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.

Oliver Sacks remains my hero to this day. He was one of the first medical writers I read. The other was Lewis Thomas, who is no longer alive but is just heroic to me.

Our great struggle in medicine these days is not just with ignorance and uncertainty. It's also with complexity: how much you have to make sure you have in your head and think about. There are a thousand ways things can go wrong.

Our health-care morass is like the problems of global warming and the national debt - the kind of vast policy failure that is far easier to get into than to get out of. Americans say that they want leaders who will take on these problems.

Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.

People say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money.

The damage that the human body can survive these days is as awesome as it is horrible: crushing, burning, bombing, a burst blood vessel in the brain, a ruptured colon, a massive heart attack, rampaging infection. These conditions had once been uniformly fatal.

The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don't.

The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care.

The writing I love has something memorable in it - an image, a smell. It's the connection between the moment and the whole concept, weaving the micro together with the macro so that it has a hold on people - that's writing.

There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not. Universal health-care coverage belongs to the first category: you can pick one of several possible solutions, pass a bill, and (allowing for some tinkering around the edges) it will happen.

To become a doctor, you spend so much time in the tunnels of preparation - head down, trying not to screw up, trying to make it from one day to the next - that it is a shock to find yourself at the other end, with someone shaking your hand and asking how much money you want to make.

We now live in the era of the super-specialist - of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn't.

You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they don't have the physical skills but because they don't have the moral skills - to practise and admit failure.

Expertise is the mantra of modern medicine.

George Orwell is a pinnacle writer, for his combination of moral insight and literary writing.

I have always believed that there is nothing greater than a life in rock n' roll - it has to be good rock n' roll - and I still think it is true.

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.

I was never born to write. I was taught to write. And I am still being taught to write.

I write because it's my way of finding cool ideas, thinking through hard problems and things I don't understand, and getting better at something.