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 ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
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P4P must fail because it uses a left brain solution to a whole brain problem
12 Dec2009
I just finished reading A Whole New Mind by Dan Pink. The book has its strengths and weaknesses, but it does make some very good points about right brain function.
Medicine is not a left brain function solely. If we just see trees then we miss the patient in the forest. Too often I see patients on too many meds, with medication side effects, because a physician (or 2 or 3 or more) was treating a problem rather than the patient.
Too often the patient is given the correct prescription, but the physician does not explain the medication appropriately. Too often the patient cannot afford the medication, but the physician does not even ask.
Patients need our empathy in addition to our checkbox medicine. We have bean counters, only examining the left brain function of patient care. But patients are not widgets. Every day I interact with patients, and try to understand how best to improve there quality of life. I try to provide high quality care, but that does not always fit onto a checklist. Many important things that we do are not included in checklists.
P4P is (as I said earlier) immoral and I believe unethical. It is not scientifically sound, because it has not passed any scientific testing!
Related posts:
- Art and science, right brain and left brain (h/t @kevinmd)
- Listen to the stories
- Retainer medicine – from 7 years ago
- 15 days at the VA – day 10
- What is quality – a reader asks
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- In: Medical Rants
2 Responses to P4P must fail because it uses a left brain solution to a whole brain problem
solo dr
December 12th, 2009 at 6:57 pm
P4P is similar to some of the capitated Medicare HMOS in my area. I elected not to join the HMOs, as each group or physician is paid based on efficiency and quality. Bonuses can reach 6 digits at the end of the year, as long as you do not have sick patients. Monthly payments based on efficiency and number of patients are paid to each physician. Office visits are discouraged, as grater than 3 visits/patient means the doctor loses money. Inpatient care is not covered by capitation, so inpatient stays are extremely short. What happens is the groups with the sickest patients "depanel" them to the new docs, so that the groups can maintain their bonuses.
pcb
December 13th, 2009 at 8:45 pm
Polypharmacy is one of the huge negative consequences of P4P schemes. I know some excellent physicians who feel one of their main purposes in medicine is to pare down the med lists of patients they care for.
Do bad there's not a quality measure for prioritizing a patient's med list to best suit the needs of the patient rather than their individual diseases.