Mea sententia...

Humility and medical guidelines

We have LOTS of guidelines and recommendations. We could use LOTS more humility.

The Advisory Committee for Immunization Practices (ACIP) issued a recommendation in September of 2014 that pneumococcal vaccine naive individuals 65 and over get a Prevnar13 followed by a Pneumovax 6-12 months later, and that those who have had a Pneumovax get a Prevnar13 a minimum of 12 months after their Pneumovax.

Ironing out a diagnosis

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.

Why bother

A professional colleague and I were discussing (bemoaning) how hard it is to do quality primary care. She asked why I bothered to keep pushing for change in the face of so much institutional resistance and evidence that it was pointless. I told her, what we put up with is what we end up with.

In return, I asked her why she didn't push back and demand change if she is so unhappy about the way things are?  

Her response: "Well, I watch you, and I can see that it is pointless."


 

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…

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.

Slow down, you move too fast

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

 

I talked to a friend recently about a serious health experience. He had became ill suddenly and was hospitalized for six days. No one from his community came to visit. Only one person from work stopped by. No one called. He described being frightened by his illness and feeling vulnerable and alone in the hospital. He was devastated by what felt like abandonment in his time of crisis.

 

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.

Results are not always the most important thing

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

In practice, it was clear she had great technique and a good motor, and could stay at the front without difficulty. In races, however, she would set out looking fantastic but come in near the end of the pack, beaten by skiers with much less ability than she, and seemed happy with her race.  It never seemed to bother her.  In fact, she never complained and was always one of the happiest in the van on the way home.b

Guiness 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.

Workplace wellness - sense, cents, 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.

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