Bmj Usa: Editor's Choice

Embracing change

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E47

This article originally appeared in BMJ USA

In Roughing It (1872), Mark Twain wrote that “Change is the handmaiden Nature requires to do her miracles with.” There's a lot about change in this issue of BMJ USA.

Once upon a time, physicians made house calls and treated most patients in their homes. Gradually, much of health care moved into hospitals. Now, with the high cost of hospital care, we are moving treatment from hospitals to outpatient venues and back into the home. In a study of 117 consecutive patients diagnosed with deep vein thrombosis at a hospital in Germany, Schwarz et al were able to provide home treatment to 80% (BMJ USA p 375). In an editorial, Eikelboom and Baker note that home treatment of DVT simplifies the initial management of the condition (because low-molecular-weight heparin can be given subcutaneously without laboratory monitoring), increases the efficiency of health care, and improves the quality of life for patients (BMJ USA p 364).

Systems of care need to be changed if we are to improve quality and access. Jane Smith reviews the teachings of the Boston-based Institute for Health Improvement, which recommends a radical redesign of health care (BMJ USA p 369). The old rule of appointment slots filled weeks ahead, for example, is replaced by the new rule that most slots are open at the start of each day.

We must change the culture of medicine to ensure safety in health care. In its report To Err Is Human (2000), the Institute of Medicine recommended that health care organizations adopt a culture of safety instead of a culture of blame. In this issue of BMJ USA, we publish an anonymous account of a serious medical error—and its cover-up—along with three commentaries (BMJ USA p 403). Singer writes that “we should learn to love mistakes because they carry in them the kernel of their own elimination” (BMJ USA p 404).

This issue features a debate about change in language. In an editorial, Barry Pless and I announce a new BMJ policy banning inappropriate use of the word “accident” in the journal (BMJ USA p 370). Safety officials and public health authorities abandoned the “A” word many years ago because an accident is often understood to be unpredictable, and thus unavoidable. A spirited debate about the new policy, from, appears on BMJ USA pp 372–374.

As a more mundane example of change, I just replaced my car's license plate for the first time in 10 years. BMJ USA is on the move!

Schwarz et al (BMJ USA p 375)

Eikelboom & Baker (BMJ USA p 364)

Smith (BMJ USA p 369)

Three commentaries (BMJ USA p 403) …

Singer et al (BMJ USA p 404)

Davis & Pless (BMJ USA p 370)

“Spirited debate” (BMJ USA pp 372–374) (Rapid responses to editorial by Davis & Pless)

View Abstract