Disobey, Please

By Kim Bellard, March 29, 2017 The M.I.T. Media Lab is taking nominations for its Disobedience Award, which was first announced last year.  As the award's site proudly quotes Joi Ito, the Director of the Lab and who came up with the idea: "You don't change the world by doing what you are told." I love it.  The site, and the award's proponents, make clear that they are not talking about disobedience for the sake of disobedience.  It's not about breaking laws.  They're promoting "responsible disobedience," rule-breaking that is for the sake of the greater good.  The site specifies: This award will go to a person or group engaged in what we believe is an extraordinary example of disobedience for the benefit of society."    In Mr. Ito's original announcement, he elaborated: The disobedience that we would like to call out is the kind that seeks to change society in a positive way, and is consistent with a key set of principles. The principles include non-violence, creativity, courage, and taking responsibility for one's actions."  The creators of the award are probably not thinking much about health care -- despite disavowing it is about civil disobedience, many examples they've given revolve around people resisting what they think are improper government actions -- but they should be.  If there's a field where lots of stupid, or even bad, things happen to people , through design, indifference, or inaction, health care has to be it. The list of disobedient acts in health care that would serve society is longer than my imagination can produce, but here are some examples: ·         The nurse who says, no, I'm not going to wake up our patients in the middle of the night for readings no one is going to look at. ·         The doctor (or nurse) who knows a doctor that they believe is incompetent and decides, I'm going to speak up about it.  I'll make sure patients know. ·         The billing expert who decides, no, I'm not going to keep up the charge master, with this set of charges that aren't based on actual costs and which almost never actually get used (except by those unfortunate people without insurance).  Instead, we'll have a set of real prices, and, if we give anyone any discounts, they will be based on ability to pay, not on type of insurance. ·         The EHR developer who realizes that, it's silly that this institution's EHR can't communicate with that institution's EHR, even though they use the same platform and/or use the same data fields.  . ·         The insurance executive who vows, I'm tired of selling products that are full of jargon, loopholes, and legalese, so that no one understands them or knows what is or isn't covered.  We're going to sell a product that can be clearly described on one page using simple language. ·         The practice administrator who understands that patients' time is valuable too, and orders that the practice will limit overbooking and will not charge patients if they have to wait longer than 15 minutes.  ·         The medical specialty that commits to being for patients, not its physician members, by developing measures, specific to patient outcomes, in order to validate ongoing competence. Going back to the award's principles of non-violence, creativity, courage, and taking responsibility for one's actions -- well, the above would all seem to fit.  They're all achievable.  It only takes someone to stand up and decide to do them. This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting