Mea sententia

One morning on rounds during medical school, in response to my question about how things were going, a young and first-time mother said that everything was fine but that it really hurt when her son nursed because of his tooth. I assured her that it was normal for the nursing to be uncomfortable in the beginning but that newborns do not have teeth. She insisted that her son did. One tooth. Left lower front. Sharp.

You know who I mean. We've all had to work with (or around) the guy everyone calls the pain in the ass.

He is not the person you would choose to make the decision, but he is a person you definitely want in the room when the options are being explored.

I was struck last week by a remark in a discussion of patient-centric care: “...patient empowerment is probably beyond the reach of individual doctors/nurses to easily provide...” Two questions come to mind: who ‘owns’ the power, and what does it look like?

“The saving of our world from pending doom will come, not through the complacent adjustment of the conforming majority, but through the creative maladjustment of a nonconforming minority.”

(Dr Martin Luther King)         

The leadership and management techniques that still dominate in the early 21st Century remind me of the mediocre and aging rock bands so common in local and regional venues: neither group has realized they are past their prime. Change is inevitable. Success is not. Mark Twain wrote that sacred cows make the best hamburger. We shouldn’t be adding spices to stale recipes or spoiled food. We should be designing a new menu.

Several recent events make this a good time for me to start posting intermittently on what I see as the collaborative approach to patient care.

“The name of the game in this economy and this health care climate and this political world is exclusion. You know it and I know it. We just don’t want to talk about it.”

First they ignore you.

Then they laugh at you.

Then they fight you.

Then you win.

(Gandhi)

Good questions can give good answers.

At recent meetings, senior leadership and management have spoken eloquently and forcefully about the huge challenges we in health care face from the perfect storm combination of an ongoing national financial crisis, the health care reform act with its unknown and largely unknowable changes, and our local revenue shortfalls. They emphasize the need for innovations that are carefully considered, centrally controlled, and rapidly developed and deployed. The theme is: “Major change is inevitable, and mistakes are not an option. We have to get it right the first time.”