A Fictional Salladhor Saan’s Game of Thrones Insights About the Patient Centered Medical Home


by Jaan Sidorov

First posted on the Disease Management Care Blog on 02/19/2013

Jaan Sidorov, host of Disease Management Care Blog

Along with millions of other fans, the Disease Management Care Blog is delighting in George R. R. Martin’s A Song of Fire and Ice book series.  In its reading (now up to Volume 3, A Storm of Swords) the DMCB especially looks forward to running into Ser Davos Seaworth’s flamboyant Lyseni smuggler-friend Salladhor Saan.  While he’s a brigand, he’s also an astute observer who is willing to share his shrewd insights with kings and commoners alike.

Yes, he’s a self-serving peacock but his syntax makes it all worth it.

So, with apologies to the creative genius of Mr. Martin, the DMCB offers up a fictional Salladhor’s insights about the patient centered medical home:

Who has served more of the unwell than the practitioners who minister in medical homes?  They seek remuneration and esteem, and that they deserve, I am thinking. True, it is vile calumny to insist on a “return on investment,” but empty coffers command the attention of royals everywhere more than the mewing of babes or the lamentations of the old, is that no so? Alas, budget fever has cooked our collective wits.

Screwy talking, I have also heard, of statistical medical home legerdemain foisted upon an unsuspecting public by clever math maesters. The medical home community takes no denial of proof of savings, while skeptics cleverly vex at their measures like sharks at a bloated whale carcass. It is, I am telling you truly, a miasma of chicanery that rivals Joffrey Baratheon’s subterfuge to ride the Iron Throne with his bony Lannister bottom.

I, Salladhor Saan, who has benefitted often from a friend’s guidance, consider well the benefits of congenial advice to those who have both need as well as a receptive heart.  If a diseased person’s costs diminish and we cannot see that, I am thinking that measuring what is not seen is no different than missing smugglers in the night.  The problem, I am believing, has less to do with the smugglers than with our skill at finding them, is that not so?

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Jaan Sidorov MD is the Host of the Disease Management Care Blog where he shares his knowledge and insights about medical home, disease management, population-based health care and managed care. He is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He is primary care by training, managed care by experience and population-based care strategies by disposition. The contents of his blog reflect only his opinions and should not be interpreted to have anything to do with any current or past employers, clients, customers, friends, acquaintances or enemies, personal, professional, foreign or domestic.