To the Editor:

Bravo to FPM and Dr. Leif Solberg for “The KISS Principle in Family Practice: Keep It Simple and Systematic” [July/August 2003, page 63]. The Institute of Medicine (IOM) and the Accreditation Council for Graduate Medical Education (ACGME) are thinking innovatively, leaving the laggards behind. As a medical director of a busy residency practice, I have been fortunate to learn about systems and how they improve care. Unfortunately, I find that many of our residents and practicing physicians are disinterested in changing our systems to take better care of our patients. I recently gave a presentation on idealized practice design for a board review course through our institution and was jolted to discover how many experienced physicians were unaware of systems thinking. Many stated this was the first time they had ever heard of these concepts.

If we are to lead the charge toward health care in the future, we must be involved with designing and demanding better systems. In Oxymorons: The Myth of a U.S. Health Care System, J.D. Kleinke states that the problem with a poor system is no one is to blame. We must take responsibility for systems that we did not create and make them better. Along with adopting better systems, we must learn how to be early adopters of innovation. Medicine needs to move from a traditional, bloated hierarchy to a lean, flexible oligarchy. Dr. Solberg’s article seemed to be just the tip of the iceberg and left me wanting more. Please keep the articles on systems thinking coming.