Back in the mid 1980s when he was an undergraduate at Stanford University in California, Atul Gawande took a literature class. "I did a terrible job. I got my lowest grade." Later, as a Rhodes Scholar at Balliol College, Oxford, he had a rude awakening after reading aloud his weekly essay to his tutor. "I didn't know how to write. It was too flabby, too verbose. It was covering up the fact that my thinking was not clear. My entire goal while I was at Oxford was to be able to successfully read an essay without the professor stopping me and saying, 'I cannot stand this any more. Can you just stop?'"

Both stories have happy postscripts. "I joined the Stanford class because there was a girl in it I was interested in. I'm married to her now," Gawande smiles. And while his essays at Oxford may have been poor, those in the New Yorker, where since 1998 he's been a staff writer focusing on issues of medicine, surgery and public health, have won him many plaudits. His books – Complications (2002), Better (2007) and The Checklist Manifesto (2009) – are bestsellers. Though in 2007 he won a lucrative MacArthur "Genius" award, he continues to work as a Boston hospital surgeon and as a Harvard professor, and also runs Ariadne Labs, a centre that devises and tests medical innovations around the world.

His latest book, Being Mortal, is his most ambitious to date. An exploration of the marginal status of death within the American healthcare system, it begins with a rather puzzled admission that he was taught almost nothing about ageing or frailty during his medical training. You don't go to medical school to cope with the dying, he explains. "You're not there to deal with ageing and its problems except insofar as you can fix them. What you love, what you envision, is 'I'm gonna save people!' Even at medical school we don't talk about the mortal process. The problem is conceptual."

Gawande learned that although 14% of Americans are over 65, the number of certified geriatricians decreased 25% from 1996 to 2010. Diagnoses for the future are grim: 97% of medical students currently take no course in geriatrics. Arguing against the profession's focus on "repair of health, not sustenance of the soul", he talks in the book to progressive hospice workers who use animals or encourage staff to bring in their children. He also cites a study in which patients who "saw a palliative care specialist stopped needing chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives – and they lived 25% longer".

Writers such as Evelyn Waugh in The Loved One (1950) and Jessica Mitford in The American Way of Death (1963) have written, with fascinated horror, on how the US treats mortality as a branch of capitalism. For much of the last decade, while its soldiers have been fighting what is claimed to be just and necessary wars in the Middle East, the bodies of the fallen have been missing from TV news coverage. Does the US, which has often represented itself as a place of rebirth, a Shangri-La or Emerald City, not accept death?

Gawande was born in 1965 to doctors – his mother worked in pediatrics; his father, who migrated to the US from India in 1963, was a urologist – and says he's "resistant to the idea that there is a particularly American pathology about dying. My father's side of the family is from a rural village in India, which in theory has a more wholesome way of accepting mortality. But they get themselves into the same craziness: if my grandfather is ill, they will sell seed corn, they'll sell the land that is crucial to the wellbeing of their family, in order to have a last-ditch chance at doing anything for the patriarch."

He is far from sharing the modish belief that death might one day be defeated (held by prominent CEOs and digital boosters, from PayPal's Peter Thiel, who has invested heavily in rejuvenation biotechnology, to Google's Sergey Brin, who is funding research into the possibility of eternal life). And although Gawande says he's no technophobe, much of his writing is about the limits of medicine, the countless ways in which conditions can be misdiagnosed, the logistical and procedural flaws that mean hundreds of thousands of US hospital patients fall sick or die needlessly each year. "I'm very interested in failure and the reality is that while technology and automation are pretty fundamental ways of overcoming many kinds of failure, they have a failure mode themselves: at the level of human touch. I think some of our technology allows us to remove ourselves from real life."

Gawande studied PPE at Oxford, and left medical school for a while to work for Bill Clinton in 1992 as his head of health and social policy. His books often argue for collectivist philosophies of health care. In The Checklist Manifesto he maintains that thinking of surgery in terms of teamwork is more likely to produce results than the cult of "the surgeon as virtuoso, like a concert pianist". And he's clear about the distinct worldviews that inform the medical systems on each side of the Atlantic. "There are some pretty fundamental things that the NHS does very well, and in many ways better than most places in the world. Certainly better than we have managed to do. One is equity: your opportunities in life can be quite limited by your health in the US in ways that they do not have to be in the UK. It's pretty fundamental to the NHS that it's understood to belong to the people. It's defended and measured by its success on delivering that promise. That's not the way people look at our health system in the US. Here it's a commodity, just another part of our retail sector."

