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.)
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?
In an organization – as in society – there is an important distinction between faith and religion.
Faith is belief in the organization’s mission, supported and embodied in its values and long term goals. In a successful organization, faith is a common good, co-owned and held by the entire community. Leadership doesn’t own or control faith, but functions as steward and guide, helping the community stay connected with (and by) their shared faith.
Quote: “I went to a PowerPoint presentation one day and a speaker showed up.”
Read the exciting conclusion on Michael Wade’s Execupundit blog.
Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”
“Therapeutic myopia” is the term coined in this insightful post for one of the drawbacks of the EMRs as currently used. If you are a clinician, you should print this and give it to your leadership and management to read, and send a link to your IT department. If you are a patient, you should print this and bring it to you providers and tell them it really concerns you, and ask them how they cope with this risk.
One morning, in response to my question about how things were going, a young and first-time mother said that everything was fine but that it really hurt when her son nursed because of his tooth. I assured her that it was normal for the nursing to be uncomfortable in the beginning but that newborns do not have teeth. She insisted that her son did. One tooth. Left lower front. Sharp.
You know who I mean. We've all had to work with (or around) the guy everyone calls the pain in the ass.
He is not the person you would choose to make the decision, but he is a person you definitely want in the room when the options are being explored.
I was struck last week by a remark in a discussion of patient-centric care: “...patient empowerment is probably beyond the reach of individual doctors/nurses to easily provide...” Two questions come to mind: who ‘owns’ the power, and what does it look like?
“The saving of our world from pending doom will come, not through the complacent adjustment of the conforming majority, but through the creative maladjustment of a nonconforming minority.”
(Dr Martin Luther King)