Editors have the damnedest preconceptions. When I was a reporter for my college newspaper in Chicago, I was sent to cover a demonstration at a hotel where President Lyndon Johnson was scheduled to speak. The editor was infatuated with the notion of LBJ "eluding" antiwar protesters to enter the hotel, so he rewrote my story's lead to characterize events that way. The trouble was, as my article went on to say, "the demonstrators left before the president arrived." Some "eluding."
This time, I plead guilty to being the editor with a pet notion. In conceiving this month's cover article (page 22), I was obsessed with two metaphors: the teacher who abandons the curriculum and teaches only the test, and the image of something "falling through the cracks" — in health care, for example, if all energies went to improving things that can be quantified.
Oddly, Contributing Editor Maria Kassberg and Senior Editor Paul Wynn hesitated to accept these metaphors in lieu of a coherent story assignment. They kept asking pesky questions: "Is our main purpose to suggest new quality indices that ought to be tracked?" (Not exactly, I said.) "Is it, on the other hand, to defend a view of medicine as partly an inscrutable art form?" (Again I demurred, mindful of what National Committee for Quality Assurance President Margaret O'Kane has to say about that view in our conversation with her.)
Finally I took refuge in a third metaphor. Our story would be "shaking the tree" in five areas of health care quality, I figured, and whatever fell out should be valuable. That idea may have been lame, but it did let me notice when an old friend tumbled out of the tree — a classic managed care goal called prevention.
Not just to save money but to provide truly high-quality care in heart disease, cancer, birth complications, asthma attacks and diabetic retinopathy, say the experts we consulted, some of the interventions most worthy of heightened efforts are those that help to prevent these conditions in the first place.