How I Write with David Perell: Atul Gawande – How to Write Consistently (While Working Full Time)
Episode Date: November 19, 2025

Episode Overview

This episode features Atul Gawande, renowned surgeon, writer, and public health researcher, acclaimed for his books and longform work in The New Yorker. David Perell explores the intersection of Gawande's demanding medical career and his prolific, influential writing. They dig into Gawande’s creative routines, mindset, editorial process, the interplay of medicine and storytelling, and practical wisdom for writers balancing full-time jobs.

Key Themes & Discussion Points

1. The Discipline of a Multipassionate Life

• Say Yes Before 40, No After 40 (02:19)

  • Gawande shares his guiding principle: in his early years, he pursued many interests—band, policy, medicine, writing—to discover what energized him. After 40, he focused fiercely on his core passions: surgery, public health, and writing.
  • Quote:

    "Say yes to everything before you're 40 and say no to everything after you're 40." — Atul Gawande [02:22]

  • This philosophy helped him channel energy into activities that sustained him rather than exhausted him.

• Energy as a Compass (10:48)

  • Gawande witnesses the common refrain, “I don’t have time to write,” and dismantles it by emphasizing energy over time.
  • Quote:

    "If it gives me energy, I want to do more of it; if it exhausts me, I do less of it... writing gave me energy, and surgery does." — Atul Gawande [10:51]

  • He averaged about 30 hours/month writing, even during his surgical residency, finding “doable” rhythms in a high-pressure schedule.

2. Making the Leap: From Surgeon to Writer

• Origins as a Writer (06:25–08:33)

  • Gawande didn’t view himself as a born writer. His start came via a friend's fledgling online magazine (Slate in its earliest days), with candid residency diaries that evolved into more structured pieces.

• Discovering Editorial Process (08:33–09:31)

  • Early lessons in humility: learning the value of feedback, rewriting, and relentless revision.
  • Quote:

    "I'd never rewritten a thing in college... For the first New Yorker piece, about 4,000 words had 22 back and forths, five complete rewrites. It ended up being nine months, but it just kept getting better." — Atul Gawande [09:17]

• Reconciling Personal Voice with Publication Style (13:18–15:20)

  • Gawande describes being mentored in the New Yorker style, yet was encouraged to preserve his distinctive voice, humor, and narrative energy.
  • Quote:

    “I was allowed to have a voice in a way that I wouldn't have if I was writing for the New York Times.” — Atul Gawande [15:20]

3. Story Structure & Writing Mechanics

• The Anatomy of an Article (19:08–22:14)

  • Gawande keeps a running list of over 400 ideas, always looking for a powerful pairing: a compelling story (“the vehicle”) and a larger philosophical or behavioral insight.
  • He describes finding both the meaningful frame and the narrative arc to bring a topic to life, whether it's about sensational medical conditions or mundane matters like handwashing.

• Entry Points & Avoiding the Predictable (22:14–24:09)

  • He discusses the importance of variety in story openings and structures (“O” shapes, “W” structures)—to avoid becoming formulaic and to surprise the reader.

• Creative Process: Math & Momentum (45:10–46:49)

  • Writing is both process-driven and quantitative: for his new book, Gawande breaks down his task to “a math problem”—2000 words a week, chunked in 30-minute increments for productivity.
  • Quote:

    "It's a math problem... I'm just trying to go start to finish as much as possible and get 2000 words down." — Atul Gawande [45:37]

• Nonlinear Process: Research, Writing, Editing (46:49–48:31)

  • The three phases are intertwined, with research often prompting new writing and drafts revealing gaps to fill with further reporting or revision.

4. Audience, Style, and Revision

• Making Medicine Accessible (48:52–50:43; 55:26–57:00)

  • Gawande balances technical language with clarity, striving to trust the reader: “I really dislike it when it feels like I’m reading someone who’s talking down to me.”
  • He keeps sentences visual and concise, editing to make each idea “crisp” and necessary.

• Audience Awareness (55:26–57:00)

  • While conscious of readership (journal, magazine, or book), he writes for readers “like himself,” surprised by how widely his work resonates.
  • Quote:

    "I'm sort of imagining it's people like me more than anything. And so the surprise to me is that the books have done well." — Atul Gawande [56:41]

• Overcoming Academic Ego (57:00–58:37)

  • Gawande critiques jargon-heavy discourse in science and medicine, arguing that professional terminology can obscure rather than clarify meaning.

