Physician leadership is essential if medical organizations are to survive and prosper in the current environment, but many physicians do not understand why or how they should do this while engaged in active practice. If we see that our interactions with those who help us take care of our patients constitutes a clinical microsystem, where our impact is critical, and we learn to shape our behaviors to improve the microsystem, we will improve the care of our patients by building stable teams who can improve their practices over time.
Being an effective clinical leader does not require a formal degree in business or management, but it does require some reflection about the nature of medical practice, the nature of medical organizations, and the pressures of health care reform. It also requires some reflection about the differences between formal and informal leadership, and between clinical and managerial leadership. Others are also addressing aspects of the problem of physician leadership, and you can find more detail there.
The articles are written by a practicing physician for practicing physicians. While each article is meant to stand alone, there are several themes. First, I believe evidence based medicine is distorting patient-centered care in ways that were not intended, just as the goals of creating value, as opposed to volume and introduction of electronic health records, is creating unintended distortions. I am a proponent of continuous quality improvement methods as a technique, but inappropriate application can cause damage that mitigates the gains. We should strive to standardize that which should be standardized, but no more. We also need to appreciate that the signals obtained about clinical practice are inherently fuzzy. Big data will not improve the certainty with which we can know the appropriate course of action in all patients at all times. The "quality paradox" is that the more we try to account for healthcare, the more we risk diverting our attention away from the things that matter to our patients and ourselves as clinicians.
Medicine is big business and a major cost to the taxpayer. There is no chance the financial pressures for efficiency will abate. However, what makes sense at the macro level may not make sense at the individual patient level. But we know that much of what we do now is not helping improve outcomes, and we must be prepared to adjust our practice habits to become more effective as well as efficient. We must also learn to admit the limits of our ability to help patients, and I predict we will develop a consensus that therapy of low, but no zero, utility, should not be applied as liberally as they are today.
Physicians have always possessed specialized knowledge and have faced the need to translate that knowledge into information patients can act upon. Today, we face the need to translate our knowledge of clinical realities into information businessmen and policy makers can act upon.
The most recent articles are listed in the panel on the right. Previous articles are grouped in four categories: clinical leadership, team building in medical organizations, medical practice, and challenges posed by healthcare reform. You can use the tabs to find a table of articles related to each topic. With each article I have tried to show links to related articles to allow you to develop your own "curriculum."
I hope you find these articles useful. My goal is to challenge you to think about how you practice medicine today, and how you can make relatively small changes that will improve your practice environment both today and tomorrow. Feedback, including arguments are welcome. I can be reached at firstname.lastname@example.org.
January 11, 2018
Waste and the Cost of Care
There is no doubt individual health care expenditures have grown faster than the economy. Is this due to increased intensity of service (waste)?
December 27, 2017
Equipoise can be defined as a state of equilibrium or counterbalance. We would do well to seek it both personally and as institutions.
December 11, 2017
What really matters to practicing physicians?
November 27, 2017
A new study suggests only 5% of Medicare spending in 2012 was preventable, much of it in frail, elderly patients. Is this good news or bad?
November 9, 2017
Dunbar's research suggests a practical limit to our human capacity for emotional connection with others. This has important implications for dialysis unit function.
October 25, 2017
Regret is a universal emotion. Although we try, avoiding regret is not possible, and our desire to do so creates costs to everyone.
October 12, 2017
Perspectives on Physician Leadership
Physician leadership is receiving more attention. Three recent articles illuminate the need for and the challenges to physicians leading.
September 26, 2017
If asked about the greatest advances I have seen, my outside the box answer would be the insight that the quality and safety of medical care is as much about system design as it is about human performance. Current efforts to make providers financially accountable, though, threaten the utility of this insight.
September 13, 2017
What Makes a Successful Physician?
What skills are required to be a successful practicing physician?
August 28, 2017
Messaging is replacing dialogue in clinical practice to the detriment of all.
August 14, 2017
Medical Care as a Commodity
Are big data and machine learning likely to solve the problem of uncertainty in medical practice?
July 27, 2017
How do physicians deal with complex, uncertain health care situations? Scenario planning is better than quoting statistics.
July 13, 2017
A recent flurry of articles show the challenges to medical practice have reached critical mass.