• Home
  • Geriatrics Blog
    • Helping Older Parents Posts
  • Helping Older Parents
    • Free Trainings
    • Newsletter
  • Podcast
    • Better Health While Aging Podcast
    • Helping Older Parents Podcast
  • Testimonials
  • About
    • About Better Health While Aging
    • About Leslie Kernisan, MD MPH
  • Courses & More

Better Health While Aging

Practical information for aging health & family caregivers

  • Popular Topics
    • Preventing Falls in Aging Adults
    • Medication Safety
    • Dementia, including Alzheimer’s
    • Advance Care Planning & End-of-Life
  • Why Geriatrics
  • Are you a caregiver?
  • How to use this site

042 – Why Healthcare is Flawed & How to Improve It:
The Work of Dr. Lawrence Weed

by Leslie Kernisan, MD MPH 10 Comments

Better Health While Aging
Better Health While Aging
042 – Why Healthcare is Flawed & How to Improve It:
The Work of Dr. Lawrence Weed
Loading
00:00 / 46:55
Apple Podcasts
RSS Feed
Share
Link
Embed

Subscribe: Apple Podcasts

Click the yellow button to subscribe to the podcast in iTunes. For step-by-step instructions on how to listen with your smartphone or tablet, see here.

In This Episode:

The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.” — Dr. Lawrence Weed, “Your Health Care and How to Manage It” (1975)

Dr. K discusses the flaws of healthcare and how medicine could be improved, per the insights of visionary healthcare reformer Dr. Lawrence Weed, who died earlier this month at age 93. She covers:

  • What is optimal medical care, and why doctors often fail to provide it to their patients
  • Why usual medical care — which relies mainly on doctors using their own internal knowledge and mental processes — leads to disorderly healthcare and frequent errors in diagnosis and management
  • Dr. Weed’s seminal insight that “Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted.“
  • Why Dr. Weed believed that healthcare professionals should use “knowledge couplers” and other more reliable tools to guide the process of evaluation and diagnosis, instead of relying on their own mental processes
  • Dr. Weed’s belief that the patient should be much more involved in his or her care, and that doctors should help patients make choices, rather than choose for them
  • Why Dr. Weed advocated for a better medical record, and why he wanted patients to have access to it
  • Dr. Weed’s lifelong advocacy for a healthcare system that would be orderly and reliable for evaluation, diagnosis, and documentation, but then would be flexible and individualized when it comes to treatment for individual patients
  • Tips on how older adults and their families can get better care from their doctors, and support the improvements that Dr. Weed envisioned

Related episodes: 

006 – Interview: Surviving Cancer & Better Healthcare Through Being an e-Patient
018 – High Blood Pressure Treatment in Older Adults: Research Findings & Practical Tips

Related Resources:

  • Medicine in Denial (2011)
  • Medicine in Denial Review: A book on how to really leverage technology to improve healthcare (Geritech.org)
  • 4 Steps to Get Better Advice from Doctors
  • Dr. Lawrence Weed, Pioneer in Recording Patient Data, Dies at 93
  • Dr. Lawrence L Weed, MD (Burlington Free Press Obituary)
  • The Heroism of Incremental Care (New Yorker article by Atul Gawande)
  • Larry Weed’s 1971 Internal Medicine Grand Rounds
Dr. Lawrence Weed and Dr. Leslie Kernisan
Dr. Weed & Dr. K, in Vermont in 2013.
Never Miss an Episode! Sign up here to be notified of our latest podcast episodes by email. Click here now.
Print Friendly, PDF & Email

Comments

  1. Bill Stocker, MD says

    December 9, 2017 at 3:35 pm

    I had good fortune to be med student at case western in late 60s. Dr.Weed was inspirational. I used the.POMR throughout my career in dermatology. The lecture on Utube from 1971 was typical Dr. Weed. You mentioned that unfortunately his ideas were not widely adopted. Certainly the POMR has become a world wide success.
    One question, when he refers,to couplers, what data base can physicians tap into with the patient sxs and clinical data? Perhaps this is discussed in his book on Denial.
    Thanks for the podcast. Bill Stocker
    .

