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.)
The process of becoming a physician is a long and gradual process. Scattered through this glacially slow and often painful process are episodes that are transformational in every sense of the word, experiences that impact what kind of physician one becomes. Or even, whether or not one becomes a physician.
I keep a bar of soap in my desk at the office as a reminder of progress in medical care. It was my grandfather’s idea.
It played out more like a television skit than most television skits. I wouldn’t believe it myself had I not been there.
“When you pay a lot of money for bullshit, you have to pretend you like how it smells. To do otherwise is to admit you were wrong, and that is not allowed in management.”
From STAR-Whacked at Trustus Pharmaceuticals.
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?