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A Piece of My Mind |

A Systems Engineer Meets the System

David H. Gustafson, PhD
JAMA. 2013;309(3):247-248. doi:10.1001/jama.2012.176580.
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I’m a systems engineer. The goal of systems engineers is to improve complex work processes. Since I started as a professor at the University of Wisconsin almost 50 years ago, I have been studying organizational change and quality improvement in health care. My colleagues and I have worked with countless patients, families, and clinicians dealing with cancer, addictions, and other long-term illnesses.

I had always exercised and eaten right and felt good. I hadn't had any warnings (at least none that I recognized) when my heart stopped at my health club in May 2007. But I got lucky: A police detective working out nearby administered cardiopulmonary resuscitation; the club's owner used the defibrillator, which was handy; the ambulance that got the call was only two blocks away. I survived and felt great for a few months. Then I began to deteriorate. My wife Rea and my friend Paul, a physician from Dartmouth, arranged a second opinion for me at a widely respected, more distant hospital, working through Rob, a hospitalist there. I reluctantly went to this hospital in 2008. My pericardium was removed. Four days later I coded again. I had CPR again, followed by 45 minutes of open heart massage. After this I was put on ECMO (extracorporeal membrane oxygenation), and then a BiVAD (biventricular assist device) was implanted. After 100 days of recuperation, I was healthy enough to be put on the waiting list for a heart transplant. After 33 days on the list, I got a new heart.


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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