    Reply
    • Leslie Kernisan, MD MPH says

      December 11, 2017 at 3:15 pm

      Thank you for your comment, how wonderful that you were able to learn directly from Dr. Weed while in med school. I also went to Case Western but he was long gone by then, alas.

      Some of Dr. Weed’s ideas did disseminate, but as far as I can tell, he didn’t think the POMR was being used as he envisioned. I recently found this 2009 interview, which is relevant: Interview with Lawrence Weed, MD— The Father of the Problem-Oriented Medical Record Looks Ahead.

      Of note, Dr. Weed is quoted as saying “It is important to understand that the discipline imposed by the POMR has not been fully embraced. Too often the POMR is sporadically employed as a convenience, not consistently enforced as a discipline. One reason is that medical education is fundamentally incompatible with the underlying philosophy of the POMR.”

      Regarding couplers, Dr. Weed and his interviewer discuss this at some length in the interview linked to above. I’m not sure if a suitable one currently exists for easy use by physicians; if you find one, let me know about it!

      Reply
  2. Dan says

    September 21, 2017 at 3:16 pm

    Excellent episode as is the whole series. Keep up the good work. Thank you!

    Reply
  3. e-Patient Dave says

    July 4, 2017 at 7:30 am

    I’ve been thinking a lot about all this.

    In the podcast you say he was a bench scientist (running lab experiments) before he got into clinical medicine. I wonder if that background was both his strength and his limitation about how to do healthcare.

    A bench scientist runs experiments, which is not at all the same as diagnosing an unknown problem, right? Experimenters need to do things in a carefully controlled way, with known ingredients, and methodically record what happens. But in walks a patient with heaven-knows-what going on, and the clinician’s job is to figure it out. I’m all for having a standardized approach, but doesn’t it run into limits?

    In your review(s) of Medicine in Denial on THCB you wonder about the practicality of following his methods in geriatrics, when the interaction between problems, and interactions with circumstances, can render it impossible to hunt down everything, right?

    btw, while the idea of problem-knowledge couplers is GREAT, a constant problem faced by e-patients is when the published / approved / ordained “knowledge” base is out of date, often by years. I long for a Watson-like up-to-the-minute knowledge FINDER that will dig up a new slide deck that was presented in Budapest last Tuesday …. but IBM has allowed Watson customers to systematically EXCLUDE new info, limiting it to only examining info its doctors have agreed is okay to look at.

    I could go on and on, but I wonder what you think about both of those issues.

    What I take from all this is the sense, which is mentioned somewhere in this, that the only really sane thing to do is say in many cases (together, pt & clinician) “This LOOKS like it could be X, so we’re going to try Y and see how it goes.”

    And it’s abundantly clear that families must indeed take responsibility for gathering and coordinating all records, and being able to “present” the patient to every new clinician … such a chore!!

    Reply
    • Leslie Kernisan, MD MPH says

      July 6, 2017 at 4:39 am

      I think Dr. Weed was correct in advocating for physicians to be very systematic in how they initially evaluate a person’s health complaint, and in how they document what happened during the evaluation encounter (e.g. what they asked the patient, what the patient said, what the clinician observed on physical exam, etc). This kind of rigor is common in laboratory science, and also in rigorous clinical trials for that matter. But most healthcare is not provided in the context of trials.

      My concern regarding the application of this type of rigor to geriatrics is that you could easily end up with a very extensive lengthy process of collecting data and documenting it…and often both patients and clinicians are resistant to processes that are lengthy and tiring. So I think Weed’s idea is conceptually sound, but could be tricky to implement in practice. We can and should still try to do better, however.

      Re the knowledge coupler and out of date knowledge: this is certainly a concern. However, my impression is that rare diseases and uncommon presentations are overrepresented among epatients. The bigger problems that affects most people is that good enough knowledge exists in the “ordained” knowledge base; the problem is that it’s just inadequately and inconsistently applied.

