Last week, inspired by the Independence Day holiday, I wrote about the important distinction between independence and autonomy. I made the case that professional autonomy is not about each doctor doing as he pleases, but about physicians as a group taking responsibility for shaping medical practice.
I was pleasantly surprised over the holiday weekend when I came across a recent paper in Health Affairs that illustrates how effective physician leadership (autonomy) can reduce unnecessary practice variation (independence) and improve clinical care. The paper also reinforced some of my earlier thoughts about the central role that physicians must play in redesigning systems of care. Continue reading More on Physician Autonomy
With the approach of the 4th of July, I have had “independence” on my mind. In my professional role, I always have “autonomy” on my mind, since it is often at the top of the list of things that doctors care deeply about, and I have been kicking around how the two relate to one another.
Webster’s (OK, the on-line Merriam-Webster dictionary) defines “independence” as “freedom from outside control or support” and offers up “self-sufficiency” and “self-reliance” as synonyms. “Autonomy” is defined as “the quality or state of being self-governing” and suggests “self-determination” among the synonyms.
Continue reading Independence and Autonomy
One of my adult daughters was on a vacation cruise last year and participated in a trivia contest. She emailed me to report that one of the questions was: “What is the first word of the Declaration of Independence?” Before reading on, I knew that she got it right.
I thought about that yesterday, when I had the privilege of viewing a copy of the Declaration, written in Thomas Jefferson’s own hand, on display at the New York Public Library. I learned that Jefferson, perhaps unhappy with some of the editing of the Continental Congress, had sent copies of his final draft to 6 of his friends, in which he underlined portions that had been cut. Two of these copies still exist, and one is in the permanent collection of the Library. It is rarely displayed because of its fragility, but there it was – 2 modest sized sheets, written on both sides, with some of the most stirring, enduring and significant words every written. Continue reading Independence Day