Wachter's World

Is it “Macaca” Time in Healthcare?

2008-08-19T07:00:00Z

August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether healthcare has also entered the YouTube era. Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him...(read more)

Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

2008-08-14T02:07:00Z

Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. First, the final “no pay” list. I’m not sure if this was CMS’s intent, but their trial balloon of possible additions to the “no pay” list included so many ludicrous items that the final list seems nearly rational. You’ll recall the proposed list;...(read more)

Is “Patient-Centeredness” a Healthcare MacGuffin?

2008-08-04T03:16:00Z

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin? What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way: MacGuffin: a plot device that motivates the characters or advances the story, but the details of which...(read more)

Will Knols and Blogs Upend the Cozy World of Medical Publishing?

2008-07-25T05:03:00Z

Yesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As healthcare advisor to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it. First, a word about Knol (the name is short for “a unit of knowledge”). Google’s vision is that providing a tool for people to write about “things that they know” will make the world a better place. Unlike Wikipedia’s...(read more)

The Long Awaited Crisis in Primary Care: It’s Heeere!

2008-07-20T18:36:00Z

I recently heard from a UCSF physician who was flabbergasted when he sought an appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare...(read more)

Another Case of Wrong Site Surgery: Are We Averting Our Eyes From Some of the Root Causes?

2008-07-09T06:52:00Z

Yet another case of wrong-side surgery, this one at Boston’s Beth-Israel Deaconess Hospital. Though CEO Paul Levy does a nice job discussing the case on his blog, I’ll focus on two aspects Paul neglects: the role of production pressures in errors, and the tension between “no blame” and accountability. First, I hope you’ll read Paul’s piece (on his always-interesting blog), which includes a courageous memo he and BI-D’s chief of quality Kenneth Sands sent to the entire community describing the case...(read more)

Door to Antibiotics Time in Pneumonia: Lessons from a Flawed Quality Measure

2008-07-02T07:09:00Z

In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary tale.As I’ve discussed previously, the biggest surprise of the last decade in the quality field has been this: public reporting alone (even without pay-for-performance) leads to huge changes in the behavior of providers and healthcare organizations…...(read more)

The New (CMO) Math: Passion + Power = Progress

2008-06-25T07:36:00Z

In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Center didn’t have a Chief Medical Officer until about 8 years ago; indeed, even today many U.S. hospitals lack a senior physician who is compensated by and works for the hospital. It is easy to understand why.Through several accidents of nature...(read more)

The Best and Worst of Times For “Infection Preventionists”

2008-06-23T04:51:00Z

As I mentioned in my last post, these should be the best of times for "Infection Preventionists" (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally arrived. But they are far from a joyful bunch. Why? In my talk to 4,000 members of the Association for Professionals in Infection Control (APIC) last week, I riffed on this question. After being prepped like a pre-debate presidential candidate...(read more)

How Infection Prevention Came to Dominate the Patient Safety Movement

2008-06-22T00:10:00Z

The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is one of the most surprising twists of the patient safety revolution.The inclusion – make that dominance – of infection prevention in the safety field was anything but preordained. The IOM Report on medical errors, which sparked the modern patient safety...(read more)

Announcing our Hospitalist CME Course, and a New Hospitalist Mini-College

2008-06-15T18:51:00Z

A quick heads-up for those of you thinking about attending this year’s Management of the Hospitalized Patient (MHP) conference, October 23-25 in SF… we’re adding a hands-on, small group “Hospitalist Mini-College” pre-course. I think it will be tremendous. This will be our 12th Annual MHP conference (co-sponsored by the Society of Hospital Medicine). It is a clinical CME course, blending lectures on key topics in hospital medicine (I hand-pick the faculty for their lecturing skill) with nearly 20...(read more)

Could Intensivists Be Harmful to ICU Patients’ Health?

2008-06-04T06:34:00Z

Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now. In a sophisticated study in today’s Annals of Internal Medicine, Levy and colleagues mine a decade-old, 100-hospital, 123-ICU database containing detailed clinical data on more than 100,000 patients to examine the association between ICU staffing models and hospital mortality. The...(read more)

Why Diagnostic Errors Don’t Get Any Respect… And What Can Be Done About It

2008-06-02T03:20:00Z

I gave a keynote yesterday to the first-ever meeting on “Diagnostic Error in Medicine.” I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo would say, the experts and advocates in the audience have some ‘splainin’ to do. I date the origin of the patient safety field to the publication of the IOM report on medical errors (To Err is Human) – it is the field’s equivalent of the Birth of Christ (as in, there was before, and there is after). But from the get-go, diagnostic...(read more)

The Funniest Satire on Interoperability You've Ever Seen (Trust Me)

2008-05-29T07:54:00Z

There is nothing better than a good satire to capture certain (uncomfortable) truths – just ask any of the presidential candidates after an episode of Saturday Night Live. So check out this hilarious spoof on information technology interoperability. As Captain Kirk said to Bones, “have you lost your mind?” Hilarious? Interoperability? But really, check it out. It is very funny. Now for those deep truths. When my friend David Brailer became the first federal IT czar, I think most people expected him...(read more)

Google Health: A View From the Inside

2008-05-22T15:24:00Z

Google Health launched on Monday, which sent the world’s Google-watchers into a tizzy. I serve on Google Health's Advisory Council – which met all day Tuesday – and so here’s a bit of inside dish, along with my impressions of the site and the company. FYI, my work on the Council is covered by a Non-Disclosure Agreement, so I won’t reveal anything that isn’t publicly known regarding Google’s products or intentions. Also, in the interest of full disclosure, you should know that I am compensated for...(read more)