Archive | October, 2007

Should We Retrofit our Buildings or our Healthcare System?

Last night, my house shook for 10 seconds or so in a 5.6 earthquake. I’ve felt a couple of dozen of them since moving to San Francisco in the mid-80s. When the rumbling begins, the thought chain is always interesting. It goes like this: Initial Thought: Hey, is that an earthquake, or is the subway […]

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Rating Doctors Like Restaurants

So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics? Whatever you think of Zagat’s cross-dressing, it again demonstrates the bottomless market for doctor rankings. HealthGrades, the Colorado company that breathlessly delivers its […]

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Are Hospitalists Killing Primary Care, Redux

The comments to my original post on this topic are so striking and passionate that I wanted to answer them in a new post rather than as another comment. First, “LPrieto” wrote, “I think the death of outpatient general Internal Medicine is inevitable.”  Then “C33333” wrote that 16/17 of his or her (hard to sort […]

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Canadian Hospitalists: A North-of-the-Border Lesson in Negotiation

In late September, I had the honor (or honour, I guess) of speaking at the 5th Annual Canadian Hospitalist Conference, held in beautiful Vancouver. It was an eye-opener. About 150 hospitalists from all over Canada were there, and they really are delightful people: enthusiastic, energetic, and really jazzed about doing something new and important. Whereas […]

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The Santa Barbara RHIO: An Impressive Post-Mortem

One of the more interesting recent concepts in the healthcare IT world is that of the “RHIO”: a Regional Health Information Organization. The idea is that – while we’ll never overcome the legal and privacy concerns to create a single national electronic healthcare record (at least not in my lifetime) – we might be able […]

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Are Hospitalists Killing Primary Care?

Primary care is tanking. Job dissatisfaction is high, burnout is rampant, residents are voting with their feet in droves, and most primary care confabs have become sky-is-falling angst-a-thons. Since many people identify me as “the guy who invented hospitalists” (to which my stock reply is “just like Al Gore invented the Internet”), I have had […]

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Time For Truth in Advertising in Quality Reporting

Just a quick heads up re: an article that Peter Pronovost (the world’s best patient safety researcher, in my judgment), Marlene Miller (both of Johns Hopkins) and I have in today’s JAMA. In it, we argue that there is now suffficient skin in the quality game that the time has come for there to be […]

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From the “I Thought I’d Heard Everything” Department

The pharmaceutical industry’s influence in clinical care is increasingly being viewed under a high-powered microscope, and the result is tightening restrictions on what pharma can do with/for/to doctors. Having lived through the era of sun-baked golf and beach “conferences” (with the invited physicians paid handsomely as “consultants”), this extra scrutiny has been long overdue. And […]

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Look At How Safe [Fill in the Blank] Is!

The rate of fatal domestic airline crashes has fallen by 65% in the past decade – from an amazingly low rate of one fatal accident in about 2 million departures in 1997, to a breathtakingly low rate of one in 4.5 million departures this year. Flying just keeps getting safer and safer. Beginning with the […]

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Can Computerized Decision Support Get Docs to Toe the Line on Quality?

A humorous and telling story about quality measurement, decision support, and human nature: I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Sometimes they present a clinical case to me, but […]

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