In 1949, the English-born physician John Wild, working at the University of Minnesota, discovered that he could determine the thickness of bowels injured in the war by bouncing sound waves though the abdominal wall. Over the next 30 years, medical ultrasound technology improved markedly, ultimately leading to the many uses we’re all familiar with. Once [...]
Digital Distractions: Time for a Diet
It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must [...]
The Patient Will Rate You Now
These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics. Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results [...]
Cutting Healthcare Costs: Searching – Ever So Gingerly – For the Right Words
During my med school psychiatry rotation, I was taught not to shy away from discussing suicide with a depressed patient. “You won’t be suggesting something they haven’t thought about,” my professor told me back in 1982. “By not raising it, you add to the sense of stigma and it just becomes the elephant in the [...]
In Search of a New Rhythm on Today’s Wards
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 [...]
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