When I was a medical student, I remember wondering what my attendings did when they weren’t on the wards. As an attending now myself, trying to cram three half-month ward blocks into my hyperscheduled life each year, I find that sentiment charmingly naïve. I – like most of my faculty colleagues – am awfully busy [...]
A Pay Within a Play: The Awkward World of Private Insurance in the UK
I remember reading an article that observed that systems of universal insurance – which need to put their energy into providing a “decent minimum” for the masses – must also offer a “safety valve for the wealthy disaffected.” Canada bans private insurance for basic hospital and medical care services. So, when affluent Canadians want “the [...]
The Crash of Air France 447: Lessons for Patient Safety
From the start of the patient safety movement, the field of commercial aviation has been our true north, and rightly so. God willing, 2011 will go down tomorrow as yet another year in which none of the 10 million trips flown by US commercial airlines ended in a fatal crash. In the galaxy of so-called [...]
Saying “No” While Being NICE
A wise man once quipped that saying that we may need to ration healthcare is like saying that we may need to respect the laws of gravity. In other words, when societies have more healthcare needs and wants than resources (and all societies do), rationing is inevitable. The question of how to ration used to [...]
“I’m the Main Breadwinner”: The British Primary Care System and Its Lessons for America
I’ve heard a lot of shocking things since arriving in England five months ago on my sabbatical. But nothing has had me more gobsmacked than when, earlier this month, I was chatting with James Morrow, a Cambridge-area general practitioner. We were talking about physicians’ salaries in the UK and he casually mentioned that he was [...]
Leaders and Leadership in Hospital Medicine: The Story Behind the IPC-UCSF Fellowship
This is a tale of leaders and leadership. And about keeping an open mind. I first met Adam Singer in 1996, when the hospitalist field still had its training wheels on. A pulmonary/critical care physician by training, Adam had become a physician-entrepreneur and was now focused on making his new enterprise, IPC, the nation’s preeminent [...]
Role Models of Diagnostic Excellence: Goop Dhaliwal and the Car Talk Guys
In a “Clinical Problem Solving” session at my annual Hospital Medicine conference last week, I presented a fiendishly hard case to Gurpreet Dhaliwal, a UCSF associate professor of medicine based at our San Francisco V.A. You can imagine how hard this is for the discussant: he’s hearing a case for the first time, absorbing and [...]
Acute Physicians: Hospitalists Bounded by Time and Space
Besides studying patient safety and watching all five seasons of The Wire, my other major goal for my London sabbatical was to understand the way the Brits organize hospital care. Mirroring the U.S. hospitalist movement, a new field—called “acute medicine”— emerged about 15 years ago and became the country’s fastest growing specialty. But there is [...]
Patient Safety in the US and UK, Part II: Top-Down vs. Bottom-Up
In my last post, I discussed the role of physicians in patient safety in the US and UK. Today, I’m going widen the lens to consider how the culture and structure of the two healthcare systems have influenced their safety efforts. What I’ve discovered since arriving in London in June has surprised me, and helped [...]
Patient Safety in the US and UK, Part I: The Doctors
A little more than a decade ago, the patient safety movement hit both the United States and the United Kingdom like twin avalanches. In both countries, high profile cases of medical mistakes led to growing anxiety, and early research outlined the vast scope of the problem and identified some solutions. All this was prelude to [...]
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