PeterEliasMD

…a meaningfully usable and user friendly EHR.

It’s impossible to learn from one’s mistakes while denying or hiding them.

First hike of the season and it’s official: I’m out of shape.

Things are seldom what they seem; 
Skim milk masquerades as cream.

 

I think there are some lessons to be learned from a recent scandal involving poor quality and safety failures at Stafford Hospital in England.

It’s easy to take people for granted. 

Over the last 44 years I have witnessed an unfortunate transformation in my chosen field of medicine. I have watched with increasing sadness (tinged increasingly with horror) as a patient centered and clinically focused profession has devolved into a revenue centered and efficiency focused business. In the words of Dr. Ofri the practice of medicine has become the delivery of health care.

Poor communication is the commonest cause of poor outcomes in medicine. Taking things for granted instead of asking questions is one form of poor communication.

Some of the things we learn during our medical training are startlingly obvious, but only after we have learned them.

My parents never yelled, let alone spanked. We always understood what was expected of us and feared failure rather than punishment. They expressed disappointment far more often than they showed anger. They often asked us to devise our own punishments. And, perhaps above all, they were masters of the object lesson.

I recently received an email with a link  and a request to fill out a short survey evaluating a new service. I had a brief gap between patients, so I clicked and did the six questions. As I hit submit, it occurred to me that the survey seemed familiar. Hmmm. Looking back in my older emails, I found that I had received a similar request from the same group about 2 weeks earlier, with the same link. I contacted the person who had sent the second email.

The scientific method has given us modern medicine, with astounding abilities to diagnose, treat and even cure. Until the last century, medical treatment was futile at best and fatal at worst. Cure was not possible and the touchstone of our profession was comforting the patient. 

Darwin observed: “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” This profound observation is poorly understood and usually ignored by institutions and organizations.

Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”

It was about 2:30 am when the phone rang, waking me from the deepest and best part of sleep. It was the answering service, and they patched my patient through.  

Osler, often referred to as the Father of Modern Medicine famously said: "If you listen carefully to the patient, they will tell you the diagnosis.” He emphasized both the value of a careful history in medical diagnosis and the value of learning from one’s patients. Ask any practicing clinician and they will have anecdotes that illustrate how right he was. One stands out for me.

In 2004, Dr. Lawrence Huntoon wrote an editorial (in the Journal of American Physicians and Surgeons Volume 9 Number 3 Fall 2004) expressing concern about the potential abuse of ‘disruptive physician’ clauses being added to many medical staff Bylaws. Below the fold is my updated version of the poem (Memo to the Disruptive Physician) included in his editorial.

 Sometimes the health care system just does not work. 

Over my three plus decades of primary care, I’ve come across some strange folk remedies. Most have a kernel of truth, or at least, a plausible origin. Some have fascinating ethic components. Some are harder to understand. And some…well, you decide.