One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge....

Late February is the pits for interns – the novelty of being a real-live MD is long gone, and the rebirth of residency is too far beyond the horizon to see. The other day, my wonderful resident Anna brought a coffee cake to my ward team's post-call rounds,...

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The...

FYI, Glenn wrote to family and friends last night saying that he is not the new CMS administrator. We'll see...(Lesson – don't believe everything you read in the blogosphere. Yes, even mine.) Turning to more important matters, now I've gotta decide about...

If you’re in healthcare, the most important announcement today will not be Steve Jobs’ introduction of the iPad (thrilling as that is). Rather, it will be President Obama’s expected announcement of the appointment of Dr. Glenn Steele as the new director...

Every family has a favorite joke or two. One of ours went this way – unsurprisingly, given my dad’s interests and pedigree, it is Borscht Belt meets US Army. Here goes:An army drill sergeant receives word that both parents of one of his enlisted men have...

Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said,...

One of the great joys of a life in academic medicine is the opportunity to work with lots of very smart people. But one regret is that there is something about academia that tends to homogenize – faculty learn that, when it comes to competing for the...

The interview, by Pauline Chen, the surgeon and NY Times author who writes the terrific "Doctor and Patient" column on-line, is here -- it mostly focuses on my thoughts about patient safety 10 years into the movement. The story and topic were also picked...

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause...

On December 1, 1999, the Institute of Medicine released a report entitled To Err is Human: Building a Safer Health System. Although its authors hoped to spark a national movement, they had little cause for optimism. After all, early efforts by advocates...

Two years ago, I wrote about the case of Julie Thao, the Wisconsin nurse sent to prison for a medication error. I argued then that – although Julie bypassed some safety rules – she most certainly did not deserve jail time.Along comes another case involving...

From Tokyo, I flew on to Singapore, where I had the honor of being visiting professor at the massive (1500-bed) Singapore General Hospital, a guest of Dr. Kheng Hock Lee. Kheng Hock, one of Singapore’s leading family physicians, has been charged with...

A couple of weeks ago, I had the chance to visit Tokyo and Singapore – the former to speak at a conference on “Training of the Generalist Physician,” and the latter as visiting professor at Singapore General Hospital. Today: some observations on the medical...

Just a quick heads up on an article in next weekend’s New York Times Sunday Magazine by my friend David Leonhardt. David profiles Intermountain Healthcare’s Brent James, capturing Brent’s (and Intermountain’s) unique and increasingly influential philosophy...

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided...

If you can spare 2 hours, do yourself a favor by listening to the two-part healthcare series on NPR's extraordinary show, This American Life. By using examples that are memorable for their simplicity and lack of hyperbole, the series (the episodes are...

Sticking with my recent hand hygiene theme, an interesting study came out last week demonstrating that outpatients were willing to help audit their providers’ hand hygiene practices. The patients felt that snooping on their docs didn’t poison the physician-patient...

In the 9th installment of his 35,000 part series, “Better Know a Lobby,” Colbert interviews the head of “Health Care for America Now,” Richard Kirsch. The whole thing is hilarious, but the funniest portion comes at 3:45, when Colbert asks Kirsch to choose...

In this week’s New England Journal, Peter Pronovost and I make the case for striking a new balance between “no blame” and accountability. Come on folks, it’s time.At most hospitals, hand hygiene rates hover between 30-70%, and it’s a near-miracle when...

A quick heads up on an article written by a very talented UCSF psychiatrist named John Young, which I had the opportunity to co-author. John observed that, despite all the recent literature about handoffs (such as here and here), no one has given much...

In a little over a decade, the field of hospital medicine has achieved most of the milestones that characterize a specialty: the field is the fastest growing specialty in medical history, it has achieved wide recognition and acceptance, and there are...

When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more...

A conventional look at the The Speech: Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not only was...

Much has been made of the superior performance – on both cost and quality – of integrated healthcare organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated...