Sessions and Themes
- Shifting the paradigm: Vikas Saini
- Magical thinking and Modern medicine: Harvey Fineberg
- What makes us do it?
- What will it take to get us there?: Don Berwick
- What are the knowledge gaps in avoiding avoidable care?
- Case discussions
- What are the ethical issues?
- Medical journals and the issue of avoidable care
- The schizophrenic life of the hospital CEO
- A reason to change: Shannon Brownlee
- Social responsibility of physicians: Bernard Lown
- Behavior-changing Best practices
- Global dimensions of unnecessary care: Julio Frenk
- Payment mechanisms and the Culture of medicine
- Choosing wisely and beyond: What are the next steps?
- How can patients help drive the needed change?
A new hip for an 87 year old: the surgeon’s Siren song
I saw an elder gent a month ago; his hip pain was getting worse …. He’d seen a surgeon.
“You’ll be out of the hospital and rehab, home in 3 weeks” the surgeon said.
“You’ll be doing nothing but rehab and exercises for 3 MONTHS; you’ll be at limited power for six months; it will be a year to be 95%” I said.
He came in today for a preop evaluation. Even though he’s been out mowing his lawn and doing most of what he wants, he thinks surgery will make him “better.” He has “good insurance” and has chosen to proceed.
I’m reasonably confident he will “do well” perioperatively but I’m dubious that he’ll be “better” in the long run.
– excerpt from this afternoon’s office hours
Ted Herwig MD, family physician