Medicine

I keep a bar of soap in my desk at the office as a reminder of progress in medical care. It was my grandfather’s idea.

It played out more like a television skit than most television skits. I wouldn’t believe it myself had I not been there.

I struggle with how best to approach attentional issues in my practice. I was taught by a developmental pediatrician in Madison that (diagnostic) labels were a convenience invented to make things simpler for clinicians and the billing office, but that they are of limited clinical value. and often actually harmful to patients. His concerns centered on the dangers of standardization and the dead-end effect. Treating the label distracts from seeing and treating the patient as a unique individual in a unique context with an individual manifestation of X.

Not all errors have negative consequences. Many go unnoticed. Occasionally they save lives.

In medicine, as in life, it is often the little things that matter.

Even if the eHR is only used as a word processing and data repository - in which case it is a very expensive technology used to duplicate the paper world - the impact on work flows would be substantial. Using the eHR as a catalyst to improve care means dramatically re-engineering huge segments of the care process. Either way, unintended consequences are inevitable.

So, what might a practice or medical center do to minimize the risk of harm from unintended consequences?

Quote: “I went to a PowerPoint presentation one day and a speaker showed up.”

Read the exciting conclusion on Michael Wade’s Execupundit blog.

“Therapeutic myopia” is the term coined in this insightful post for one of the drawbacks of the EMRs as currently used. If you are a clinician, you should print this and give it to your leadership and management to read, and send a link to your IT department.  If you are a patient, you should print this and bring it to you providers and tell them it really concerns you, and ask them how they cope with this risk.

One morning, 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.

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?