Saturday, November 27, 2010

First principles

The conversation here will, by necessity and design, be fluid, unsystematic, and hopefully transgressional. That said, it will not be so amorphous that it stands for nothing; should not be so casual it becomes merely an online version of that popular medical bloodsport, bitching about our jobs.

These are the principles of what I am doing, whatever it is:

1. We are all in this together. There is not physician crisis, or nursing crisis, or patient crisis, or taxpayer crisis. We will not exalt one perspective at the expense of the others, as if the solution were only better training for residents or more nurses or better support for outpatients.

2. We are broken -- not in every way, not every time, but we are broken and we need to be whole. We will be whole when great healthcare is available to everyone at a reasonable cost, when compassion and good humor are ubiquitous, good communication a premise and errors as rare as your passenger jet falling out of the sky.

3. There will be no sacred cows, not private insurance or physician salaries or the autonomy of clinical decisions. There is a goal -- great healthcare for everyone, every time, at a reasonable cost. Anything that might get us a step closer to that is on the table.

Friday, October 1, 2010

A blog about medicine, American healthcare, healing and wellness

By now it's no secret that American healthcare is in the weeds. Some of its problems have been well described -- the funding crisis, the moral and practical challenge of the uninsured, the increasing recognition of medical errors and poor communication with and support of patients and families by their caregivers.

On the inside of the health system, where I and my colleagues are, all these problems are recognized, although some our obscured by the conditions in which we work (cost) and others by our work habits, our culture, and our self-protective rationalizations (few caregivers recognize how poor their communication with patients and families is, for example.) But also from the inside there are many more stress points that the public does not see. Care that sets out to be interdisciplinary and ends up fractured and confused. Reckless use of technology and medicine, often to patient's detriment, chasing the impossible dream of a work-up that takes no time, involves no exercise of judgment (which might leave it open to criticism), and misses nothing. The black hole of documentation which is swallowing giant swathes of time. And so on.

The mission of this blog is simple: we will confront the ways in which we, the American medical community, are broken, the way in which the country itself is broken as regards public health, medicine and law, and what can and is being done about it.