It was a pleasure to read Dr Cadesky’s article [BCMJ 2018;60:389 [11]]—succinct, and things that needed to be said. To paraphrase Bill Clinton, “It’s all about the patient, stupid.” If change starts with what will benefit the patient and not what is perceived to benefit the system, better health care will ensue. And the monolithic, inflexible system redesigns are antithetical to how medicine evolves. We need flexibility and readiness to change as we try out any system. Indeed, that’s how we practise patient care.
—Barry Koehler, MD, FRCPC
Delta

This letter was submitted in response to “Innovation is everywhere. Why isn’t it here?” [11]