beginning - In the beginning

December 11, 2006 -- To begin, I don't believe the U.S. health system is "broken," or that it will let people die in the streets, or that it will drive millions into medical bankruptcy, or that it will bring down the entire U.S. economy.

Instead, I believe the health system will adjust, it will innovate, and its current major players will "do the right thing." The talents, intelligence, and abilitiies of two of those major players, unfortunately, to take responsibility for their health and medical conditions have been sorely neglected.

I am referring to practicing physicians and their patients. You. Yes, You. You practicing physicians and you patients who go to them for care in the clinical trenches.

This is for you. I have thought for a long time that medical care is directed too much from the "top down" --government, employers, health plans, hospitals, large physician advocacy groups. It is not that these organizations are bad. They are simply so big, bureaucratic, and political that they make innovation at the grass roots practice level difficult.

Also they tend to confine physicians through regulations, evidence based guidelines, advice on what to do and not to do, how to reorganize their practices, and what electronic and personal health records to install. Again there is nothing wrong with this heart-felt and well-intended advice as far as it goes.

But constraints and rules from above by those who have never spent a day in a busy medical practice have produced uninticipated side effects --demoralization among physicians , dissatisfaction among patients, and a feeling of helplessness to control or improve what is taking place on the ground.

In these series of blogs, I shall describe clinical innovations that facilitate the patient-doctor relationship, ease the cost of care, deepen understanding of disease, help patients understand and comply with medical instructions, and clearly document what takes place in the office, and what to expect from medical treatments, procedures, and disease.