5. Writing as a Tool for Personal & Professional Growth

• Writing Out of Confusion (32:24–33:50)

  • Gawande uses writing to grapple with professional dilemmas, particularly when science, art, and humanity collide—e.g., end-of-life issues in "Being Mortal".
  • Quote:

    "Writing is my way of grappling with the problems that confuse me... sorting it out is what I can do on the page." — Atul Gawande [33:19]

• Revision and the Search for the 'Heart' (42:44–44:45)

  • Each piece needs an “intellectual heart,” a story arc, and above all, an “emotional heart”—something gripping, urgent, or deeply human.

• Feedback Process: “Pizza Night” Manuscript Reviews (40:12–42:26)

  • Before finalizing a manuscript, Gawande gathers friends for a candid, deadline-driven feedback session—crucial for surfacing what truly resonates.

6. Tackling Timeliness & Timelessness

• The ‘Why Now?’ of Publication (26:28–28:16)
  • Explains how his pieces, especially for The New Yorker, aim to be both relevant and enduring, sometimes waiting months for publication if the story is evergreen.
  • Quote:

    "Can I write something that people will still want to read five or ten years from now?... My holy grail is five or ten years." — Atul Gawande [26:56]

7. AI and the Future of Writing

• AI as Research & Editing Tool (59:35–62:46)

  • Gawande uses AI to assist with research and editing—acceleration of information gathering and copy editing—but cautions that it can hallucinate sources or miss narrative nuance.

• Example:

  "We went from three months of library research to two weeks... AI is a valuable tool along the way and in writing I'm just using it as another tool." — Atul Gawande [59:35]

Notable Quotes & Moments with Timestamps

• On the Joy (and Pain) of Revision:

  "I hated revising. But now it's the part I look forward to... The first draft is always painful, but the revisions, I know that will make it better." — Atul Gawande [47:03]

• On Writing about the Profound (End of Life):

  "Our ultimate goal, after all, is not a good death, but a good life to the very end." — Atul Gawande [34:03]

• On Physician-Writers as Athletes:

  "Surgeons seem to me like the professional athletes of the world of medicine in terms of the intensity, the commitment to improvement." — David Perell [38:34]

Timestamps for Key Segments

• 02:19 — Gawande’s philosophy of career exploration and focus
• 06:25 — How/why a surgeon turns to writing
• 09:12 — The editorial journey of Gawande’s first New Yorker piece (22 rewrites!)
• 10:48 — Managing writing with full-time, high-intensity career
• 13:33 — Reconciling Gawande’s voice with The New Yorker’s distinct style
• 19:08 — How Gawande generates and selects story ideas
• 24:09 — The role of creativity in writing vs. precision in surgery
• 26:28 — Balancing timeliness and timelessness in publication
• 32:24 — Writing to process confusion, especially in medicine
• 40:12 — Manuscript “pizza night”: how group feedback sharpens a draft
• 45:10 — Writing process as “math problem”: batching incremental effort
• 48:52 — Blending medical terminology and narrative clarity
• 55:26 — Audience awareness across genres
• 59:35 — The pros and cons of AI as a writing aid
• 62:46 — Ambitions for future books; fiction & memoir temptations

Memorable Moments

• Gawande describing his first assignment for Slate, writing after grueling hospital shifts because it energized him rather than drained him. [07:06]
• Walking through the deeply personal story of his father’s illness as the emotional core of “Being Mortal.” [34:03]
• Candid discussion of writing fears, feedback, and the group “pizza night” manuscript review. [40:12]
• The moment Gawande realizes he loves revising—after years of dreading it. [47:03]
• David Perell's metaphor of surgeons as medicine’s “professional athletes” and Gawande’s answer on surgical ego/humility. [38:34–39:47]
• Gawande’s clear, practical breakdown of breaking writing into a numbers game to finish his book on deadline. [45:37]
• Real talk about the limits and advantages of AI for modern writers. [59:35–62:46]

Style & Tone

The conversation is candid, insightful, and full of honest self-reflection. Gawande’s humility, wit, and surgical precision come through, while Perell’s admiration and curiosity frame the discussion for both aspiring and seasoned writers managing ambitious creative goals alongside demanding careers.

Further Listening

• For more on Gawande’s editorial process and The New Yorker’s approach, revisit [09:12–15:20].
• For in-depth talk on structuring stories and finding emotional heart: [42:44–44:45].
• For philosophy on balancing professional work with writing, and using writing as inquiry: [10:48, 32:24, 34:03].

Prepared as an engaging resource for writers, creatives, and fans of Atul Gawande or longform storytelling. This summary omits ads, sponsorships, and opening/closing non-content sections.