Editors' Comments

You take a break from lawnwork one Saturday afternoon to discuss the sad state of the US health care system with your neighbor, and are caught a little off guard when he asks you what is unique about being a Permanente physician ...

On a return flight from a Continuing Medical Education (CME) meeting you are asked by the woman sitting next to you to tell her what is special about Permanente practitioners ...

In the few short years of its existence, a major accomplishment of The Permanente Journal has been to present in each issue the values of the Permanente physician. Just as a perusal of a person's checkbook reflects what he or she really values in life, the Table of Contents of each issue reflects the characteristics of what it is to be Permanente. The Permanente Journal regularly highlights our core values (eg, physician-directed care), along with other values that have been woven over time into the fabric of Permanente.

The diverse articles found in this Fall edition of The Permanente Journal are no exception with many of the values defining Permanente being represented.

The Clinical Contributions and the Permanente Abstracts sections are always presented first, a reflection that providing high-quality care is a fundamental Permanente value. I believe that, in the future, as population-based and evidence-based care becomes even more integrated into our daily Permanente practices, you will see the content of our research articles becoming even more divergent from the non-Permanente research community. While these values have been present since Dr Garfield's early days in the desert, we can expect to see them even more evident in our practices in the future because of the ongoing efforts of Permanente's Care Management Institute and contributions of outstanding CME courses such as the annual Permanente Primary Care Conference.

This edition also includes a contribution by Vivian Nagy from Southern California in the Clinician-Patient Communication (CPC) Corner, underscoring how highly Permanente values good patient communication skills. At times, we may take this value for granted and mistakenly assume that this emphasis is also inherent in community physicians' practices. We may also not be aware of Permanente's organizational competency for developing and implementing highly effective CME endeavors in CPC. I have to tell you, the Permanente Medical Groups are on the cutting edge of clinician-patient communication strategies. An obsession with improving our patient communication skills is a critical and distinguishing value of Permanente.

Teamwork--a value that has always been evident as Permanente care has traditionally been organized around several disciplines and with the patient, not the physician, being the center of focus. However, over the recent years, teamwork has been taken to the next level as Permanente Medical Groups have come to realize that care organized around teams will alleviate much of the daily stress of practice while enhancing both care and service. My editorial on teams in the recent Summer edition of The Permanente Journal stimulated a response from our readers that is well represented by an excellent letter on health care teams in this edition from Dr Ben Tamura, the Hawaii Permanente Medical Group Chief of Medicine.

This edition also includes a section on the community service involvement of Permanente physicians --a fundamental hallmark of the Permanente person and a reflection of the rich heritage of Kaiser Permanente. This article, championed by Jon Stewart of The Permanente Federation and a member of The Journal's editorial team, is an exciting testimony to the community spirit of Permanente. While this value is certainly not uniquely Permanente, the breadth of involvement of the individual Permanente physicians is eye-opening. As you read this article, I'm sure you will be impressed with how rewarding it is to be involved in such activity. Interestingly, many Permanente physicians are involved in countries that have a population half that of the membership of Kaiser Permanente! It has been my experience that leaders of these countries wish to replicate how Permanente organizes care so that they can spend their limited resources in areas where they will derive the most impact.

So next time your neighbor asks you about the uniqueness of being Permanente or when a conversation on a plane trip evolves to the question of why being Permanente is so special, you may want to cite examples of people living out the values of Permanente in any one of your recent Permanente Journals.

The Permanente Journal--telling the story of the unique Permanente person.

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