Mea sententia

“One does not discover new lands without consenting to lose sight of the shore for a very long time." 

André Gide (1869-1951)

"In an ideal world, your job as a manager would include setting goals and acquiring the resources to achieve them. But you don't live in an ideal world, largely because there are people like you in it."

- From Dogbert's Top Secret Management Handbook by Scott Adams

Shared decision making based on both evidence and patient preference is much in the medical literature of late. The part I don’t understand is why anyone would object.

During a recent Quality Initiative meeting at our medical center, concern was voiced that non-compliant patients make it hard for our individual providers and the institution as a whole to achieve our QI goals.

“Madness is the exception in individuals but the rule in groups.”

(Nietzsche) 

Tim Jackson has written a fascinating piece about the economic limits of productivity. Aside from the economic considerations, I increasingly believe that the philosophy underlying medical care is incompatible with the concept of productivity.

If not, it doesn't mean you are smart.  Remember...

"Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof."

John Kenneth Galbraith, economist (1908-2006)

"Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof."

John Kenneth Galbraith, economist (1908-2006)

This imaginary letter, penned after attending a Quality Initiative meeting, is fictional today, but I suspect something like it will appear in the near future and be sadly common within five years.