Medicine

How often do we think about what goes into solving a problem or making a decision? There are always at least half a dozen separate opportunities to take a wrong turn, so it pays to review the components of problem solving and decision making. In many ways, the medical model works well.

My wife had to undergo a minor outpatient surgical procedure in a nearby medical center. Their system was efficient and the people we dealt with friendly and helpful, from parking and access, through signage, registration, medical intake, explanations of the process, keeping me informed of her status, post-procedure monitoring and the discharge process. It was after the discharge and while we were packing up our things and getting ready to leave that we had the most extraordinary experience.

The hospital where I work has recently recognized the serious negative impact our disengaged and non-participatory community of providers is having on the ability of our medical center to innovate and achieve excellence. Evolving from an apathetic to an activist staff is not easy. 

Unless you have been living in a cave for the last 5 years, you have heard lots of talk about Web 2.0 and Health 2.0, the 21st Century versions of the internet and the health care system.  Changes in technology, social structures, medical science and culture has led to huge changes. Is the same thing happening in the fields of management and leadership? Is there a management (or leadership) 2.0 just over the horizon? If so, what would it look like in health care?

During medical school we were admonished never to take short cuts. High on the list of forbidden behaviors was to fail to do a complete physical exam, regardless of how focal the presenting problem seemed. For one thing, our diagnostic skills were in their infancy, and narrowing the focus too early was a way to miss important things. For another, there is a wide range of normal and multiple exams would help us recognize an outlier. The relationship with the patient was felt to be enhanced by the process of a methodical and attentive exam with laying on of hands.

The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.

When we were a group of four primary care providers it was easy to share information, communicate and work collaboratively. Having grown to ten, we struggled. As our lives became more hectic, our time scarcer, and the number and complexity of issues grew, it became impossible to manage practice governance, pursue QI projects, develop work flows, and deal with directives from our parent organization. Keeping everyone in the loop was simply not possible. Even if we could get all ten providers in one place for an hour/week, the task was too large to squeeze into an hour a week.

My first appointment on that rainy Monday morning was a 24 year old woman there for her annual health maintenance visit, Pap and contraceptive review. We talked about her wedding...

The call came just after breakfast on a Saturday.  A patient of one of my partners was hoping I could do him and his employer, Bates College, a favor and see a woman who was not a patient in our practice. She was visiting from out of town to see her grand nephew graduate on Sunday but had taken ill, and was reluctant to visit the ED. 

She was spitting mad....