“A condition counts as a disease independently of whether there is safe and effective treatment.”
– Journal of Medicine & Philosophy, August 2017
What is a disease anyway? Mrs. Jones is 90 years old and frequently experiences episodes of chest pain. She has numerous partially blocked coronary arteries, and her physician has told her to come to the emergency room because she might be having a “heart attack.” …
Are we medicalizing everything?
The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” …
5 steps to create medical quality without trying
My hospitalist medical group consists of as great collection of atheists, agnostics, and skeptics as you will ever find. But we all agree that quality is our religion. We believe to our last breath that patient care is sacred and an invaluable gift. And so, as with all faith, there is no halfway. You believe, or you stand around scratching your head asking what those other fools are worshipping. Just …
Quality is this physician’s religion
I scream in frustration as the flickering screen creates another required check box. Silently of course. I am on the hospital ward, and broadcasting the doctor’s frustration will not help patients or nurses. “Who created this tool?” I wonder for the thousandth time. Why don’t doctors make their own tools?
Contemporary philosopher Daniel Dennett ponders thinking tools. “Like all artisans, a blacksmith needs tools, but — …
Doctors, we need to start making our own tools
Why does the universe have conscious beings? The physical and biological laws of nature do not seem to explain the existence of conscious creatures such as humans. Neuroscience has done well to explain many of our behaviors, illnesses and medical therapies based on purely physical and observable rules. But no one has ever measured consciousness. And yet it appears fundamental to whether my patient will recover from their disease.
After 15 …
Should doctors be more conscious of consciousness?
“There is no document of civilization which is not at the same time a document of barbarism.”
– Walter Benjamin, Theses on the Philosophy of History
It is 1940, and the Nazi horror is bearing down on Europe. France has fallen, and refugees are streaming out, fleeing to safety through neutral states and America. Walter Benjamin, a Jew, and a German philosopher, joins a small group being guided through southern Spain with …
The metric, the dialectic, and the chart electric
Two quality metrics walk into a bar.
One demands, “Give me the best beer you’ve got!”
The other says, “Give me the second-best beer you’ve got.”
The bartender pours the beers and states, “You can have them both for free if you can tell me why this one is better than that one.”
Quality metrics were invented to quantify the ineffable, such as the taste of a fine lager or IPA. I see that …
Quantifying quality doesn’t help patients
Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data. And the picture does not look good. Paying doctors to improve their quality metrics does not, in general, improve those quality metrics. Like all good scientists, we can now either question the data, or discard the hypothesis.
Most payors and administrators appear to be reacting to the lack of efficacy data on …
What was the hypothesis with pay-for-performance?
I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it’s too refreshing to pass up. So at 2 a.m. Friday night, I’m zooming (you always “zoom” on a scooter) through the industrial district after a tiring admitting shift. I see …
We must remember to humanize our patients
How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?
It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.
“In despairing over …
The double meaning of despair in the hospital
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