three essential virtues: diligence (the willingness to do the work even when it's tedious), doing right (navigating ethical dilemmas), and ingenuity (finding creative solutions to hard problems). The book tackled contentious issues like malpractice law and whether doctors should participate in executions.

The Checklist Manifesto (2009) took a single idea and showed how it could transform not just medicine but any complex endeavor. It's perhaps his most practical book, the one most likely to change how readers approach their own work.

Being Mortal: Medicine and What Matters in the End (2014) might be his most important. It asked a question that medicine has long avoided: What should we do when we can't cure someone? How should we think about aging, dying, and what makes life worth living at its end?

The book became a number-one New York Times bestseller and was adapted into a documentary for the PBS series Frontline. It sparked conversations in hospitals, nursing homes, and living rooms about what patients actually want at the end of life—which often isn't more treatment, but more time with family, less pain, and the ability to maintain some sense of purpose and identity.

Haven: The Trillion-Dollar Failure

In 2018, three of the most powerful business leaders in America announced they were joining forces to fix healthcare. Warren Buffett, Jeff Bezos, and Jamie Dimon—representing Berkshire Hathaway, Amazon, and JPMorgan Chase—said they would create a new company to provide better, cheaper healthcare for their combined million-plus employees.

They named Gawande as CEO.

It was an extraordinary bet. Here were three companies with virtually unlimited resources, led by executives who had disrupted or dominated their industries, choosing a surgeon-writer to lead their healthcare moonshot. The venture was called Haven, and it was based in Boston.

It didn't work.

Gawande stepped down as CEO in May 2020, staying on as executive chairman while the company searched for a new leader. In January 2021, Haven announced it was shutting down entirely.

What went wrong? According to sources familiar with the company, Haven came up with good ideas, but each of the three founding companies ended up executing their own projects separately with their own employees. The joint venture became unnecessary because the partners weren't actually working together.

It was a reminder that even the smartest people with the most resources can't easily fix healthcare. The system is too complex, the incentives too entrenched, the interests too powerful.

From COVID to USAID

When Joe Biden won the 2020 presidential election, he named Gawande to his COVID-19 Advisory Board. The pandemic had exposed every weakness in American public health: the fragmented healthcare system, the distrust of expertise, the unequal impact on different communities, the politicization of basic safety measures.

In 2021, Biden nominated Gawande for a different role: Assistant Administrator of the United States Agency for International Development, the organization that manages America's foreign assistance programs. USAID works on global health, humanitarian aid, economic development, and democracy promotion around the world.

The nomination became contentious. Senator Marco Rubio of Florida delayed Gawande's confirmation, citing the 1998 Slate article about abortion. Rubio claimed Gawande had defended "infanticide"—a characterization that misrepresented the article's argument about when moral consideration should begin. The Senate confirmed Gawande anyway, 48 to 31, and he was sworn in on January 4, 2022.

Gawande served at USAID until January 20, 2025, when Donald Trump began his second term as president. A New Yorker documentary later featured Gawande discussing the consequences of dismantling the agency he had helped lead.

Recognition and Honors

The awards accumulated over the years. In 2004, Newsweek named him one of the "20 Most Influential South Asians." In 2006, he received a MacArthur Fellowship—the so-called "genius grant"—for his work on surgical practices and medical ethics. Time magazine included him in its 2010 list of the hundred most influential people in the world, ranking fifth in the "Thinkers" category.

In 2014, he delivered the BBC's prestigious Reith Lectures, giving four talks on "The Future of Medicine" in Boston, London, Edinburgh, and Delhi. The Reith Lectures have been running since 1948 and have featured thinkers like Bertrand Russell, Arnold Toynbee, and Robert Oppenheimer.

He won the Lewis Thomas Prize for Writing about Science in 2014, named after the physician-essayist who wrote The Lives of a Cell. He was elected to the American Philosophical Society, the oldest learned society in America, founded by Benjamin Franklin.

The Imperfect Science

What makes Gawande interesting isn't just his accomplishments—it's his willingness to acknowledge what he and medicine don't know.

He titled his first book Complications: A Surgeon's Notes on an Imperfect Science. Not "perfect science" or even "improving science," but imperfect science. Medicine, he has argued throughout his career, is not like physics or chemistry, where the laws are fixed and the answers are certain. It's more like politics or parenting—a domain where you have to make decisions with incomplete information, where the right choice depends on values as much as facts, where even experts disagree and sometimes get it wrong.

His checklist work succeeded not because it made surgery perfect, but because it made surgery less imperfect. It reduced the obvious, preventable errors—the operations on the wrong side, the sponges left inside patients, the allergic reactions to anesthesia that someone should have caught. It couldn't prevent every complication, but it could prevent the stupid ones.

His writing about end-of-life care succeeded not because it gave people the right answers, but because it asked the right questions. What matters to you? What are you afraid of? What tradeoffs are you willing to make? These aren't questions that medicine traditionally asks, but they might be the most important questions of all.

Atul Gawande has spent his career trying to make medicine better—through politics, through writing, through research, through checklists, through honest conversation about death. He hasn't fixed healthcare. No one could. But he's made it slightly less broken, one complication at a time.