DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Being a physician – lessons learned from Harry Bosch

I just finished listening to the latest Michael Connelly mystery – Two Kinds of Truth.  His main character in many books is Harry (short for Hieronymus) Bosch.  Bosch is a police detective who epitomizes characteristics that we see in the best clinicians.  Here is a compilation of what I find in this novel as well as his previous novels.

  1. Harry Bosch focuses on justice for the victim.  Great physicians worry about the patient first.  They want to make the proper diagnosis and provide the most appropriate treatment for their patient.
  2. Harry Bosch is guilty of framing, but will recognize his mistake.  In this book, he initially mentally labels a victim incorrectly.  As he researches the victim, he quickly leaves the label because of new information.  Great physicians must be careful to not succumb to framing bias.
  3. In this story, Harry studies some evidence carefully, but despite knowing there must be clue he is missing, he just cannot see the clue.  So he shares the evidence with a colleague, and the colleague finds the clue.  Regularly, my colleagues and I share confusing patient stories with hopes that a colleague will give us an assist.  Even the best clinicians can get too close to the patient’s story and clinical story, getting lost in the trees and not recognizing the forest.  When confused, discussing the story with colleagues often helps.
  4. Harry Bosch has little respect for authority, especially when he believes that the authority is hindering his work.  Most great clinicians in 2017 express great frustration with the authorities that have mandated EHRs, inane billing rules, and a variety of rules that hamper our focus on the patient.  Please read The Patients vs. Paperwork Problem for Doctors

Michael Connelly is my favorite current crime novelist.  He has created a character who is flawed, but always honors the victims.  The great clinicians that I know and have known always honor their patients.  Our job should be simple, do what is best for the patient.

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