So, what's the problem?

Medical care presents complex problems to physician executives--thoughtful problem definition is a crucial management task. Without understanding the context, cultures, bottom line implications, and personal relevance, problem definition is incomplete and problem resolution may be inadequate or inappropriate. If our choices are complex, some of the difficulty may lie in our understanding of the problem. Until we have properly defined the problem, we can't act to resolve it. We need to step back, reframe the issue, ask if it feels right, and understand the whole story, not just the situation at hand. The tests of an organized story are coherence, direction, meaning, and implication. These should be perceptible both as individual attributes and as a whole. The purpose of such a story is not the resolution of the problem, but a coherent understanding of the direction to be taken. When the diagnostic work-up is complete, the next step can begin.