April 1, 2013 – Atlanta, GA

danger april fools

I’m gullible.  For decades on this day my friends have enjoyed crafting tales that begin innocently and plausibly, progressively becoming more outrageous, culminating in the humiliation of being duped once again.  Had the tale begun outrageously, even I would figure it out straight away.  No … It’s in the slow turn of the tale, each successive plot turn plausible, where the magic lies (or is it, the magic of lies).  Perhaps I’ll hear one of these today:

#1 “Rob – immediately following your facilitated discussion regarding the benefits of Evidence Based Medicine (EBM) at the Medical Association of Atlanta (MAA) meeting last week, the many skeptics in the audience were furious.  They thought, ‘How could Rob propose that the benefits to patients of EBM were greater than (real or perceived) harm to doctors?’  But in the days that followed, something odd happened – they read a few of the summary papers you referred to, realizing that EBM is in fact a physician-led process of continuous clinical improvement, rather than narrowly defined ‘rigid, eventually outdated practice guidelines’.   They also read your blog-post entitled ‘Intuition v EBM’ (which annoyed them, by the way).  Anyway, through some strange combination of enlightenment, embarrassment and altruism, the skeptical in the Association have agreed to no longer oppose an MAA position statement supporting the use of EBM as a standard part of every physician’s practice.  They still think you are arrogant when describing Permanente Practice, but nevertheless are eager to learn more.  Congratulations.”

rodent recovery and rescue team

#2 “Rob – as a result of the debate generated by the recently defeated Georgia tort reform bill entitled “Patients for Fair Compensation” (http://www.patientsforfaircompensation.org/), doctors around the state have begun to call for not ONLY the preservation and advancement of tort reform, but also delivery-system culture reform as well.  That is to say, following an unanticipated outcome in a case, the doctor fully and completely discloses the unanticipated outcome, provides authentic empathy and answers hard questions to his/her ability, then fully participates in a process to identify root system causes of the unanticipated outcome, such as they exist.  Doctors are beginning to believe that addressing the soul-wrenching emotional poison caused by baseless allegations of Medical Malpractice requires (1) a fair and effective tort system, true, but also (2) early and complete disclosure of the event or near-event, and (3) an emphasis on process improvement to repair defects in care systems, creating a culture of safety.  Our colleagues around the state are realizing it’s not all about asking the law to protect physicians from baseless allegations of malpractice, rather asking the science of process-improvement and highly-reliable teams to protect the patient and the physician from actual harm.”

#3 “Rob – I hesitate to tell you this, because you are unlikely to believe me … particularly on this day of all days.  But here goes.  In the wake of the Justice Department’s announcement last week it will begin prosecuting many large orthopedic surgery groups in California and Utah for Medicare Fraud (http://online.wsj.com/article/SB10001424127887323466204578384793253488174.html), stemming from their unethical use of so-called Physician Owned Distributorships (POD) to unjustly enrich its physicians via the resale of hardware and implantables, the national academies of many highly compensated specialties have called for those doctors to abandon “fee-for-service” compensation mechanisms, instead opting for case-rates, global payments or some form of pre-payment, eliminating perverse incentives for physicians.  While the latter mechanisms will certainly result in lower annual compensation for those specialties, their compensation will remain in the top 99.3% of the US population on average.”

happy april fools with frog

A man can hope, can’t he?

 

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