Donald M. Berwick, MD, MPP
Note: This paper is based on a plenary address, “My Right Knee,” delivered at the Institute for Healthcare Improvement's 15th Annual National Forum on Quality Improvement in Health Care, New Orleans, Louisiana, on 4 December 2003.
Acknowledgments: The author thanks Jane Roessner, Valerie Weber, and Frank Davidoff for their extraordinary help in preparing this manuscript.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Donald M. Berwick, MD, MPP, Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138; e-mail, firstname.lastname@example.org.
Berwick DM. My Right Knee. Ann Intern Med. 2005;142:121-125. doi: 10.7326/0003-4819-142-2-200501180-00011
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Published: Ann Intern Med. 2005;142(2):121-125.
Times have been good recently for quality improvement in health care, but in 2004 the stakes on improvement went up for me personally. The problem we need to solve is this: Despite the good news, improvement is still happening in pieces. It must take some different level of energy, insight, and courage than we have mustered so far to get to total quality of care. Where will we find the courage we are going to need?
I propose this: If we are going to care enough to provide really different care, top to bottom, we are going to have to begin seeing patients and their lives not “out there,” but as mirrors of our own lives, “in here.” Mahatma Gandhi was asked to help a diabetic child stop eating sweets and starches, but before he was willing to do so, Gandhi stopped eating them himself for a few weeks. He could then say to the child, “I, too, have felt what I am asking you to feel.” Then, and not before, he was able to help.
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Hospital Medicine, Pulmonary/Critical Care, Rheumatology, Healthcare Delivery and Policy, Osteoarthritis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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