For the last five years, I've been teaching an undergraduate class at Harvard College. I've been doing that with Don Berwick. Teaching undergraduates has been one of the most satisfying aspects of my teaching career. They are wonderful young people. Their pores are wide open, their knowledge is, you know, is extraordinary, and their eagerness to apply that knowledge to important problems is wonderful.

Often the... the title of the program, of the course is The Quality of America's Healthcare. Very often - and obviously the kids who take the course are people who are concerned about the quality of America's healthcare - very often I'm asked by a student: what can I do that would make a difference, shall I go to medical school? Well, I tell them, if you want to be a doctor, if you want to take care of sick people - and there's nothing I've done that's been more gratifying than taking care of sick people at that stage in my life when I did it - then you have to go to medical school, and I urge you to consider that seriously; we need people like you in medicine.

But if your goal is to change the healthcare system because it's in urgent need of change, despite my book, then going to medical school will occupy years that would be much better spent in other areas. If you were to train yourself in economics or in law or in political science or in anthropology, you might do much more for the healthcare system than via the route of being a doctor, and increasingly, decision-making in medicine is less in the hands of doctors and more in the hands of the public, and for that reason alone you should think about a career outside of medicine, unless, as I said, it's patient care that interests you to a large extent.

But, have you thought of public service? Have you thought of the possibility of running for political office? Of becoming a council person in your city or town? Ultimately considering becoming a Governor or a member of Congress? We need, desperately we need people like you in public service.

And, you know, I think I've maybe nudged one or two people over the years in that direction. So often the response is: I wouldn't go into politics! Why would I want to do that? And, of course, the cumulative attitude of that sort means that we don't have the people in public life that we want.