My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
"Programming today is a race between software engineers striving to build bigger and better idiot-proof programs, and the universe trying to build bigger and better idiots. So far, the universe is winning."
Robert Cringley (columnist, author, host of "Triumph of the Nerds")
There are five requirements for successful shared decision making (SDM) between patients and their clinicians.
I found this on a scrap of paper tucked inside an old version of the Appalachian Mountain Guide. I suspect I copied it from a Hut register, though I do not remember. My note indicates it was written by Poetry Man in 1993.
At morning work rounds the attending suggested we start with a patient I had seen and admitted through the Emergency Room the night before.
Long ago, in a distant land, in circumstances seeming dire, a dear friend penned this for me. It surfaced this week while I sorted papers. Like all truths and most good literature, it is timeless. I offer it, with thanks to Jill, for those in need.
Ode to the Grumps
Many a time it hath been stated
to the grumps we oft are fated
tho' such condition is rare to find
“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)