Today's thought

All photos are accurate. None of them is the truth. Richard Avedon


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Mea sententia...

Feb 22, 2015

The Ten Commandments of Therapeutics

I found a wonderful article by Udkin, Dreger and Sousa, and have updated and adapted it. See below the fold…


Categories: Medicine

Feb 15, 2015

It's not as easy as you think...

I found a snippet in my Evernote file, sadly without anything citing a source. I have adapted it to fit my experience with Clinical Quality Improvement activities. I suspect it is broadly applicable…

  • It will take longer than expected.
  • Not everyone will understand.
  • At least one key player is not engaged.
  • No matter how diligent the process, the team will miss something important.
  • If everyone agrees, someone is not paying attention, or is being dishonest.
  • The risk manager, lawyers, and upper level management really want to say no.
  • When you are done, people will complain and you'll have to remind them of the mission.
  • The result will not be what you planned.
  • To the extent that you succeed, the important benefits will result from solving unforeseen complications.

Categories: Medicine

Feb 08, 2015

Of geese, ganders, and pay-for-performance

Like most employees of large institutions, I am subject to a variety of ‘incentives’ that are designed to meet institutional needs, which may or may not be well aligned with my needs, to say nothing of the needs of my patients. 

Categories: Medicine

Feb 01, 2015

I teach to remain a learner

Teaching in our local family practice residency is one of the most enjoyable parts of my week. When a colleague recently asked why I liked it so much, it took some reflection to answer.


Categories: Medicine

Jan 29, 2015

Slow down, you move too fast...

Slow down, you move too fast.  It will all be over far too soon. 


Jan 22, 2015

CPOE for management

At a recent clinical staff meeting, a physician complained that the new requirement that clinicians enter all orders manually into the electronic record (CPOE) is slowing us down and causing errors. The IT and administrative staff were not the least sympathetic. Their message: it’s really not a big deal, it only takes an extra minute or two, and smart people like you should be able to master a simple skill like this. On the way home, I came up with a way to help them better understand: CPOE for management.


Categories: Medicine

Jan 15, 2015

Distractions and interruptions

Did you know that there is a whole branch of psychology devoted to the impact of interruptions and distractions on learning, memory, performance, productivity, and decision making?

Categories: Behavioral

Jan 08, 2015

Playwrights and critics

It’s frustrating when they won’t let you be a playwright, but then complain when you become a critic. 


Categories: Management

Dec 22, 2014

Results are not always important

Lisl was very good high school skier but seemed not to have the race results she was capable of and everyone expected.  


Dec 15, 2014

Meetings: a tool to create apathy

A physician friend commented recently that he was being ‘meeting-ed to death’ and wondered if it was intentional. It turns out, he was on to something.

Categories: Medicine

Dec 08, 2014

Chart review

Chart review is one of my occasional clinical responsibilities.  The charts I see overwhelmingly document good quality medical care. Last week I saw a chart that gave me pause. 

Categories: Medicine

Dec 01, 2014

Guinness Book of World Stupid

You can’t make this stuff up. I pulled into our local BJ’s gas station on a recent rainy morning. It was quite busy and I looked around for the shortest line to join, Seeing a woman in her early 20s who appeared to be finished fueling as she re-holstered the nozzle in the pump and returned to her car, I pulled in behind her, expecting to promptly be able to pull up and buy gas.  A car pulled in behind me, so I was now committed.


Categories: Humor

Nov 29, 2014

The perfect storm of discontent

A friend recently explained why he retired from a long and rewarding career in medicine and medical education, despite still loving his one-on-one interactions with patients. 


Categories: Medicine

Nov 22, 2014

The innovator's prayer

Words of wisdom…

Categories: Philosophy and ethics

Nov 15, 2014

Workplace Wellness Programs: sense or nonsense?

Workplace wellness and chronic disease management programs (now encouraged by the ACA) are quite common, but being a $6 billion dollar industry doesn't make them useful. Recent personal experience with one such program has led me to look more closely at the topic.


Categories: Medicine

Nov 08, 2014

Two very different cultures in medicine

Was the surgeon a princess, complaining about a pea under her mattress? Or am I a sheeple, accepting a woefully inadequate system? What do you think?


Categories: Medicine

Nov 01, 2014

The admission ticket

Why does the ‘chief complaint’ make me think about  pancakes and fig newtons? The chief complaint may just be an admission ticket.

Categories: Medicine

Oct 29, 2014

Is the patient always right?

Patient satisfaction has become a prominent goal in health care. Is this a good thing?


Categories: Medicine

Oct 22, 2014

The ice-pick headache

Categories: Medicine

Oct 15, 2014

Why I decided against pediatrics

I love children. I won’t claim to ‘understand’ them, but I am comfortable with them, and happy to work in their universe rather than asking them to be part of mine. I find them easy to work with. The ED nurses occasionally referred to me as the “child whisperer.” I am often asked by friends and colleagues why I did not become a pediatrician. 


Categories: Medicine
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