The US News “Best Hospitals” List: In God We Trust, All Others Must Bring Data
I knew it would happen sooner or later, and earlier this week it finally did. In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same...
View ArticleOn Becoming Chair of the ABIM: Why the Board Matters More Than Ever
On September 10, 1986, soon after I completed my residency in internal medicine, I “took the Boards” – the certifying examination administered by the American Board of Internal Medicine (ABIM). A few...
View ArticleIn Today’s JAMA: Abraham Verghese and I Discuss the Changing World of Ward...
Senior attendings like to quip that the medical students seem to be getting younger every year. They’re not. But the attendings on the wards of American teaching hospitals actually have gotten...
View Article“Unaccountable”: An Important, Courageous, and Deeply Flawed Book
In his new book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Johns Hopkins surgeon Marty Makary promises a “powerful, no-nonsense, nonpartisan...
View ArticleDenying Reality About Bad Prognoses: Not a Benign Problem
The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American...
View ArticlePay for Performance in Healthcare: Do We Need Less, More, or Different?
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs,...
View ArticleMaking Clinicians Get Flu Shots: More Important Than Simply Preventing the Flu
I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said,...
View Article“Doctor, Step Away From That Cookbook!”
A middle-aged man develops chest pain at home. Minutes after calling 911, he’s in an ambulance, whizzing through traffic to the nearest emergency room. The paramedics radio ahead, and by the time the...
View ArticleIs the Patient Safety Movement in Danger of Flickering Out?
These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one...
View ArticleHIT Job: How the New York Times Blew it on Healthcare IT
I’m well aware that a good fraction of the people in this country – let’s call them Rush fans – spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be...
View ArticleMeasuring the Quality of Doctors and Hospitals: When Is Good Enough, Good...
In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and...
View ArticleThe Dangers of Curbside Consults… and Why We Need Them
Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge...
View ArticleHow UCSF is Solving the Quality-Cost-Value Jigsaw Puzzle
I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate. “The world is going to push us, relentlessly...
View ArticleReflections On My Year as Chair of the American Board of Internal Medicine
Today is my last day as chair of the ABIM, and the end of my eight-year tenure on the Board. In this blog – a bookend to the one I wrote at the start of the year, which went near-viral – I’ll describe...
View ArticleMedicare’s Most Maddening Policy… and Why CMS’s Attempts to Improve It May...
There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which...
View ArticleDiagnostic Errors: Central to Patient Safety, Yet Still In the Periphery of...
In 2008, I gave the keynote address at the first “Diagnostic Errors in Medicine” conference, sponsored by the Agency for Healthcare Research and Quality (AHRQ). The meeting was filled with people from...
View ArticleLights, Camera, Action… In Healthcare
About eight years ago I was desperate to improve my golf game. I just couldn’t straighten out my drives or hit my irons crisply. (Yes, I’m fully aware that this is a First World problem). I decided to...
View ArticleGlobal Health Hospitalists: Strange but Noble Bedfellows
As my Division of Hospital Medicine has grown – now to about 60 faculty – I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne...
View ArticlePatient Safety’s First Scandal: The Sad Case of Chuck Denham, CareFusion, and...
In retrospect – always in retrospect – it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right. In a remarkable number of cases of medical errors, it’s...
View ArticleHospitalist Potpourri
I’m just back from the annual meeting of the Society of Hospital Medicine and, as usual, I was blown away. I’ve not seen a medical society meeting that is remotely like it. As Win Whitcomb, who...
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