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.)
Many organizations talk about and attempt to use quality improvement management tools, such as those drawn from the Toyota TQM, Lean, and other recent popular management paradigms.
I’d been seeing Derek for just under a year. He was 29 and told me he had moved here from Oklahoma to help care for his aunt when she was diagnosed with cancer. He was not married but had a child ‘back home’ in Oklahoma, about whose mother, a former girl friend, he had nothing good to say. He came with a thick stack of records and several disks with MRIs, which told a history of a fall at work resulting in severe back pain with radicular symptoms (pain and some numbness into his right foot and little toe).
Beginning at least as early as the pre-Socratic era around 6 centuries BCE, it was assumed that the earth (and therefore humanity) stood at the center of the universe. It was all about us - and only about us.
Bob was 18, a high school senior, a good student, played soccer and ran track, excelling at the 400. He was in the office with his mother to follow up after an ED visit and brief hospital stay earlier in the week. The discharge sheet they brought in noted that he had responded promptly to treatment for a viral illness with vomiting, diarrhea and dehydration (VDD), but because of an unexplained tachycardia he was advised to be seen ASAP to obtain a referral for cardiac evaluation.
The language of medicine is highly evolved and complex and allows clear, detailed, specific and unambiguous descriptions. Except when it’s not.
What do scribes and managers have in common? (And how are they different?)
My Dad was not a gardener, and yard and garden chores were never a major interest for him. Lilacs, however, were special. He would always stop to comment on the scent and beauty of blooming lilacs. Here, in his own words, is the explanation.
How often do we think about what goes into solving a problem or making a decision? There are always at least half a dozen separate opportunities to take a wrong turn, so it pays to review the components of problem solving and decision making. In many ways, the medical model works well.
My wife had to undergo a minor outpatient surgical procedure in a nearby medical center. Their system was efficient and the people we dealt with friendly and helpful, from parking and access, through signage, registration, medical intake, explanations of the process, keeping me informed of her status, post-procedure monitoring and the discharge process. It was after the discharge and while we were packing up our things and getting ready to leave that we had the most extraordinary experience.
The hospital where I work has recently recognized the serious negative impact our disengaged and non-participatory community of providers is having on the ability of our medical center to innovate and achieve excellence. Evolving from an apathetic to an activist staff is not easy.