Mea sententia

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."

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."

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.