Unintended consequences – we need to think like chess masters

After 12 years of blogging, I wonder if I should have titled this blog “unintended consequences”. So many rants focus on the unintended consequences that follow from health care policies. The aphorism (falsely attributed to Samuel Johnson) states “the road to hell is paved with good intentions”. Too often our policy makers, be they bureaucrats in government, insurance company managers or guideline creators, think like a chess beginner. They see the problem, and take the obvious solution. As H.L Mencken did say, “For every complex problem there is an answer that is clear, simple, and wrong.” Chess masters make a move and then do a mental pre-mortem analysis, predicting in their minds what the implications of the move are. Where will we be after that and several more moves? Too often in health care, as well as other policy areas, we ignore the unintended consequences of premature solutions. Too often we hear the excuse that there was a good reason for the policy. As examples, first consider the 4 hour rule for antibiotics in pneumonia patients. Any hospitalist or ID expert could have predicted the unintended consequences, yet Medicare adopted the rule that led to much unnecessary antibiotic use. Consider the VA appointment scandal. If we give bonuses to administrators for decreasing appointment waiting times, and do not provide moneys for adequate primary care physicians, we will stimulate dishonesty in some administrators. This out...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs