Medicine

Sometimes the health care system just does not work.

The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients.

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.

Eczema had been her only real health problem, but what a problem it had been. 

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.

There are limits in both music and medicine. Go beyond those limits, and disaster is inevitable.

Two quotes from Donald Berwick’s Escape Fire address sum it up quite nicely.

Shortcuts, humorously defined as the longest path between two points, can be dangerous in clinical medicine.

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.

Well, I had a post about this subject in notes and outline form in my pile. But Dr V handles it so well, it seems silly for me not to simply give him credit and send you to his site.