Mea sententia

Three years and ~ 250 posts ago I started doing this, wondering if I would be able to find things to write about. As it turns out, that was the wrong question. A better question would have been, would I care enough to keep writing. So far, the answer is a resounding yes. My plan for the next year is to keep questioning so I can keep learning and growing. The future has a way of sneaking up on us like a windshield on a bug.

I hope you all have a wonder-full New Year, and that all your answers lead to better questions.

Peter

Anne came in for her annual health maintenance visit with great news. Her irritable bowel syndrome was no longer a problem. “I hope you aren’t upset with me, but I’m cured.”

I miss the relative simplicity and patient-centeredness that characterized the early years of my medical career.

Decades of behavioral economics research and management science predict that framing quality of medical care as something that can be captured effectively by a simple metric, and then incentivized by financial rewards or punishment based on that metric, would misfire.

I find it disheartening that those who push for QI and P4P programs based on evidence do not understand the most basic principles of the scientific method.

Patient-centered shared decision-making is one of the toughest tasks in clinical medicine. It involves a collaborative effort to collect and assess evidence, leavened with clinician experience, and framed within the context and values of the individual patient. 

The world of medicine is quite properly focused on finding and applying the best available evidence to processes of care. Unfortunately, too often this results in the use of inappropriate hard targets and mis-applied guidelines.

Dear Universe.

Happy Thanksgiving.  I am truly thankful, and here is a partial list of my reasons:

1. I won the lottery. No, not the one at the corner store. I mean being born at this time in history in the US and to parents who cared deeply about their children and the future and had the wherewithal to give me a good start.

2. My health. As a physician for the last 35 years, I am all too well aware of how tragic and undeserved ill-health can be. 

The deluge of clinical information I face every day is littered with clinical junk mail.

All day long I work with patients who want answers and certainty. My awareness of how few questions have proven answers, and how unpredictable human health and disease can be, is a heavy burden.  This discordance may be why I enjoyed Stuart Firestein’s excellent book, Ignorance,  so much.