Improving Patient Care Can Set Your Brain on Fire

When I was an intern and resident, I was learning so much so fast that I sometimes felt my brain was on fire. One thing I learned was that much of what was known about good medical care was not being used. I was providing care to people whose problems were avoidable. My teachers in medical school taught me how to prevent these things, and the textbooks were absolutely clear that achieving this goal was possible, but there they were every day—unnecessary catastrophes. I concluded that having medical knowledge about how to prevent, diagnose, and treat disease is not enough.

Patients are part of the problem. Some don't know what to do. Others know what to do but can't afford it, and still others are unwilling or unable to do it. But patients are only part of the problem. In the United States, too many people don't have access to care and the costs are too high for many who have access. These problems are too big for clinicians to solve alone.

Another part of the problem is the way clinicians use, or don't use, existing medical knowledge to care for patients. None of us knows everything. Even when we know enough, we may be rushed or tired or distracted or we may not have the right resources to do the best job possible. We can always do better, but we need more help than that. Many thoughtful people have concluded that we need more and better systems to support us.

To encourage the development of those systems, Annals introduced a new section in June 2003 with the help of the federal Agency for Healthcare Research and Quality (AHRQ): Improving Patient Care (1). This section features papers about quality improvement and patient safety: “...[It is] about the organization of …