Mea sententia

Life must be understood backward. But it must be lived forward. (Soren Kierkegaard)

I struggle with how best to approach attentional issues in my practice. I was taught by a developmental pediatrician in Madison that (diagnostic) labels were a convenience invented to make things simpler for clinicians and the billing office, but that they are of limited clinical value. and often actually harmful to patients. His concerns centered on the dangers of standardization and the dead-end effect. Treating the label distracts from seeing and treating the patient as a unique individual in a unique context with an individual manifestation of X.

Not all errors have negative consequences. Many go unnoticed. Occasionally they save lives.

In medicine, as in life, it is often the little things that matter.

I have been called argumentative, disputatious, a vexatious nuisance, oppositional, a disagreement looking for an opportunity, and far worse.

 With these descriptions, I would not argue. The folks who say these things are correct. But I wonder if they know why I like to argue?

Not to win. Not to prove a point. Not to sell a position. Not to convince.

Even if the eHR is only used as a word processing and data repository - in which case it is a very expensive technology used to duplicate the paper world - the impact on work flows would be substantial. Using the eHR as a catalyst to improve care means dramatically re-engineering huge segments of the care process. Either way, unintended consequences are inevitable.

So, what might a practice or medical center do to minimize the risk of harm from unintended consequences?

In an organization – as in society – there is an important distinction between faith and religion. 

Faith is belief in the organization’s mission, supported and embodied in its values and long term goals. In a successful organization, faith is a common good, co-owned and held by the entire community.  Leadership doesn’t own or control faith, but functions as steward and guide, helping the community stay connected with (and by) their shared faith.

Quote: “I went to a PowerPoint presentation one day and a speaker showed up.”

Read the exciting conclusion on Michael Wade’s Execupundit blog.

Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”

“Therapeutic myopia” is the term coined in this insightful post for one of the drawbacks of the EMRs as currently used. If you are a clinician, you should print this and give it to your leadership and management to read, and send a link to your IT department.  If you are a patient, you should print this and bring it to you providers and tell them it really concerns you, and ask them how they cope with this risk.