      So yes, although the ideal is to have a knowledge coupler that can incorporate the latest bleeding edge of knowledge, I’d be happy if most people could access the “ordained” and well-established base, because that would already be a huge improvement.

      Lastly: a large part of Weed’s book addresses the need to help patients go through this journey of “this is what it seems to be, let’s try this and see what happens.” He really was for standardization at the beginning and then customization to the preferences and circumstances of the individual. But he wanted clinicians — and perhaps patients as well — to be very diligent in documenting our process and observations.

      Reply
      • e-Patient Dave says

        August 18, 2017 at 9:50 am

        > But he wanted clinicians — and perhaps patients as well —
        > to be very diligent in documenting our process and observations.

        And pretty much nobody wants to pay for that. Which blocks this from ever becoming a learning health system, eh?

        Reply
        • Leslie Kernisan, MD MPH says

          August 21, 2017 at 5:15 pm

          Yes, it’s often tricky to make a financial case for better care. Better care has proven to save money in several studies, but usually that’s when it’s delivered to a subset of people who are at high risk for ER/hospitalizations.

          Reply
  4. Terry Graedon says

    July 1, 2017 at 5:37 pm

    Dr. K, this is a WONDERFUL summary and discussion of Medicine in Denial. When I finished reading it several years ago, I wondered why doctors and patients weren’t talking about it.

    Reply
    • Leslie Kernisan, MD MPH says

      July 2, 2017 at 12:03 am

      Thank you, I’m glad you liked it.

      I think the ideas in Medicine in Denial might have gotten more traction if the material had been packaged and directed a little differently. Or perhaps promoted differently…one would like to believe that good ideas will spread on their own, but often they need a little help.

      Reply
    • e-Patient Dave says

      July 3, 2017 at 9:12 am

      I completely agree. Much has been written about Larry and his passing and about his works, but nothing gets the point across like Leslie’s telling of the issues.

      Yes, beyond a doubt the message will get across better if it can be distilled to something far more granular, far less “thick.”

      I myself was unable to get far into it … it seemed to me that the book was written for people not like me – academics who can absorb long paragraphs and unpack deep thoughts. We can all long for the days when most people had that ability, but I think it would be great if someone could repackage it in morsels that match the modern method (for better or worse) of knowledge dissemination.

      Like, wouldn’t it be great to have a Neil DeGrasse Tyson telling of all this??

      Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Find It Here

Recent Podcast Episodes

  • 163 – Dehydration in Older Adults: Symptoms, Treatment, & Prevention
  • 162 – Chronic Pain in Aging: What Really Helps & What to Know About Prescription Painkillers
  • 160 – Is Your Blood Pressure Too Low? Understanding Hypotension
  • 159 – Best Ways to Treat High Blood Pressure
  • 158 – Bradycardia and Pacemakers in Aging: What to Know
  • 157 – High Blood Pressure in Aging: When to Treat & Why It Matters
  • 156 – Methylcobalamin vs Cyanocobalamin: Which Vitamin B12 is Best?
  • 155 – Vitamin B12 Deficiency in Aging: Causes, Symptoms and Treatment
  • 154 – Protein, Metabolism & Aging: Nutrition Tips for Longevity
  • 153 – Heart Failure in Aging: Symptoms, Types, and Treatments
  • 152 – Inside Alzheimer’s Research: New Medications and Innovative Care
  • 151 – How Memory Medications Like Donepezil and Memantine Work
  • 150 – Caring for UTIs in Alzheimer’s, Dementia and Nursing Homes
  • 149 – UTIs in Older Adults: Symptoms & Prevention
  • 148 – How to Plan for Successful Aging
  • 147 – Essential Parts of Medicare & Open Enrollment
  • 146 – Atrial Fibrillation in Older Adults: Watchman, Medications & Other Treatment Options
  • 145 – COVID & Fall 2024 Vaccines Update
  • 143 – Unsafe Driving in Aging: What to Know & Do
  • 142 – Vitamin D: Why Less is More in Aging
  • 141 – 4 Most Common Types of Dementia in Aging
  • 140 – How to Exercise to Age Well
  • 139 – How to Treat Mild Cognitive Impairment
  • 138 – How to Promote Brain Health & Memory in Aging
  • 137 – Aging Life Care (and Geriatric Care Managers) Explained: Who They Are & How They Help
  • 136 – 8 Things Doctors Should Check After a Fall
  • 135 – How to Pay for Elder Care
  • 134 – COVID & Aging August 2023 Update: Staying Safe, Boosters & More
  • 133 – COVID Summer 2023 News Update for Aging Adults
  • 132 – COVID 2023 News Update for Aging Adults (2.23.23 Edition)
  • 131 – COVID Update for Aging Adults (12.8.22 Edition)
  • 130 – COVID Booster Update for Aging Adults (9.7.22 Edition)
  • 129 – COVID Update for Aging Adults (7.21.22 Edition)
  • 128 – COVID Update for Aging Adults (5.5.22 Edition)
  • 127 – COVID Update for Aging Adults (2.24.22 Edition)
  • 126 – Update: COVID Vaccination in Aging (1.6.22 Edition)
  • 125 – Update: COVID Vaccination in Aging (12.16.21 Edition)
  • 124 – Does Your Aging Parent Need Help?
    What to check & how to talk about it
  • 123 – Update: COVID Vaccination in Aging (10.28.21 Edition)
  • 122 – Update: COVID Vaccination in Aging (9.9.21 Edition)
  • 121 – Update: COVID Vaccination in Aging (7.29.21 Edition)
  • 120 – Depression in Aging: Diagnosis & Treatment
  • 119 – Update: COVID Vaccination in Aging (5.14.21 Edition)
  • 118 – Updates: COVID Vaccination in Aging (3.26.21 Edition)
  • 117 – Leg Swelling in Aging: What to Know & Do
  • 116 – Interview: Dr. K’s New Book: When Your Aging Parent Needs Help
  • 115 – COVID Vaccination in Aging (12.17.20 Edition)
  • 114 – Coronavirus Updates & Suggestions (11.18.20 Edition)
  • 113 – Interview: Urinary Incontinence In Aging
  • 112 – Flu Shots for Older Adults in COVID Times: What to Know (2020 Update)
  • 111 – Coronavirus Updates & Suggestions (7.16.20 Edition)
  • 110 – Coronavirus Updates & Suggestions (6.11.20 Edition)
  • 109 – Interview: Nursing Homes & Other Long-Term Care During COVID Times
  • 108 – Live QA: Aging Health in COVID Times
  • 107 – Interview: A Guide to Better Medical Care for Families of Aging Adults
  • 106 – Coronavirus Updates & Suggestions (3.27.20 Edition)
  • 105 – Coronavirus Updates & Suggestions (3.20.20 Edition)
  • 104 – Coronavirus Special: Planning to Help Aging Parents (Plus Q&A)
  • 103 – Interview: Better Sex in Later Life
  • 102 – Interview: The Importance of Grandparents & Intergenerational Connections
  • 101 – Interview: Avoiding Holiday Pitfalls with Aging Parents
  • 100 – Interview: Bill Thomas on Ageism, Housing & Changing Aging in 2019
  • 099 – Flu Shots for Older Adults: What to Know (2019 Update)
