Mea sententia...

Mea Sententia (which translates roughly as 'My Opinion') 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 persona/family anecdotes.
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The ineluctable logic of the child

We couldn’t find her sneakers anywhere. They weren’t in the travel bag, under the bench in the mudroom, in either car,  at friends’ houses, in the closet or under the bed. After two days, we gave up and bought a new pair sneakers.

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Hide problems or fix them?

A recent article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast.

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Quality versus innovation: a conundrom

"The art of progress is to preserve order amid change and to preserve change amid order. "

(Alfred North Whitehead)

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True North, or 'Has Medicine Lost It's Way?'

What is True North for medicine? Is there an enduring core value that serves as a reliable touchstone across the nearly infinite range of medical activities? Given how medicine and society change, can there even be an enduring True North? If we have one, are we pursuing it faithfully?  

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Why I speak up

I was asked by a colleague at work (someone who frequently but privately agreed with me but never spoke up publicly), “Why do you tilt at windmills?” Many have answered this better than I.

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Doing nothing - but doing it right

It’s always easier to do something than to do nothing. Doctors often offer treatments for things they know are what we call ‘self-limited’ meaning that they will clear up all by themselves.  I think this form of unnecessary treatment reflects an awareness that although many things resolve without intervention, both doctors and patients are driven to DO SOMETHING. Though it is usually tempered by the wish to do something as benign as possible, sometimes doing nothing is the best choice. The trick is knowing how to do nothing properly.

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Humility and medical guidelines

We have LOTS of guidelines and recommendations. We we need is more humility.

The Advisory Committee for Immunization Practices (ACIP) issued a recommendation in September of 2014 that pneumococcal vaccine naive individuals 65 and over get a Prevnar13 followed by a Pneumovax 6-12 months later, and that those who have had a Pneumovax get a Prevnar13 a minimum of 12 months after their Pneumovax.

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System overload

Under stress, including conditions of overload, systems degrade in a predictable manner.  

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Ironing things out

Rachel called about her elderly father, Blaine, better known to me as Bucky. She requested a ‘nerve pill’ to calm him down at night and a referral to a neurologist to test for dementia.

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Ironing out a diagnosis

Rachel called about her elderly father, Blaine, better known to me as Bucky. She requested a ‘nerve pill’ to calm him down at night and a referral to a neurologist to test for dementia.

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