"There is no document of civilization which is not at the same time a document of barbarism." - Walter Benjamin, Theses on the Philosophy of History It is 1940, and the Nazi horror is bearing down on Europe.  France has fallen, and refugees are streaming out, fleeing to safety through neutral states and America.  Walter Benjamin, a Jew, and a German philosopher, joins a small group being guided through southern Spain with ...

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Two quality metrics walk into a bar. One demands, "Give me the best beer you’ve got!" The other says, "Give me the second-best beer you’ve got." The bartender pours the beers and states, "You can have them both for free if you can tell me why this one is better than that one." Quality metrics were invented to quantify the ineffable, such as the taste of a fine lager or IPA. I see that ...

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Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data.  And the picture does not look good.  Paying doctors to improve their quality metrics does not, in general, improve those quality metrics.  Like all good scientists, we can now either question the data, or discard the hypothesis. Most payors and administrators appear to be reacting to the lack of efficacy data on ...

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I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it's too refreshing to pass up. So at 2 a.m. Friday night, I'm zooming (you always "zoom" on a scooter) through the industrial district after a tiring admitting shift. I see ...

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How can a doctor resist an essay entitled, "The Sickness Unto Death?" Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence? It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on. “In despairing over ...

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