Mea sententia

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 we need is 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.

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.

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. 

Niels Bohr said: “There is no quantum world. There is only an abstract quantum physical description. It is wrong to think that the task of physics is to find out what nature is. Physics concerns what we can say about nature…”

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 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."