Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Dec - 19
Jan - 21
Feb - 8
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Thinking versus bureaucratic rules
10 Jul2009
As many readers know, I do have a major administrative position. I try to have the philosophy of thinking rather than applying rules.
I believe that distrust of bureaucratic rules defines the American ethos. We love characters who ignore bureaucracy to get at the truth – Harry Bosch, John Rebus, Jack Reacher, Jack Bauer.
“You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.” – Thomas Sowell
As I consider my week of anger and ranting, I thought last night about my dislike of bureaucracy. I understand the need for rules, but dislike those who enforce rules rigidly without understanding circumstance.
I love the comment I recently received:
Old teaching: A good physician knows when not to follow the guidelines.
New teaching: A good physician follows guidelines at a higher rate than his/her colleagues.
this is progress?
We should not have “rule based” medicine. The original intent of the guidelines movement clearly involved guides rather than rigid rules. The performance measurement movement has, in my angry opinion, perverted the intent.
Physicians have an obligation to do the best for their patients. We often have to make difficult decisions about medications or tests within the context of the patient, their desires, and their other diseases.
Talk to practicing physicians (which I do regularly) and you will find nearly universal disdain for performance measures. They distrust measures calculated from databases, divorced from complete patient information.
We do need to encourage adoption of important new evidence, however, we have an obligation to understand the evidence behind performance scoring and physician ranking. I hope some readers can educate me on the benefits to patients of these activities. My private practice friends find this movement bureaucratic – and that term is meant to be an insult.
Related posts:
- Guidelines not rules
- How to insure quality
- Work hours – medical student perspective
- The danger of bureaucratic rules
- My position on performance measures
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- In: Medical Rants
1 Response to Thinking versus bureaucratic rules
AnnR
July 11th, 2009 at 5:25 pm
I’m all for thinking and reject the notion that one size fits all.
The prospect of 42 million people coming into the medical system and the medical system sticking to dogmatic and overblow protocols is one that I don’t think we can afford!
I am as big a fan of Jack Bauer as any, but I am going to point out that he spends at least 1/4 of each season un-doing stuff that had his co-workers adhered to protocol wouldn’t have ever happened!
How many bad CTU employees has he battled? Don’t they ever vet anybody? Just last season we had an FBI guy in a highly sensitive position taking cash from the African guy. How did that get missed? Those folks have to fill disclosure out regularly. And security — they’re giving each other passwords back and forth and hacking into stuff right and left. Given the preformance of Vice President’s on the show I think the position should be seriously reconsidered.
If the “system” worked right Jack could reduce his workload greatly.