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A recent article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, so it is in everyone’s best interest to make the record hard for patients to obtain.
The art of progress is to preserve order amid change and to preserve change amid order. (Alfred North Whitehead)
What is True North for medicine? Is there an enduring core value that serves as a reliable touchstone across the nearly infinite range of medical activities? Given how medicine and society change, can there even be an enduring True North? If we have one, are we pursuing it faithfully?
I was asked by a colleague at work, “Why do you tilt at windmills?” Many have answered this better than I:
It’s always easier to do something than to do nothing. Doctors often offer treatments for things they know are what we call ‘self-limited’ meaning that they will clear up all by themselves. I think this form of unnecessary treatment reflects an awareness that although many things resolve without intervention, both doctors and patients are driven to DO SOMETHING. Though it is usually tempered by the wish to do something as benign as possible, sometimes doing nothing is the best choice. The trick is knowing how to do nothing properly.
We have LOTS of guidelines and recommendations. We could use LOTS more humility.
Under stress, including conditions of overload, systems degrade in a predictable manner.
Rachel called about her elderly father, Blaine, better known to me as Bucky. She requested a ‘nerve pill’ to calm him down at night and a referral to a neurologist to test for dementia.
Our job – though many of us actually see it more as a calling than a job – is to care for patients.
I think this parallels the enduring human drive to search for Truth. There may or may not be an absolute Truth, but it is wrong to think we can discover Truth or understand what Truth is. Science, philosophy and religion are merely our endeavors to see what we can say about Truth.
I am both excited and worried about the recent enthusiasm for precision medicine (PM)
When I envision the ideal health care organization, I picture six characteristics.
A professional colleague asked me during a recent conversation bemoaning how hard it was to do quality primary care, why I bothered to keep pushing for change in the face of so much evidence that it was pointless. I told her, what we put up with is what we end up with.
I asked, why don’t you push back and demand change if you are so unhappy about the way things are? Because I watch you and see that it is pointless, she said.
The wave of the future is bringing game-changing cultural shifts in patient awareness and expectations. These are paralleled (and fed) by paradigm changing technologies. Clinicians and medical institutions will sink or swim depending on how well they ride these waves.
Those who choose the comfort of the familiar and predictable, who sit safely on the beach while they watch and wait, who allow others to build the future, these late adopters will ultimately be forced to enter the water. I predict they will never catch up, and will struggle merely to survive.
Are you a swimmer? Are you in the water, making waves? Or are you the audience, seeing life and health care as spectator sports?
I found a wonderful article by Udkin, Dreger and Sousa, and have updated and adapted it. See below the fold…
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.
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.
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.
Slow down, you move too fast. It will all be over far too soon.
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.