The prevailing "culture" of academic medicine -- where docs are educated -- is "individualistic, autonomous, scholarly, expert-centered, competitive, focused, high-achieving and hierarchical."

What the culture needs to be is "collaborative, transparent, outcomes-focused, mutually accountable, team-based, service-oriented and patient-centered."

Those aren't my thoughts. They're drawn from a powerful speech -- "Culture and the Courage to Change" -- delivered Nov. 7 in Washington, D.C., by the president of the Association of American Medical Colleges, Dr. Darrell G. Kirch. You'll find it on the Web at www.aamc.org and it's well worth reading.

He talks about creating "medical homes" for patients, putting as much energy into culture as into strategy and recapturing professional excitement.

Interestingly, a related item popped up in the New York Times, which reported that the nonprofit National Committee for Quality Assurance is floating a new model to identify the best primary care docs -- and then pay them more for spending more time with patients and for communicating with patients by phone and email outside office hours.

The story quotes Dr. Paul H. Grundy of IBM: "We don't want to buy the kind of care we're getting any more. We have turned doctors into chipmunks on a wheel, pumping out patients every five minutes."

Speaking of pumping, Big Tobacco won again this week as voters in Oregon rejected a cigarette tax hike that would have funded insurance for children. No surprise -- the Wall Street Journal praised the rejection while the New York Times railed about the power of money, shill groups and misleading ads.