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?
Social responsibility of physicians: Bernard Lown
Featured Speaker: Bernard Lown, MD, Professor Emeritus, Harvard School of Public Health; Senior Physician (ret.), Brigham and Women’s Hospital, Boston
For over 50 years, those of us who trained with Dr. Bernard Lown didn’t think we were learning how to avoid unnecessary care. We thought we were learning to practice medicine. We could not imagine doing it any other way. It was only after we left his presence and went out into the world did we learn how truly different our experience had been. The time with him demonstrated the absolutely critical nature of a point of view, an approach and a culture to sustain it.
Here is an excerpt of his speech from the Avoiding Avoidable Care conference, a masterful summary of a lifetime of deep clinical experience:
“Ever since starting clinical practice 62 years ago I have looked forward to this conference. Mercifully, good fortune and good genes enable me to attend. From my earliest days in medicine I have struggled against the prevailing model of healthcare. My opposition in part was provoked by the growing prevalence of overtreatment. Resort to excessive interventions seemed to be the illegitimate child of technology in the age of market medicine. If more than a half century ago overtreatment was at a trickle pace, it is now at flood tide.
Reflecting back on early days, the first overtreatment I encountered was not related to technology. It involved keeping patients with acute MI’s at strict bed rest for 4 to 6 weeks. This was a form of medieval torture. It promoted depression, bed sores, intractable constipation, phlebitis, lethal pulmonary embolism and much else. Worse it augmented cardiac ischemia and predisposed to malignant arrhythmias. Physicians were aware of what was transpiring but felt it was necessary to protect patients against cardiac rupture which activity may provoke.
The great Brigham clinician, SA Levine, my teacher and mentor, believed that patients would fare better when nursed in comfortable chairs. Yet he was not ready to challenge established practice. With his backing I launched such a study in 1951. The house staff initially was vehemently opposed, even greeting me with “Sieg Heil“ Hitler salutes. Soon they became avid supporters…”
For the full text of Dr. Lown’s speech, visit his blog: http://tinyurl.com/bernardlownblog