Over the past month I have contemplated the directions that this blog has taken over the past 5 years. While I continue to comment on purely medical issues, more and more I address those issues which impact medical care. Examples include malpractice, guidelines, health insurance, health insurance proposals.

As a physician, I usually see the world using a medical paradigm. I have recently realized that I am focusing on side effects. As I discuss P4P, I worry about the unintended side effects of these plans. As I consider guidelines, my mind works through the implications of guidelines and therefore the side effects.

I believe the medical paradigm works well for these issues. When I use IV lorazepam to calm an intubated patient, I must know that too much of this preparation can induce an unwanted side effect. When I prescribe metronidazole for a serious infection, I am aware that the patient will have the undesired side effect of a metallic taste.

All medical therapies have effects and side effects. Many diagnostic tests have side effects.

Health policy decisions induce side effects. We need to stress understanding likely side effects before we champion major health policy changes.

Over my 30+ years as a physician, I have become increasingly cautious about new therapies. Rarely do I adopt new medications quickly. I need to see carefully done studies. I need to understand the pluses and minuses of doing things a new way.

As I view health policy statements, I view them the same way. While I champion change, I worry about change.

I feel so strongly about the importance of side effects, that I am considering renaming this blog. While I probably will not (I understand the value of my current “brand”), I do understand that much of what I currently write involves an exploration of side effects. And side effects can be disastrous.