Tag Archives: Annals of Internal Medicine

Physician Leadership and Clinical Practice

A recent opinion piece in the Annals of Internal Medicine really resonated with me. It is entitled Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care and made many of the same points I cite for my own ongoing clinical practice, and which I often point out to maturing or aspiring physician leaders.

The authors lay out 4 reasons for physician leaders to remain clinically active:

  1. Access to information about how the organization really works. I can tell you from personal experience that this is absolutely true. When I was a hospital chief medical officer, I used to joke (but truly meant) that I learned more about how the hospital really worked by being on call on a Sunday than by going to hours of meetings during the week.
  2. Credibility. This also rang true for me personally. I have had physicians’ attitudes toward me turn on a dime when they learned that I was still seeing patients and had not become a full-time “suit.” Despite the fact that effective organizational leadership requires a distinct skill set from clinical expertise, it is exceedingly difficult to be a physician leader without having genuine clinical bona fides.
  3. Personal fulfillment. Amen to that too. I refer to this as having an opportunity to “connect to purpose” by getting back to the reason why we became physicians in the first place – to forge intimate bonds with others, and to make a positive difference in their lives.
  4. Job security. OK, so they didn’t call it that, but they did say that physician leaders should maintain their clinical skills so that they can go back to being clinicians when their leadership roles expire. This reason fell a little flat for me. Most leaders I have seen do not go back to full-time (or predominantly) clinical practice, and it seemed like a hedge against failing rather than a positive game plan.

Here’s a big reason for physician leaders to continue to practice that the authors didn’t discuss. For me, physician leadership is an extension of clinical practice. Clinicians have the sacred and honorable ability (and responsibility) to make a positive difference for each patient that they see. I have always embraced the idea that physician leadership is about extending that ability and responsibility from one patient at a time to many patients at a time. I think that maintaining the one-on-one connection that can only be had through clinical practice is an important reminder of that higher calling.

What do you think?

Guide for the Perplexed

It is clear that the way that health care gets paid for in the United States is undergoing rapid change. What is not at all clear, at least not to me, is exactly what the payment model will look like in the future, or how far off that future is. Although everybody agrees with Yogi’s assessment that “it’s tough to make predictions, especially about the future,” this exercise seems particularly challenging because of the wide variety of “alternative payment models,” likelihood that they will co-exist, and the prevalence of regional differences.

It is because of this complexity that I found a recent paper in the Annals of Internal Medicine to be helpful. It is a simple “field guide” to different payment models that starts with distinguishing the “unit of payment” (e.g., per unit of time, per episode of care, per beneficiary, etc.) and then uses these to review efforts at payment reform over time.

I found this helpful in keeping all of these things straight in my head, and I liked the way it started from “first principles.” I think it is worth the read.

What do you think?

A Global Force for Good

A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy – a global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a “global force” and that the force exists for a good purpose, but I guess most people thought that it made the Navy sound too much like a bunch of social workers.

I was reminded of the phrase, and of an experience I had while serving in the Navy Medical Corps, when I read a recent article in the Annals of Internal Medicine.  A Navy physician retold the story of a mission he was on to a remote village in Honduras. He and his team were flown into small villages, where they would “see dozens of patients each day and dispense an assortment of symptomatic medications” and where “the most practical health benefit that we provided villagers consisted of hundreds of tooth extractions.” He further noted that “although advertised as humanitarian missions, these exercises provided US military personnel with experience working with military and civil authorities from host nations.”

Continue reading A Global Force for Good

Health Numeracy

There is a growing awareness of the importance of health literacy – the extent to which patients and their families are able to understand words we speak and the written materials we provide. This is a good thing, since there is very good evidence that patients who have a better understanding of their condition and recommended treatment feel better, adhere better to recommendations, enjoy better health outcomes and rate the experience of their care higher. Oh, and they also sue for malpractice less frequently. The problem for providers is that it is not easy to get this right. Continue reading Health Numeracy

Practice Guideline Overload

I think I am like many practicing physicians in my “love-hate” relationship with clinical practice guidelines. On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice. On the other hand, I am well aware of the shortcomings of practice guidelines, including the limitations of the underlying evidence base, the challenge of synthesizing the available evidence into guidelines, and the often limited applicability of recommendations to clinical practice. Continue reading Practice Guideline Overload

Violence Prevention

As I suspect is the case with many of you, I find it hard to keep up with all the medical journals that cross my desk. It is especially hard when the latest issue of Car and Driver also crosses my desk, but that is another story. So, generally speaking, the journals pile up. When the pile gets too high, I either skim them “in bulk” or just declare defeat, throw the pile out, and start over again. Despite the general pattern, there is one item in one journal that I read in “real-time”: the “On Being a Doctor” column in the Annals of Internal Medicine. Continue reading Violence Prevention