Posted by: notdeaddinosaur | April 8, 2014

Forests and Trees, or: Why I Don’t Take Care of Populations

We lost a branch off a big old tree a few weeks ago.

“Call the tree guy,” said DSS.

“It’ll cost us a grand,” I muttered.

“No it won’t,” he said, dialing Dan, the tree guy.

$300 later and the branch was gone. Such a deal. But Dan the tree guy discovered that the tree was starting to rot out. Also, without the fallen branch, the tree was now dangerously unbalanced and really should be taken down, as it could present a safety hazard. $700 later and the “big stick” (as he called it) was history.

“Told you so,” I muttered to DSS.

But I had the chance to talk with Dan the tree guy.

“So I guess your dream job would be something in forestry, right?” I asked.

“No. I take care of trees.”

“But isn’t a forest just a whole bunch of trees?”

“Well, yeah. But there’s much more involved in taking care of a forest than just taking care of one tree at a time.”

Hm. Sounds familiar.

I take care of patients. Many patients. But, contrary to the impressions of the medically naive regulators who somehow consider themselves competent to pontificate on health care, a “population” is more than just a collection of “many patients.”

My job is to take the best possible care of the patient in front of me. Then the next, and the next, and the one after that. At the end of the day, however many patients I’ve seen, I still haven’t taken care of a “population.”

Caring for populations is called “Public Health.” It includes such things as access to potable water, food supplies, and schools as well as hospitals, doctors, and medical care. Physicians can be involved in public health, but it really doesn’t have anything to do with “practicing medicine.”

If the patient in front of me needs an MRI, I cannot in good conscience tell him that he can’t have it because someone else may need it more. That’s a population calculation, and it falls into the realm of public health. If you don’t need whatever it is you’re asking for, it’s my job to explain to you why you don’t need it. It has nothing to do with “good stewardship of scarce resources.” If you need an MRI, a consultation, or a procedure, my job is to do everything in my power to see that you get it. Period.

All these calls for Primary physicians (in Orwellianly named “Patient Centered Medical Homes“) to “manage populations” are disingenuous at best, and counterproductive at worst. We don’t manage populations. We take care of patients. One at a time. Each to the very best of our ability, with the help of the best possible evidence, but still one at a time.

And then the next.





  1. Nicely said. We are seeing more and more population recommendations in gynecology which confuses the care of the individual patient.

  2. One doctor, one pair of hands, one patient at a time. That is the way it has been done since the ancients. Just because an idea is new doesn’t mean it’s a good idea. Population management my foot.

  3. Patients? The term is a dinosaur; time to bury it along with T-Rex. Healthcare today is about treating customers, not patients. One doctor, a population of customers.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s


%d bloggers like this: