Saturday, December 15, 2007

First do no harm

Recently I came across the following comment on a physician’s health blog. I saved the link, but am not posting it because the specific source is not really important. But the point of view it expresses is important because it is common among physicians. Here is the comment:

"unless the physicians are vigilant in correcting [policy wonks’] fantasies, the absurdities will press on unabated."

This is the beginning of an important insight. But it’s left unfinished.

Meanwhile, and in reality, such absurdities have grown for 40 years and IMO are likely to become even worse.

Let's keep in mind that health care policy wonks do not fall out of the sky. It's trite, but true: nature abhors a vacuum. The policy vacuum in health care sucks in people who become health policy wonks, when otherwise most of them would pursue more useful vocations.

And how have these wonkish folk gained significant control within our "system?" IMO, because physicians have increasingly failed to assert control.

The resulting vacuum of physician leadership has become especially harmful during the past 40 years.

Moses found a way out of the wilderness in 40 years. OK, health care is a more difficult problem. But still . . .

Regrettably physicians by their inaction cede leadership on far too many fundamentals of health care management. If physicians want health care to be managed differently, they must find ways to exert more significant and direct leadership.

Physicians’ attempts to correct others' fantasies won’t work. Physicians' attempts to persuade policy wonks to lead, but in a manner agreeable to physicians rather than to policy wonks, won’t succeed. Physicians’ complaints about others’ poor leadership is not leadership. In fact, none of these behaviors is leadership. What to do? Well, I’m no wonk. I don't know for a fact what will work. If I knew I’d be very rich. But my opinion is that physicians must assert much more direct influence on health care policy and management in this country.

“First, do no harm” is sometimes a call to take action, rather than to refrain from taking action. If now is not one of those times to act – then when?

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