Archive | 2012

Don’t Pawn Off the Work: Bob’s Method for Tackling Big, Hairy Projects

In my last post, I promised – just in time for the New Year – to describe my fail-safe method for tackling overwhelmingly large projects. Please, please don’t waste this method on cleaning out a closet or writing an abstract. That would be like using a flamethrower to light a holiday candle. Rather, consider it […]

Read full story Comments { 12 } 6,538 views

(Not) Saving the Best for Last: Managing One’s Time on Rounds and Sign-Out

A clever little study was published last month in the Archives of Internal Medicine, and it – plus the fact that I’ve just started a stint as ward attending – prompted me to think about the importance of managing a set of tasks in the hospital. In my quarter-century of mentoring residents and faculty, I […]

Read full story Comments { 9 } 2,738 views

Pay 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, the debate is no longer theoretical. Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that it doesn’t. We’ve […]

Read full story Comments { 12 } 2,156 views

Denying 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 settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and […]

Read full story Comments { 6 } 1,537 views

“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 prescription for reforming our broken health care system.” And he partly delivers, with an insider’s and relatively unvarnished view of many of the flaws in modern hospitals. Underlying […]

Read full story Comments { 4 } 1,817 views

In Today’s JAMA: Abraham Verghese and I Discuss the Changing World of Ward Attendings

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 younger. At UCSF Medical Center, for example, about 90% of our ward attending-months are now staffed by hospitalists, about half of them physicians in […]

Read full story Comments { 11 } 1,814 views

Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem

A colleague recently sent me a remarkable video – of Professor Lawrence Weed giving Medical Grand Rounds at Emory University in 1971. It’s fun to watch for many reasons: the packed audience composed mostly of white men in white jackets and narrow ties, the grainy black and white images a nostalgic reminder of Life Before […]

Read full story Comments { 49 } 13,365 views

On 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 months later, I learned that I passed the exam, and that success, combined with an attestation by my residency program director, rendered me […]

Read full story Comments { 229 } 14,244 views

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 year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and […]

Read full story Comments { 6 } 2,695 views

Today’s Supreme Court Decision: My Two Cents

The United States government, for all its exasperating foibles and silliness, retains the capacity to surprise and even delight. Five years ago, who could have guessed that we would elect a centrist African-American president with a middle name of Hussein. Three years ago, who could have guessed that our deeply divided Congress would pass ambitious […]

Read full story Comments { 15 } 1,378 views