Mea sententia...

Mea Sententia translates roughly as 'My Opinion' and has been my intermittent blog since 2011. Much of my writing is about medical issues, but my topics range through philosophy, behavioral and decision making, management, humor, and personal/family anecdotes.


A Cialis dilemma

He was there for a common acute problem when the dilemma caught me off guard. After I had explained the likely cause of his six weeks of sore throat (allergic post nasal drip) and treatment options, I asked if he had any questions and he answered that he would like a prescription for Cialis.

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Four steps to improved engagement

Many discussions of improving engagement involve either complex philosophical/behavioral explanations or potentially disruptive (and therefore frightening and hard to do) widespread change. There is actually a pretty simple way to make significant change happen.

As soon as any project or issue is identified, and regularly thereafter, ask AND ANSWER the following four questions:

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Structure, ritual, and threat

Joseph Campbell studied and wrote about myths, rituals and ceremonies, and the roles played by these early precursors of theater in the human experience. One of his enduring insights about the function of rituals in a society is informative to the role of structure in an organization.

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Input must precede (collaborative) discussions

This week I reviewed the most recent minutes of a hospital committee charged with initiating and managing clinical quality initiatives. As usual, the minutes documented a substantial amount of conscientious hard work by a very motivated group. However, one item caught my attention: they were sending a draft of quality goals for 2012 to the four Division Chiefs for approval, with a deadline of 9 days later. 

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Intelligent (?) design, evolution, and failure

At a recent management meeting, top leadership spoke eloquently and forcefully about the huge challenges we face from a ‘perfect storm’ combination of our ongoing national financial crisis and the health care reform act with its unknown and largely unknowable changes. They emphasized the need for innovations that are carefully considered, centrally controlled, and rapidly developed and deployed. The underlying theme was: “Major change is inevitable, and mistakes are not an option. We have to get it right the first time.” 

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Evidence based medicine (EBM) done right: Deming, not Taylor

Evidence Based Medicine (EBM) is a relatively recent but very popular development with great potential for both good and ill.

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Making a difference

It was my day to see ‘acutes’ - patients who call with issues that need to be seen that day. A day to be prepared for anything.

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Monthly Mangled Medicalese (MMM)

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

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When I saw Josh on my morning schedule for a college physical, I was surprised. Pleased, but nonetheless surprised. Josh was a good kid with a quick intelligence for things he could touch or build, who always made it clear he didn’t care for school, but who had never been in academic difficulty, getting by with mostly Cs and occasional Bs. He worked some in his uncle’s electrician’s business, and I had always thought this was a good match for him. College was something he had never expressed interest in.

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My approach to medical blogging

I have been blogging at for almost 6 months and have learned a great deal.

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