Mea sententia

In medical school, I was taught to TAKE a medical history in such as way that I didn’t MAKE a medical history.

At the time this seemed burdensome and inefficient, another of many unmeetable requirements whose justification was either ‘that’s how I was trained’ or ‘you’ll understand when you have more experience in medicine.’  Well, now I understand. And I no longer chafe (much) at the patience and work involved in letting the patient tell their story, in their own words, and largely at their own pace.

It was the summer before my last year of medical school and I was traveling around the US for family practice residency interviews. My wife and I were staying with some of her college friends while I looked at a program in Denver.

Leadership can focus on making sure everyone does their job. Or leadership can focus on making it easy for everyone to do their job. The former is more common, the latter is more effective.

I recently finished reading Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together by Peter Ubel, MD.  It should be required reading for all the following...

In medicine, unlike much of the world, it is the questions one doesn’t ask that lead to trouble. When taking a medical history, the biggest enemies are time and fear. Time, because there is never enough to ask all the questions, listen carefully to all the answers, and pursue all the possible clues. Fear, because the natural reluctance to ask certain questions is a trap.

I was taught that being an asymptomatic carrier of strep in the throat was not associated with either illness or risk of complications. That’s not always true. The schedule said ‘strep throat x 5 weeks and diarrhea.’  Handing me the encounter form, my nurse warned me: ‘Mom’s not a happy camper.’

Teaching to the test is controversial. It helps students pass tests and makes educational programs look successful, but everyone knows it does not guarantee improved education.  

It is ironic that evidence-based medicine was introduced, not to eliminate variability, but to ensure that variability was both present and appropriate. 

After reading this excellent study in the BMJ showing no benefit and some risk of harm from annual mammographic screening for breast cancer (see also this discussion in the NY Times) I suggested to a local institution that they should reconsider their Pay for Performance (P4P) initiative which penalizes their clinicians (by lowering their pay) if thei

Quality in the EHR is a zero-sum game, involving a balancing act among three key but competing needs: scope, resources and usability.