Medicine

I understand the concept of the hospitalist and I’ve seen the data. There is no doubt about their value. But...

Sometimes I have to stop, sit back, and just admire a patient for something. Today it was grace and humor under fire.

With regard to the EHR:

(crappy process) + (technology) = (fast, expensive crap)

‘Nuff said. 

Dr. David Nash makes some very good points about  the importance of recognizing both the relevance and the lack of alignment with physician beliefs of patient preferences, commenting on a December 4, 2011 JAMA commentary by Dr. Allen Detsky.

“…it’s easier to add stuff than to take it away.  It brings to mind thesecond law of thermodynamics in physics, which (very loosely) says that a system will always develop greater disorder (or randomness, or “entropy”) unless work is done on that system.  Stated from a clinical point of view: unless we invest more time and energy in our patients, their care will become more scattered, disorganized, and chaotic.”

During an interview in the post season, the franchise quarterback explained his success.

Our institution has recently started using NRC PIcker to collect patient feedback and grade clinical providers.  When I learned of this, I was anxious, defensive, offended and prepared to be angry at the prospect of being graded by data from some feedback form. I suspect my reaction is pretty common among providers. My discovery that the data includes some very useful material - and that I score well - has been a surprise, somewhat confusing, and led me to do some self-observation while with patients. 

For all my friends and colleagues at CMHC (with deepest apologies to Lerner and Lowe)…

All I want is a place somewhere,

Not locked down by Committee Chairs,

Where all who want can go to share,

Now wouldn't that be loverly?

Lots of documents for us to read.

Lots of communication, indeed.

Where creativity can breed.

Oh, wouldn't it be loverly?

Oh, so loverly as we all collaborate at will

We would never need to budge

For stuff that thrills like a sleeping pill.

Sir William Osler famously said: “Listen to the patient. He is trying to tell you what ails him.”

The process of becoming a physician is a long and gradual process. Scattered through this glacially slow and often painful process are episodes that are transformational in every sense of the word, experiences that impact what kind of physician one becomes. Or even, whether or not one becomes a physician.