It’s not like you don’t have enough to read, or that I don’t have enough to do. So, why do I blog? And why should you read?

We are in the early days of a revolution in healthcare. The hospitalist field has grown from an idea – given breath by a handful of hardy pioneers – to a thriving specialty of more than 20,000 doctors: the fastest growing field in the history of American medicine. Hospitals have moved from assumed, reputational quality to a new kind of quality: measured, reported, and sometimes even paid for. Evidence-based medicine is rapidly supplanting eminence-based medicine. Patient safety wasn’t even in the lexicon a decade ago; now it seems to dominate every discussion. Housestaff work hours, nurse-to-patient ratios, the Joint Commission, medication reconciliation, CPOE, EMRs, PHRs....

What an incredibly exciting time to be in the middle of the storm. But it is also disorienting and a little bit scary; some days it feels like we’re in the carnival Fun House, the exit sign nowhere in sight.

Starting from my days as an intrepid college poly sci major, I found that I enjoyed – and maybe had a bit of talent in – analyzing complex situations and articulating my understanding to others. Since then, I’ve done work in healthcare policy, epidemiology, ethics, quality, safety, and medical education, and remain a (semi-) active clinician and teacher. Few things make me happier than dissecting and explaining healthcare issues, particularly when they’re clinically meaningful and politically and ethically charged, with passionate advocates and foes. Although I enjoy following healthcare Policy-with-a-capital-“P” (i.e., what happens inside the Beltway), my real interests lie closer to the ground: how changes in policies, practice, science, economics, and culture affect the way we care for patients, teach our trainees, and organize our work.

As I trolled around the World Wide Blogosphere, I found many terrific healthcare blogs, but none that approached our work from this particular angle: the policy and practice issues that affect real docs and nurses – and real patients – in real hospitals and clinics.

Ergo, this blog. Although I’ve written half-a-dozen books and 200 articles, these formats are a bit too formal, their time horizon a bit too elongated, to handle my daily impressions of the key issues of the day. Sometimes, I make a connection that helps illuminate my understanding of an issue, or stumble upon an article or a website that I find fascinating, or meet a colleague who educates me about something important and cool. In these circumstances, the idea of sharing it with my friends – or a few thousand of them – seems like the thing to do, as natural as breathing.

So I suspect I’ll be blogging a couple of times per week. I’ll really try not to waste your time or just blog for blogging’s sake. Most of my postings will be represent my thoughts, though I welcome your comments and hope we can generate a lively dialogue. At times, I’ll act as a curator, bringing items that I think you’ll be interested in to your attention. But even then, I’ll try to place the pieces in context, not simply becoming a library or another daily update of the literature or news cluttering your In-Box.

And I’ll do my best to make it fun, interesting to read, and a bit contrarian and controversial. But never boring or wishy-washy. 

At least, that's my goal. My 16-year-old son (who I hoped would be impressed by "My Dad, The Blogger"), saw the title "Wachter's World", rolled his eyes, and snorted, "I have an idea for your subtitle. How about "Just Like Wayne's World... Only Nerdier!"

Well, you can't please everbody. I hope you enjoy the blog.