Today's thought

There is only one thing more painful than learning from experience, and that is not learning from experience. Archibald McLeish


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Mea sententia...

Mar 22, 2015

Cells or Selves?

I am both excited and worried about the recent enthusiasm for precision medicine (PM)     


Categories: Medicine

Mar 15, 2015

My ideal health care organization

When I envision the ideal health care organization, I picture six characteristics.


Categories: Medicine

Mar 08, 2015

Why bother?

A professional colleague asked me during a recent conversation bemoaning how hard it was to do quality primary care, why I bothered to keep pushing for change in the face of so much evidence that it was pointless. I told her, what we put up with is what we end up with.


I asked, why don’t you push back and demand change if you are so unhappy about the way things are?  Because I watch you and see that it is pointless, she said.


Mar 01, 2015

Sink or swim

The wave of the future is bringing game-changing cultural shifts in patient awareness and expectations. These are paralleled (and fed) by paradigm changing technologies.  Clinicians and medical institutions will sink or swim depending on how well they ride these waves.

Those who choose the comfort of the familiar and predictable, who sit safely on the beach while they watch and wait, who allow others to build the future, these late adopters will ultimately be forced to enter the water. I predict they will never catch up, and will struggle merely to survive.

Are you a swimmer? Are you in the water, making waves?  Or are you the audience, seeing life and health care as spectator sports? 



Categories: Medicine

Feb 22, 2015

The Ten Commandments of Therapeutics

I found a wonderful article by Udkin, Dreger and Sousa, and have updated and adapted it. See below the fold…


Categories: Medicine

Feb 15, 2015

It's not as easy as you think...

I found a snippet in my Evernote file, sadly without anything citing a source. I have adapted it to fit my experience with Clinical Quality Improvement activities. I suspect it is broadly applicable…

  • It will take longer than expected.
  • Not everyone will understand.
  • At least one key player is not engaged.
  • No matter how diligent the process, the team will miss something important.
  • If everyone agrees, someone is not paying attention, or is being dishonest.
  • The risk manager, lawyers, and upper level management really want to say no.
  • When you are done, people will complain and you'll have to remind them of the mission.
  • The result will not be what you planned.
  • To the extent that you succeed, the important benefits will result from solving unforeseen complications.

Categories: Medicine

Feb 08, 2015

Of geese, ganders, and pay-for-performance

Like most employees of large institutions, I am subject to a variety of ‘incentives’ that are designed to meet institutional needs, which may or may not be well aligned with my needs, to say nothing of the needs of my patients. 

Categories: Medicine

Feb 01, 2015

I teach to remain a learner

Teaching in our local family practice residency is one of the most enjoyable parts of my week. When a colleague recently asked why I liked it so much, it took some reflection to answer.


Categories: Medicine

Jan 29, 2015

Slow down, you move too fast...

Slow down, you move too fast.  It will all be over far too soon. 


Jan 22, 2015

CPOE for management

At a recent clinical staff meeting, a physician complained that the new requirement that clinicians enter all orders manually into the electronic record (CPOE) is slowing us down and causing errors. The IT and administrative staff were not the least sympathetic. Their message: it’s really not a big deal, it only takes an extra minute or two, and smart people like you should be able to master a simple skill like this. On the way home, I came up with a way to help them better understand: CPOE for management.


Categories: Medicine

Jan 15, 2015

Distractions and interruptions

Did you know that there is a whole branch of psychology devoted to the impact of interruptions and distractions on learning, memory, performance, productivity, and decision making?

Categories: Behavioral

Jan 08, 2015

Playwrights and critics

It’s frustrating when they won’t let you be a playwright, but then complain when you become a critic. 


Categories: Management

Dec 22, 2014

Results are not always important

Lisl was very good high school skier but seemed not to have the race results she was capable of and everyone expected.  


Dec 15, 2014

Meetings: a tool to create apathy

A physician friend commented recently that he was being ‘meeting-ed to death’ and wondered if it was intentional. It turns out, he was on to something.

Categories: Medicine

Dec 08, 2014

Chart review

Chart review is one of my occasional clinical responsibilities.  The charts I see overwhelmingly document good quality medical care. Last week I saw a chart that gave me pause. 

Categories: Medicine

Dec 01, 2014

Guinness Book of World Stupid

You can’t make this stuff up. I pulled into our local BJ’s gas station on a recent rainy morning. It was quite busy and I looked around for the shortest line to join, Seeing a woman in her early 20s who appeared to be finished fueling as she re-holstered the nozzle in the pump and returned to her car, I pulled in behind her, expecting to promptly be able to pull up and buy gas.  A car pulled in behind me, so I was now committed.


Categories: Humor

Nov 29, 2014

The perfect storm of discontent

A friend recently explained why he retired from a long and rewarding career in medicine and medical education, despite still loving his one-on-one interactions with patients. 


Categories: Medicine

Nov 22, 2014

The innovator's prayer

Words of wisdom…

Categories: Philosophy and ethics

Nov 15, 2014

Workplace Wellness Programs: sense or nonsense?

Workplace wellness and chronic disease management programs (now encouraged by the ACA) are quite common, but being a $6 billion dollar industry doesn't make them useful. Recent personal experience with one such program has led me to look more closely at the topic.


Categories: Medicine

Nov 08, 2014

Two very different cultures in medicine

Was the surgeon a princess, complaining about a pea under her mattress? Or am I a sheeple, accepting a woefully inadequate system? What do you think?


Categories: Medicine
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