He says that writing, which he began doing for Slate magazine in the 1990s at the urging of editor and old friend Jacob Weisberg, "feels very parallel to my role as a surgeon. The operating theatre has a whole team – I don't know what five out of six of them know – and then I go up to the waiting room when we're done and I get all the credit. Writing is exactly that way. But I'm fascinated how some of my favourite shows are written by a committee; the idea that a group can do that is compelling.

"For myself, I can write at B-level, and I can only improve it by a group effort behind the scenes. I'm in constant dialogue with my editors; they're my coaches and really shape the work. I learned from Malcolm Gladwell that midway through your book – while you're still open to change – you have to share it. So I have a Rough Draft Book Club – my editor and four writer friends; I buy take-out dinner, we sit in a friend's apartment, and they'll tell me what they like and don't like about it."

One of the writers who influenced his approach was Susan Sontag. In her essay "Illness as Metaphor" (1978) she launched a now celebrated attack on the figurative language deployed by society to discuss cancer: "The metaphors we have imposed on it are so much a vehicle for the large insufficiencies of this culture; for our shallow attitude toward death, for our anxieties about feeling." Gawande points out that "part of her criticism was that we begin to see the experience itself as a metaphor rather than the thing it really is, that the cancer becomes a battle … I didn't want to fall into the same trap. If I was going to use those metaphors, I was going to do it knowingly."

Gawande's prose is crisp and clean, written, he says, "to puncture mist and create more transparency about health". It's also full of intriguing reference points. His 2012 essay "Big Med" compares (unfavourably) the quality and cost controls at American hospitals with those at the Cheesecake Factory restaurant chain. In The Checklist Manifesto, a book that centres on the vital role concise lists can play in saving lives in operating theatres, he referred to the Van Halen rider that asked concert promoters to furnish the band with a bowl of M&Ms with the brown ones taken out. What seemed like puerile arrogance was a way of encouraging venues to pay very close attention to the details.

This idea of precision is something he feels writers could learn from medics. "As a doctor you have to remove yourself emotionally from a given situation and observe it from a slightly different vantage point. You have to notice the particular shade of blue the patient turns. You need to be very factual and physiological about what's happening, but not so removed that you forget it's more than physiology in front of you."

In other ways, being a surgeon is different from being a writer. "In surgery there's a learning curve: I'm trying to do the same thing over and over again and to get better at it. In writing you're trying to never do the same thing again." I tell him that Being Mortal, which ends with him scattering the ashes of his father into the Ganges, feels more porous and perhaps more lyrical than his earlier work. "I'm trying to force my writing to go somewhere new, to feel less clinical, to not sound like a formula. I'm pushing the way I even write a sentence, to get rid of certain words that are like my fingerprint … Ideally I'd like to reach the point in my career when I'm not just a physician-writer, the stage where my writing is simply writing."

Traditionally, viscerality is part of the physician-writer's stock-in-trade. "I remember where I had a sort of battle with New Yorker editor David Remnick when he kept cutting a line in which I described a child with a snot rope. He thought it was disgusting and I liked it because it was disgusting. It was perfect. If I haven't succeeded in making you itchy or disgusted or cry I haven't done my job. I love the connection."

Connection is a word Gawande uses about music. He enthuses about indie rock bands, and compiles soundtracks to be played as he's working in the operating theatre. "If I could have been in a rock band I wouldn't be doing any of what I'm doing," he says. At college he wrote moody pop songs partly influenced by the Smiths and the Cure. "The lyrics were really bad. I wrote one love song for my girlfriend about how Marxism was dying but not my love for her. It's just terrible.

"I played about three shows. It was just me with an electric guitar, but at one point I had another guy join me on bass. One night we played we were called Thousands of Breaded Shrimp. Another time it was the Houyhnhnms – after Gulliver's Travels. I don't even remember how to spell it any more. I wish I'd discovered then the importance of rewriting and practice!"

• Being Mortal by Atul Gawande is published by Metropolitan Books (£16.99). To order a copy for £12.74 go to bookshop.theguardian.com or call 0330 333 6846.