  • 098 – Interview: Medicare Open Enrollment: What to Know & When to Switch
  • 097 – Interview: Common Elder Law Issues When Helping Aging Parents
  • 096 – Interview: Paying for Long-Term Care: 2019 Updates
  • 095 – Interview: Hearing Aids & Other Hearing Loss Treatment Options
  • 094 – Interview: Hearing Loss in Aging: Why It Matters & Getting Evaluated
  • 093 – Interview: Hiring In-Home Care for Aging in Place: What to Know
  • 092- Interview: Addressing Nighttime Urination & Insomnia in Aging
  • 091 – Interview: Reducing the Risk of Power of Attorney Abuse
  • 090 – More on Avoiding Risky Medications & on Using the 2019 AGS Beers Criteria
  • 089 – Giving Yourself (And Your Family) a Gift on National Healthcare Decisions Day
  • 088 – Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria
  • 087- Interview: Coping with Difficult Older Parents
  • 086 – Interview: Creating Age-Friendly Health Systems at UCSF
  • 085 – Understanding Lab Tests:
    4 Common Blood Tests for Older Adults
  • 084 – Interview: Understanding White Matter Changes in the Aging Brain
  • 083 – Interview: Disrupting Dementia and Creating Dementia-Friendly Communities
  • 082- Interview: Bill Thomas on Housing & Communities as Engines of Independence in Aging
  • 081 – Interview: How to Plan Ahead for Your Later Years
  • 080 – Interview: Smartwatches as Medical Alert Devices
    (What to Know & How to Choose)
  • 079 – QA: Advice for Older Parents Frustrated by Their Family’s Concerns
  • 078 – Interview: The Biology of Aging & Longevity
  • 077 – Interview: Making Advance Care Planning Easier Through PREPARE
  • 076 – Flu Shots for Older Adults: What to Know (2018 Update)
  • 075 – Preventing Falls: 4 Approaches to Ask Your Doctor About
  • 074 – Interview: How the Village Model Supports Aging in Place & Community
  • 073 – Anticholinergic Medications & Protecting Brain Health
  • 072 – Cognitive Aging: How Memory & Thinking Change as One Gets Older
  • 071 – Interview: How Estimating Life Expectancy Helps Older Adults Get Better Care
  • 070 – Interview: Addressing & Preventing Financial Exploitation in Aging
  • 069 – Evaluating Memory & Thinking Problems:
    10 Causes & 10 Things to Check
  • 068 – Interview: Putting Older Adults at the Center of Technology Conversations
  • 067 – Interview: Managing Difficult Alzheimer’s Behaviors Without Medications
  • 066 – Interview: Addressing Potential Self-Neglect in Older Adults
  • 065 – Reconsidering “Successful Aging”
  • 064 – What to Know About Constipation & Laxatives
  • 063 – Giving Yourself (And Your Family) a Gift on National Healthcare Decisions Day
  • 062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health
  • 061 – Interview: Using Technology to Balance Safety & Autonomy in Dementia
  • 060 – Interview: Negotiating Family Caregiving Expectations After Hospitalization
  • 059 – Interview: Long-Term Care Insurance & Financing Late-Life Care Needs
  • 058 – Avoiding Missed Flu in Older Adults
  • 057 – How to Manage Cardiovascular Risk Factors for Better Brain Health
  • 056 – Top 10 Checklist for Better Health This Year
  • 055 – Interview: Bill Thomas on Ageism & Innovations to Improve Aging
  • 054 – How to Make Difficult Decisions Easier:
    Using Goals of Care & Weighing Benefits vs Burdens
  • 053 – Interview: Addressing Loneliness in Aging
  • 052 – Maintaining Mobility & Preventing Falls in Aging: Myths & Truths
  • 051 – Interview: Innovations to Help Older Adults & Family Caregivers
  • 050 – Flu Shots for Older Adults: What to Know
  • 049 – Better Primary Care for Older Adults:
    the Oak Street Health Story
  • 048 – How Cerebral Small Vessel Disease Affects Most Aging Brains
  • 047 – Unintended Weight Loss in Aging
  • 046 – Interview: Deprescribing & Reducing Risky Medications in Aging
  • 045 – HIPAA: Key Basics & 5 FAQs for Family Caregivers
  • 044 – Hospice Medications & What to do if You’re Concerned
  • 043 – How Hospice Helps at the End of Life, & Hospice for Alzheimer’s
  • 042 – Why Healthcare is Flawed & How to Improve It:
    The Work of Dr. Lawrence Weed
  • 041 – UTIs and Urine Bacteria in Aging:
