Philosophy and ethics

The wave of the future is bringing game-changing cultural shifts in patient awareness and expectations. These are paralleled (and fed) by paradigm changing technologies.  Clinicians and medical institutions will sink or swim depending on how well they ride these waves.

Those who choose the comfort of the familiar and predictable, who sit safely on the beach while they watch and wait, who allow others to build the future, these late adopters will ultimately be forced to enter the water. I predict they will never catch up, and will struggle merely to survive.

It’s frustrating when they won’t let you be a playwright, but then complain when you become a critic.

Patient satisfaction has become a prominent goal in health care. Is this a good thing?

I don’t consider myself a laborer, though I surely work very hard. I work because I love to.

“No man needs sympathy because he has to work, because he has a burden to carry. Far and away the best prize that life offers is the chance to work hard at work worth doing.” (Theodore Roosevelt)

“Each morning sees some task begin,

Each evening sees it close;

Something attempted, some done,

Has earned a night’s repose.”

(Henry Wadsworth Longfellow)

Having problems is not a problem. Believing or pretending there are no problems, and then punishing or marginalizing those who want to fix the problems - THAT is a problem.

I have a serious problem with the ubiquitous use of 'due' when talking with patients about what their medical options are. This came up recently when I was given a list of my patients who were ‘due’ for certain services, required if my institution is to receive a financial quality incentive. Typically, ‘due’ shows up in EHR alerts (the diabetic patient is 'due' for their A1c or microalbumin) and quality programs (patients are 'due' for a mammogram every 2 years, a DXA at 65, a pneumovax at 65, even well child visits at set intervals).

"We live in a society absolutely dependent on science and technology and yet have cleverly arranged things so that almost no one understands science and technology. That's a clear prescription for disaster." (Carl Sagan)

I recently finished reading Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together by Peter Ubel, MD.  It should be required reading for all the following...

After reading this excellent study in the BMJ showing no benefit and some risk of harm from annual mammographic screening for breast cancer (see also this discussion in the NY Times) I suggested to a local institution that they should reconsider their Pay for Performance (P4P) initiative which penalizes their clinicians (by lowering their pay) if thei

All day long I work with patients who want answers and certainty. My awareness of how few questions have proven answers, and how unpredictable human health and disease can be, is a heavy burden.  This discordance may be why I enjoyed Stuart Firestein’s excellent book, Ignorance,  so much.