Thursday, March 06, 2008

finding your limit

indoctrinating oneself into the culture of medicine is literally and figuratively like jumping through a series of hoops, each hoop slightly higher and more challenging than the first. just when you jump through one, the next hoop comes into focus. supposedly, there's a carrot dangling magically at the end. or so i've been told. i've never actually seen it, but everyone says it's there.

the next logical questions would be: what is the carrot? why do you want it? why do you keep jumping through these hoops in order to get it? how many damn hoops are there?

i, like many in my profession, am a bit of a perfectionist. it was recently pointed out to me how crazy this is. one of our noon conferences was on medical malpractice. the speaker, an engaging lawyer whose father was a surgeon, gave the following example to highlight the stark difference between lawyers and doctors:

(at a deposition)
mr. lawyer: mr. doctor, would you say that it is likely that the crash caused this man's injuries?
mr. doctor: well, i don't know if i could say that...
(mr. doctor's lawyer whispered to mr. doctor, "he means 'greater than 50%', not 'greater than 95%' ")
mr. doctor: ... oh, yeah, i could say that!

voltaire said, "le mieux est l'ennemi du bien." roughly translated, "the best is the enemy of the good." are we forever doomed to seek the best and never find it? can we ever really reach the best? or is it like an asymptote, forever approaching but never actually intersecting? if we can't ever reach it, could we be content with just good?

does P really = MD?

over the next two days, P (for me) = passing step 3 = medical license = fellowship. i'm hoping that it's not a mathematical impossibility.

is it likely that i will pass? well, i don't know if i could say that. if i were a lawyer, i might be able to. but for now, i'm just a doctor.


GirlTuesday said...

i'm a lawyer, so i'll call it: it's likely (and more than likely) that you'll pass. thinking good thoughts for you here in the smallish state.

your fan,


daedalus2u said...

Best is the enemy of good. That is such a problem for so many people. That is the essence of the consumer mindset that advertising tries to ingrain in everyone, abandon and discard that which is good for something that is better. Even if it isn’t better.

When that intersects with the “grass is always greener” phenomena in relationships, people can always be striving for something perfect they will never encounter.

In engineering there is the expression “Good, Fast, Cheap: pick any two”. Engineers understand and make explicit the immutable trade-off between quality, timing and cost.

A rule of thumb is that one can cut the time of an engineering project in half, if one increases the cost by a factor of 10. But this can only be done once. There are some things that cannot be accelerated with more resources. No matter how many you assign to the task, it still takes 9 months for a baby to come to term.

I think some of the problems in medicine are from people (not MDs generally) trying to break the Good, Fast, Cheap paradigm.

daedalus2u said...

There is an excellent cautionary tale about perfect being the enemy of good. The fisherman and his wife.

Melissa said...

Do you want to give your patients the ability to pay via the web? How about setting automated recurring payment plans so you are not chasing “false promises”?
We will develop a bill payment system via the web:
• allows customers to pay their bills using credit card, debit card or check
• allows customer or your staff to schedule a single payment and/or recurring
• may be customized to automatically update the patient record in the PMS