Science as a Profession, Art as Individual Physicians . Horner Lecture University of Tennessee October 17, 2003 James L. Reinertsen, M.D. www.reinertsengroup.com. “Every system is perfectly designed to achieve the results it gets.” Donald Berwick, M.D.
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University of Tennessee
October 17, 2003
James L. Reinertsen, M.D.
Donald Berwick, M.D.
The American health care system is perfectly designed to produce dazzling technologies, large numbers of exceptionally well-trained doctors, very high costs, serious safety risks, underuse, overuse, and misuse of resources, mind-boggling administrative waste, lack of access for a significant number of Americans, and distrust and dissatisfaction for virtually everyone—including the key professionals who are needed to deliver quality care.
More than 40% of nurses surveyed would not feel comfortable having a family member or loved one cared for in the facility where they worked.
American Nurses Association, 2001
Jody the medical office assistant asks:
“Why can’t you guys do this the same way?”
Crossing the Quality Chasm
We were taught to revere pure science and descriptive statistical evidence, and to disdain applied science and operational (analytic) statistics
High Science and Low Science: Two Pathways to Improved Care
Theory of systems
Theory of variation
Theory of human psychology
Theory of knowledge
“Having a craft worth knowing, and applying it for the benefit of our patients”
We are losing our clinical autonomy “tampering”in part because the public has learned that the basis for it, the full power of our scientific knowledge, is not being consistently applied for their benefit.
Surgical Wound Site Infection Prevention Collaborative, www.ihi.org
PHYSICIAN CULTURE “tampering”
We regularly engage in vigorous conversations about clinical evidence with our colleagues.
But we seldom enter into those conversations with the clear understanding that any conclusions we reach will be translated into a system of standing orders, reminders, measurements, feedback loops, and other steps to implement any consensus that emerges from the dialogue.
Practice the science of medicine as a team, so that society will continue to give us the privilege of practicing the art of medicine as individuals. By sharing individual autonomy in the science, we can regain professional autonomy, and rediscover precious touch time.
Jody, my medical office assistant