A Conversation with Atul Gawande

Every year, at commencement ceremonies around the world, graduates will be simultaneously marking the end of their education and the beginning of a career—or more school—that will set the stage for the rest of their lives. However, a successful career does not need to follow a single path—a concept with which commencement speaker Atul Gawande is quite familiar.

Gawande, a surgeon and public health researcher who is also a bestselling author and staff writer for the New Yorker, will address the graduates at Caltech's 122nd annual commencement ceremony on Friday, June 10, 2016. The ceremony will also be live-streamed online.

He recently spoke with us about how he juggles his professional interests and how his work as a writer shapes how he does research and practices medicine.

You have found success in two very demanding yet very different careers. What inspired you to do both?

The medicine part was kind of the obvious part because I come from a family of doctors. My parents are Indian immigrant physicians, and in our particular community, there is practically an expectation that you will think about becoming a doctor. I spent a lot of time in college trying out lots of other things, including writing. And music—I had a terrible rock band. I ended up doing a degree in biology, yes, but also [a degree in] political science, finding I was really interested in public policy and public affairs.

I did a master's degree in politics and philosophy at Oxford, and I worked in government for a while, but eventually I found that although I loved many of the things I was working on, I didn't love having my career be dependent upon the politician you work for, or the government agency you work for. I ended up coming back to a career in medicine. The surprise to me was finding along the way that writing was the easiest way for me to feed that part of my brain that was curious and connected to public affairs. But I wasn't very good at writing in college; it evolved as a late part of my career. I certainly wasn't born to be a writer.

Your career in surgery and public health research inspires your writing, but has there ever been an instance where something you wrote about changed how you practice medicine?

Constantly. In many ways, the writing is the reason that I feel I'm able to stay in surgery and stay in research. It's very easy in the day-to-day of the work to start to feel like you lose sight of the reasons why you are in it, and the writing has been—at least for me—a way that I can step back and ask the interesting questions and be curious.

One example is my most recent writing about mortality. It was prompted out of feeling that I was not very effective at taking care of people who were facing the end of life. As a writer, I got the excuse to go around and look at how my colleagues were taking care of people at the end of life. I found some who were phenomenally good at it, and that changed my whole approach to how I took care of people with terminal illnesses. That led to the New Yorker piece, which led to a change in my practice; investigating further led to a whole book, and that led to a randomized trial that I'm now running with a team of people at the Dana Farber Cancer Center. So the two [interests are] unendingly influencing one another.

How do you balance all of these interests and priorities in your life?

Well, I've sort of thrown balance out the window. I love the variety that I get to have, but I think if you want to try to do things that matter, you often have to give up on balance as part of that. My wife and kids have often ended up getting the brunt of it when I'm late because of surgery or I'm wanting to spend the weekend days working on a book chapter. And then there are other times that I'm sacrificing the writing in order to be there for them and for myself. So there is no good answer. You're just constantly adjusting.

Many Caltech students will be entering technology-related fields. How do you think technology might impact medicine in the future?

I think that the fascinating questions are less about what technology should be doing for health and more about how technology has genuinely improved people's lives. The idea of "well being" is larger than just about survival; it's your quality of life—your purpose in life. When you don't really have a clear understanding of people's genuine goals, then you can have a mismatch between what we're doing and what people actually want, no matter how amazing our technology might be.

It's often surprising how quickly we come to conclusions about a technology that we believe will do tremendous good without being really clear from the start whether the purposes we serve are actually ones that people want and value.