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.

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