Submitted by PeterElias on Sat, 06/22/2013 - 06:00
One has to ask the right question in order to get the answer.
The chief complaint on the encounter form said ‘panic attack’ and a quick review of the chart before I entered the room showed a healthy 28 year old woman with no health or emotional issues who came in every year for a routine birth control visit. She told me she had had a ‘panic attack’ the day before and was sure there was nothing serious wrong, but came in at the insistence of a colleague. “It’s probably a waste of time, but Seeley made me promise to come.”
Submitted by PeterElias on Sat, 06/08/2013 - 06:00
Measuring something is not the same as improving it.
Improving something requires thinking of quality as a process rather than a product.
Before we think about how these two principles apply to medicine, let’s consider two approaches to coaching basketball: one using incentives tied to outcome metrics, and one using interventions designed to identify and address process problems.
Submitted by PeterElias on Fri, 02/01/2013 - 06:00
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.
Submitted by PeterElias on Tue, 12/11/2012 - 06:00
A recent conversation about an institution’s use of the A1c (a measurement of average blood glucose levels over the preceding 100 days) to grade clinician performance and adjust compensation frustrated me. The issue was the misunderstanding and misuse of surrogate markers, those things we measure when we can’t measure what we really want to know.
Submitted by PeterElias on Sun, 11/25/2012 - 06:00
As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let alone occasionally heal. It has been - and continues to be - a glorious and fulfilling career. But it has not been easy or without pain, confusion, fear, or despair.
Submitted by PeterElias on Mon, 10/22/2012 - 06:00
The Grand Rounds presentation that week was in the form of a Clinical Pathological Conference (CPC), a medical tradition where a case is presented to an expert or panel of experts in front of an audience of clinicians. The presentation is usually done in the order the information became available during the patient’s hospital course and the experts ask questions, discuss what they think is going on and why, are given more data based on the questions they ask, and ultimately try to come to the diagnosis that was proved at surgery or autopsy.