Mea sententia

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of information, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.  During my 30+ years as a family doc, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Below the fold are my Ten Rules.

There are four questions that should be asked AND ANSWERED as soon as a project is initiated, a problem solving process is started, or an issue is identified for analysis.  

I think it was during 6th grade that I found the envelope of money on my way home from school and realized immediately that it was enough to purchase the PeeWee Reese shortstop glove I so dearly wanted from Tim and Tom's Sport Store on Central Avenue. 

I’m not sure when the change happened, but it was quite apparent this month. 

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.

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:

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.

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. 

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.” 

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