My blog represents my personal experiences and perspectives. This includes many anecdotes from my medical practice. I have been scrupulous to anonymize these anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
"In an ideal world, your job as a manager would include setting goals and acquiring the resources to achieve them. But you don't live in an ideal world, largely because there are people like you in it."
- From Dogbert's Top Secret Management Handbook by Scott Adams
Shared decision making based on both evidence and patient preference is much in the medical literature of late. The part I don’t understand is why anyone would object.
During a recent Quality Initiative meeting at our medical center, concern was voiced that non-compliant patients make it hard for our individual providers and the institution as a whole to achieve our QI goals.
“Madness is the exception in individuals but the rule in groups.”
(Nietzsche)
Tim Jackson has written a fascinating piece about the economic limits of productivity. Aside from the economic considerations, I increasingly believe that the philosophy underlying medical care is incompatible with the concept of productivity.
If not, it doesn't mean you are smart. Remember...
"Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof."
John Kenneth Galbraith, economist (1908-2006)
"Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof."
John Kenneth Galbraith, economist (1908-2006)
This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years.
This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years. I hope I have retired by that time, because it would be truly shameful to actually sign and send such a letter.
Dear (computer generated patient name),
I am writing to express my deepest regret that I can no longer serve as your PCP. I will continue to provide you with all appropriate care during the next sixty days while you arrange an alternative provider.
This folk wisdom is variously attributed to Sun Tzu (The Art of War), Carl von Clausewitz, Mae Zedong, and the heavyweight prizefighter Jack Dempsey. Regardless of origin, it deserves its place in the pantheon of behavioral truths.
During a recent conversation with a patient about her irritable bowel syndrome, I asked about possible stressors:
“So, tell me, I know it’s hard to manage both full time school and a part time job, but I wonder if there are any other things going on for you that you wish you could change?”