I thought this article was interesting. It talks about two eras in medicine and the need to evolve into a third. First there was the era of “professional trust and prerogative” and then there was the era of “accountability, scrutiny, measurements, incentives, and markets.” Dr Donald Berwick suggests we need to move on to a third era where we focus on quality instead of revenue.

I studied the first era a bit out of an interest in the history of ethics in clinical trials. So much of the knowledge we have today about cardiology, anesthesiology, nephrology, and cancer was learned at major universities, that conducted dangerous clinical experiments on patients without their knowledge or consent. Dr. Maurice Pappworth finally blew the whistle in 1967 and things started to change.

Carol, an RN, has some funny stories about the start of the second phase. Hospitals were evaluated for competence and efficiency. Some conclusions were funny, like expecting a nurse not to make an unscheduled stop at a patient’s room if a patient had fallen down, because it’s inefficient. Or the recommendation that the department needed to hire two and a half nurses.

Anyway, Carol and I agree with Dr Berwick that medicine needs to focus quality over revenue.