An Evening with Larry Weed

Dr. Weeks’ Comment:   Lawrence L Weed, M.D. is a giant astride the landscape of health care delivery and health care reform. Once a professor of medicine until his colleagues and students would not keep up, he created the SOAP note and  founded PKC  Problem Knowledge Couplers  all in an effort to offer tools (and the possibility of accountability) to the all too human practice of medicine.  My daughters and I shared an evening with this inspirational visionary last night and I am much the better for it.

Who is Larry Weed?

Creator of  the Problem Oriented Medical Record

Creator of the electronic medical records revolution

Instigator of bringing computers into medicine  (see this compelling 1971 Grand Rounds at Emory University)   In 1971 Dr. Larry Weed articulated how well-organized problem lists and medical records are essential to clear and sound clinical thinking. Now more than 40 years after publication of Dr. Weed’s seminal “Medical Records that Guide and Teach” (N Engl J Med. 1968;[11]278:593-600), we believe his message is more relevant than ever. If electronic medical records are to support accurate clinical decision making, they must have a standard structure and format based on many of the principles that Larry Weed articulated so many years ago. We encourage today’s CMIOs, clinicians, residents, and medical students to watch this video.


Required reading for every medical doctor and every medical student and every patient  (Yes. I mean YOU~!) is this 91 year old phenom’s  most recent work    “Medicine in Denial

     Deep disorder pervades medical practice. Disguised in euphemisms like “clinical judgment” and “evidence-based medicine,” disorder exists because medical practice lacks a true system of care. The missing system has two core elements: standards of care for managing clinical information, and electronic information tools designed to implement those standards. Electronic information tools are now widely discussed, but the necessary standards of care are still widely ignored.

  Because these two elements are external to the physician’s mind, they address a root cause of disorder: dependence on the internal capacities of autonomous physicians–their personal knowledge, intellect, habits and judgment. In this dependence on the limited, idiosyncratic capacities of individuals, medical practice lags centuries behind the domains of science and commerce. Breaking that dependence is the subject of this book.

     Going back 400 years to the philosophy of Francis Bacon, and examining parallel ideas from 20th Century thinkers, this book illuminates the origin of medicine’s disorder. The analysis is more than theoretical. It grew out of decades of development and clinical experience in finding a new approach to medical practice. Designed to create order and transparency, this new approach involves not only standards and tools but also institutional changes essential to building a true system of care. 
     In the current non-system, physicians bear impossible burdens of performance, other practitioners are barred from sharing those burdens, patients do not participate effectively in their own care, the U.S. spends $2.5 trillion annually without clinical accounting standards, third parties manipulate the situation for their own advantage, and none of the stakeholders are accountable for their own behaviors.
     This book offers a clear blueprint for building a better system of care, a system that patients, practitioners and third parties could trust. A better system could make health care a source of hope for our economic future, rather than its greatest threat.



Last night Larry Weed shared this wisdom which his professor once wrote…

Dickenson Richards wrote: 
“The plain fact is man is not Lord of Creation and never will be.  Once an eager explorer, then a confident builder, he has become by a curious turn of fate, the destroyer, at the moment destroying his habitation and not far from destroying himself. “They have sown to the wind,” said the prophet, three centuries before Hippocrates, “and they shall reap the whirlwind.”
And nature on her side can indeed be deranged, but if sufficiently deranged, may she not simply dispose of her one-time little conqueror”

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