Mea sententia

Playing with my three year old granddaughter is teaching me to be mindful of whose world I am in, and to behave accordingly. 

In her world, she is the native and I am a tourist. The rules and customs are hers. Things go well when I can relax and let the native guide me. My attempts to impose customs or rules from my world on her world fail spectacularly. As they should.

I have written before of my belief that P4P as often practiced is unethical because it attempts to tilt the clinician away from shared decision making with an autonomous patient, and towards directed decision making serving the interest of the clinician or the institution.

In health care, replacing volume based economics with value based economics is essential.

One has to ask the right question in order to get the answer.

The chief complaint on the encounter form said ‘panic attack’ and a quick review of the chart before I entered the room showed a healthy 28 year old woman with no health or emotional issues who came in every year for a routine birth control visit. She told me she had had a ‘panic attack’ the day before and was sure there was nothing serious wrong, but came in at the insistence of a colleague. “It’s probably a waste of time, but Seeley made me promise to come.”

This week I received an email from the leadership at my hospital, encouraging me to contact my elected (Maine) state representatives in support of some pending legislation...

Two points:

1. Measuring something is not the same as improving it. 
2. Improving something requires thinking of quality as a process rather than a product.

Before we think about how these two principles apply to medicine, let’s consider two approaches to coaching basketball: one using incentives tied to outcome metrics, and one using interventions designed to identify and address process problems.

It is all too easy to forget that it is (or should be) entirely about the patient.

Horseshit on a trail run is fitting and pleasant, but in the work place is painfully destructive.

…a meaningfully usable and user friendly EHR.

It’s impossible to learn from one’s mistakes while busy denying or hiding them.