Medical Practice Mores

That last word is more-ay's, like the eel, not mores, like 'hey, that's good pizza, give me some mores'. Just thought I'd mention that.

I've been intrigued by the operation of medical practices for quite some time. Part of the reason is that medicine itself interests me; diagnostic skills fascinate me, to the point that I was actively disappointed to realize that the very best diagnosticians can't tell you how they arrived at their conclusions. Studying decision theory will give hints as to how decisions are raised (the articles on decision methodology which suggested that good decision makers have not only an alternative decision conclusion but a whole series of them amazed me; the way one article put it was that good decision makers come to a conclusion; great decision makers come to several) but the theory doesn't tell you how they make the leap from the same set of facts that stumped or misled the lesser diagnosticians to an accurate diagnosis. I'm charmed and fascinated by things like that. And knowing what the effects of drugs are on certain bodily functions borders on the mystical for me; I remember when I first found out what an SSRI actually was, and why inhibiting the reuptake of serotonin was a good idea (first reaction: if it was a good idea, why doesn't the body do it naturally?). And beta blockers -- though I have to admit, I still stumble on exactly what a beta blocker is, the concept of knowing that, having that level of fluency with the body -- it just delights me. Its that level of skill that almost -- usually not, but almost -- makes me willing to accept the level of superiority that some doctors exhibit. I think Well, gee, if I know that much about my discipline, I'd likely have more than a little arrogance myself.

But when you move away from the nuts and bolts of the practice of medicine to the practice of managing a medical practice is when you get into an area that for me is even more mysterious, in part because for years I thought 'well, what's the big deal? Make appointments, schedule things, keep track of charts, why is it so difficult?' It seems like its the same problems that the guys who schedule maintenance on my aging Buick have, or the painters who come to my house, or the plumber, or the electrician. But as articles like the one in today's Washington Post show, the practice of medicine is a lot more volatile because its a lot more personal. You're dealing with people, and the people aren't always what you expect, just as you aren't what they expect. It ranges from scheduling an appointment that they know they can't keep, but their attitude is that you Never say no to authority; better to accept the appointment knowing you won't make it than to do that, to understanding who actually gives the medical history when you're talking all at once to the whole extended family. Its a whole shift of mindset. To the credit of some medical practices, they're beginning to shift the way that they operate, and the way that they think, but there's lots more who haven't even contemplated the necessity.

Fascinating stuff.