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 [...]
Archive | 2011
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 [...]
Important Notice For Email Subscribers To Wachter’s World
Dear Readers: Later today, Wachter’s World will get a facelift, as we migrate to a new “platform” (don’t ask me what that means but the good folks at Wiley, and your teenage children, will know). This will make the website more stable, give it better graphics, and prevent it from crashing and blocking comments, as [...]
Summer in London: First Impressions
First of all, let’s get the important stuff out of the way. Mom, I’m fine. Thanks for your concern. Really. I’ve now been in London for about 6 weeks on my sabbatical. The recent riots here are all folks are talking about and the trauma is real. One wonders whether the inevitability of budget cuts, [...]
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