I choose to be an optimist. I can visualize a health care system that is better than the one we have. A system where we function as a coordinated team, learn from day-to-day care, enabled by analytic methods and information technology designed to make that happen. A system where we can measure improvement in patient experience and outcomes. A system that is efficient enough to make great care affordable and accessible to everyone.
But, I’ve been fighting the fight for long enough now that I can’t help but notice how little progress we’ve made. Whenever I come across work I did 20 years ago, I am struck by the fact that I could write the same thing today, and it would still be applicable. I might have to use my word processor to do a search-and-replace to update from old to new buzz words. But, we’re still struggling with basically the same barriers to real process transformation and still debating the same issues. It is valuable to face that reality, because the gap between expectation and reality is a source of “creative tension” that can be motivating. But, facing that reality can also be demoralizing if the gap looks more like a chasm that can’t be crossed.
It is in this context that I viewed an excellent 45-minute video created by the New England Journal of Medicine in celebration of the 200th birthday of the Journal in January, 2012. The video is entitled “Getting Better: 200 Years of Medicine.” I found it energizing to see how far we’ve come as a field, making a profound positive impact on human life — using the examples of surgery, chemotherapy, and AIDS treatment. It also exposes how long it took for changes to be accepted and adopted, before they eventually became standards of care. Maybe by the 250th anniversary presentation (shown on the holodeck?), the NEJM will celebrate breakthroughs in cost-effectiveness analysis, outcomes measurement, care coordination, team care planning, clinical process management, and patient-centered primary care.