Remember what happens to Pip when a stranger tells him he has "great expectations" in the Charles Dickens novel with that title? That's me after my RWJF Investigator Award in 1994. Pip is snatched from disreputable surroundings (I was a journalist) and poverty (See: Journalists, Pay of), but despite his background he flourishes (successful author, scholar and consultant) when given encouragement and the means to make good.
My Investigator Award ranks up there with marriage, children, and a few similar items as one of the most important events in my life. But just as importantly, it opened the door for me to play a unique role in pushing to transform the practice of medicine for the better.
OK, unlike Pip, I wasn’t an orphan, just a guy with a BA (no graduate degrees) and a burning passion to expose the quality lapses in U.S. health care and show how they could be fixed. As the Investigator judges later confided, they took a chance on me, hoping I'd produce a book like Paul Starr's The Social Transformation of American Medicine. (So did Northwestern University, inviting me to be a visiting scholar.) Talk about great expectations!
To be fair, I'd been nominated three times for a Pulitzer Prize at the Chicago Tribune; had attended research meetings for years; and proposed a project that squarely fit the emphasis on cross-disciplinary work. Still, when I had to defend my research methods at the first Investigators meeting, I was shocked to discover academics could be as ruthless as journalists! (The judges later told me I passed their test—expectations again.)
I’d planned to write a book based on a series I'd done for the Trib, but that ended up playing just a small role. Instead, I was wrenched from my comfort zone. Determined to demonstrate to potential skeptics the depth of the problems, I researched original sources and the literature and conducted extensive site visits and interviews—an autodidact's PhD thesis. With a journalist's fervor, I added human interest stories to highlight the death toll from preventable errors, the lack of evidence-based medicine, and the potential of value purchasing and the power of the patient. All this years before those topics were popular.
I also made it clear that a cultural unwillingness to change, not technology, was the crucial barrier. Seeing good, caring doctors and administrators nonetheless overlook the evidence of unsafe and inappropriate care right in front of their eyes radicalized me. Over the past 20 years, my crusading in my book, other writing and speeches has helped radicalize others. I didn't win a Pulitzer like Starr, but Demanding Medical Excellence: Doctors and Accountability in the Information Age became a landmark book in the quality movement. It is taught in universities and has inspired community initiatives, changed individuals’ career choices and led to actions that saved lives. Great expectations, indeed.
I left journalism (I was ready) to become a consultant and am still adjunct faculty at Northwestern. I write and blog and remain involved in research as an author, reviewer and editorial board member. Since I don’t have to worry about tenure, grants or politics, I say out loud what others will only whisper, with seminal articles such as, “The Silence” or my later Health Affairs blog, “Why We Still Kill Patients.” RWJF helped change my life and others’ lives. And yet, most of the critical issues raised in Demanding Medical Excellence back in 1997 still remain.