Malpractice Methodology by Peter Orszag

Article in the NYT, October 20th, 2010

How can we encourage doctors to make evidence based decisions and while avoiding excessive care?

Aggressive national effort to protect doctors who follow evidence-based guidelines. That's how malpractice reform could broadly promote the adoption of best practices.

NASA-like mistake reporting system that provides immunity for reporting system failures.

Better align financial incentives for delivering higher-quality care.

Hospitals lose medicare dollars if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.

A Touch of Sense by Abraham Verghese

Patients and physicians connect through touch and trust

great article

Preparing Medical Students for the Continual Improvement of Health and Health Care: Abraham Flexner and the New "Public Interest"

AAMA publication by Berwick and Finkelstein.

need continual improvement of patient health and community health

need to learn scientific foundations of system performance

The physician is a social instrument

current quality of care is unacceptable, given the improvements that have been shown to be possible in some systems

physicians can lead and accelerate changes in care processes that are grounded in good data and sound theory

improvement of systems

Dartmouth Hitchcock Leadership Preventive Medicine residency program

Skills, knowledge and attitudes for improvement of care

a) personal excellence in clinical skills, reflective practie

b) mastering scientific foundations of system performance, psychology, conflict resolution, negotiation, group process, human motivation, cognitive and social psychology, creativity, epistemology (how to gain knowledge)

Case Western Reserve residency program

Then a whole bunch of stuff about how the education needs to change

pretty good article

Complications by Atul Gawande

Great essays on the search for perfection in medicine. Truly shows how far we have left to go.

Disturbing that lowest error rates occur in the most specialized procedures. Gawande explains in "The Computer and the Hernia Factory" how these clinics that specialize in one procedure come very close to perfection. This is disturbing to me because I don't want the medicine I practice to be super specialized super repetitive, yet the data shows that computers make fewer mistakes then human judgement and they show that humans who perform more repetitive tasks ( to a point) perform those tasks with greater precision.

Three parts to the book.

I Fallibility of doctors.

a) learning to cut

b) computer and hernia factory

c) when doctors make mistakes

d) surgical convention

e) when good doctors go bad

II Mysteries that remain in medicine 

a) pain

b) nausea

c) blushing

d) obesity

III Uncertainty and decision making

a) autopsies

b) SIDS

c) doctor vs. patient centered care. who knows best?

d) and of course an exception, when intuition pays off (necrotizing fasciitis)