E.A. Codman and the Rhetoric of Battle: A Commentary

June 1989 | Donald M. Berwick

Why have we not pursued Ernest Codman’s vision to determine the end results of patient care? What he asks is simple—ineluctable. We intend to help out patients, he says, so let us find out how we are doing. Habit is not enough, he says, nor is impression, nor is seniority, nor is oath, nor is good intention. The key, he says, is learning—learning from our own well-intentioned experience. In uncharted terrain, he asks that we build compasses, simple ones of paper and pencil, checklists, tallies, counting, measuring, learning. He does not, in the main, doubt our sincerity; he doubts only our intuition. In darkness, an airplane can be upside down and the pilot unaware of it except for what his instruments tell him. Codman recommends instruments.

Author(s): Donald M. Berwick

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Volume 67, Issue 2 (pages 262–267)
Published in 1989