While comparing summer “must read” lists, a friend suggested I pick up a copy of “Good to Great” (Jim Collins, Harper Collins 2001). My friend argued the premise of this book (that companies and indivi-duals who leap from “good to great” follow a consistent formula) has important implications in medicine.


Collins and his team searched for companies who over the past three decades transitioned from average performers to sustained outperformers with returns at least three times that of the market. Next, they examined the characteristics of their surprising list of 11 good-to-great companies and found consistent qualities.

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Among these are that these companies recognize that “good is the enemy of great” and avoid complacency. They seek and maintain level 5 leaders who embody a paradoxical mix of personal humility and professional will and build a team around them. Moreover, they use technology to accelerate their competence, not to define it.


So what does all of this have to do with clinical medicine? Increasingly, physicians recognize that mastering the business of medicine is essential. Traditionally, we have relied on administrators and MBAs and have been content with a degree of relative prosperity in patient care. Over the past decade, however, more complex economic forces have been put upon us by government, insurers, lawyers, industry, and patients.


The difficulty is that while free market forces drive most economic decisions in our country, a social ethos stating that every individual is fundamentally entitled to limitless health care undercuts most rules of our supply-and-demand capitalist infrastructure.


In this context, basic economic principles cannot apply to all aspects of health care. If a certain symptom is associated with an undiagnosed malignancy in only 5% of cases, should a CT be obtained? The insurer would see 95% of such CT scans as unnecessary, but to the patient with an early diagnosis, the scan is essential. Policymakers and administrators oversee the health-care system, but clinicians must care for individuals.


Although basic business economics cannot always be directly applied to patient care, the ability to avoid complacency, to maintain a mix of humility, integrity and professional will, to team build, and to avoid over-reliance on technology as a substitute for clinical skill or acumen are essential principles in health-care delivery.