    How to get the right diagnosis & avoid unneeded antibiotics
  • 040 – Dehydration in Older Adults:
    How to Prevent It, Detect It, & Treat It
  • 039 – Interview: Creating Age-Friendly Health Systems
  • 038 – FAQs On “Incompetence” & Losing Decision Capacity
  • 037 – Interview: Using Powers of Attorney to Help Older Adults
  • 036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents
  • 035 – Interview: Aging in the Right Place
  • 034 – Preventing Falls: 10 Types of Medication to Reconsider
  • 033 – Safer Treatments for Insomnia in Aging
  • 032 – 5 Top Causes of Sleep Problems in Aging
  • 031 – Choosing the Safest Over-the-Counter Painkiller in Aging
  • 030 – Drugs for Difficult Dementia Behaviors: What to Know
  • 029 – The Healthy Aging Checklist
  • 028 – When Older Parents Resist Help: 4 Tips for Better Talks
  • 027 – Interview: Planning for Aging When Single & Childless
  • 026 – 4 Medications for Alzheimer’s & Other Dementias: FAQs & Tips
  • 025 – Interview: Palliative Care to Live Well with Cancer
  • 024 – Interview: Better Cancer Screening While Aging
  • 023 – Anemia in Aging: 10 Common Causes & What to Ask
  • 022 – QA: Helping a Paranoid Older Parent and Checking Safety
  • 021 – Vitamin B12 Deficiency: Risks, Diagnosis, & Treatment
  • 020 – How to Diagnose & Treat Mild Cognitive Impairment
  • 019 – Interview: How Foundations Are Improving Health & Aging
  • 018 – High Blood Pressure Treatment in Older Adults: Research Findings & Practical Tips
  • 017 – Interview: Paying for Long-Term Care & Other Family Caregiving Challenges
  • 016 – 3 Reasons You Should Have a Home Blood Pressure Monitor
  • 015 – Interview: Practical Advice for Family Caregivers & Next Step In Care
  • 014 – Delirium & Hospital Confusion
  • 013 – Interview: Solving Hard Problems in Helping Aging Parents
  • 012 – Q&A: Answers to Your Questions On Aging & Health
  • 011 – Vitamin D: The “Healthy Aging” Dose & FAQs
  • 010 – Interview: Choosing a Wearable Medical Alert System for Older Adults
  • 009 – Q&A: Answers to Your Questions on Helping Older Parents
  • 008 – Interview: Helping Families with Memory Loss: The Care to Plan Online Tool
  • 007 – How a Personal Health Record Helps You Be Proactive
  • 006 – Interview: Surviving Cancer & Better Healthcare Through Being an e-Patient
  • 005 – Interview: Otago & Proven Exercises for Fall Prevention
  • 004 – What to Do If You’re Worried About Falls
  • 003 – Interview: Helping Reluctant Parents Address Memory Concerns
  • 002 – What to Do If You’re Worried About Someone’s Memory
  • 001 – Introducing the Better Health While Aging Podcast

Helpful Info If You’re New to Podcasts

Wondering what a podcast is? Not sure how to listen to the episodes? 

See this post for step-by-step instructions on listening, and answers to FAQs. Includes detailed instructions on how to subscribe, rate, and review too!

Disclaimer

The material on this site, including any exchanges in the comments section of the blog, is for informational and educational purposes only.

Any comments Dr. Kernisan may make regarding an individual’s story or comments should not be construed as establishing a physician-patient relationship between Dr. Kernisan and a caregiver, or care recipient.

None of Dr. Kernisan’s website or group information should be considered a substitute for individualized medical assessment, diagnosis, or treatment.

Please see the full Disclaimer for more information.

Please also carefully read our Terms & Conditions of Use, before using this site.

Creative Commons License
This work by Leslie Kernisan MD & Better Health While Aging LLC is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at BetterHealthWhileAging.net.

Privacy Policy & Disclosures

Your privacy is very important to us. Your information will never be sold to anyone, whether you browse the site, sign up for email updates, or register for an event.

Pleae read our complete Privacy Policy for more information and for Dr. Kernisan's financial disclosures.

© 2025 Better Health While Aging, LLC · Terms & Conditions · Disclaimer · Privacy Policy · Contact Us