Well, it happened again. Last Thursday evening, I was somewhere over Saskatchewan, returning from a lovely Mediterranean cruise, in that uncomfortable semi-conscious state that passes for sleep when you’re flying coach, when the airplane’s PA system rang...

Don’t read this. That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog.But if you can spare a little time, I’ll be focusing on some of the...

I thought I was an oddball in college. I've only recently learned that I was avant-garde.Right before beginning college in 1975, I decided I wanted to be a doctor. Being the first-born son – with decent SATs – of an upwardly mobile Long Island Jewish...

Early on, many social movements depend on a charismatic leader to focus attention, build a burning platform, and inspire people to action. You know when the movement has made it when it no longer needs such a leader for fuel.The safety and quality movements...

The recess appointment of Don Berwick to lead CMS can be seen as a cynical act of political opportunism, sidestepping the Congressional approval process using a tactic worthy of Machiavelli, or Karl Rove. Or it can be viewed as a pragmatic decision by...

After serving on the board of the American Board of Internal Medicine for the past few years, I’ve come to truly appreciate the value of board certification in demonstrating – and enhancing – our competence and commitment to professionalism. But not all...

One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?A few moments ago in the on-line version of the New England...

This is an amazing tale of leadership – by my hospital CEO, our former chancellor, and, most importantly, a remarkable philanthropist. I’ll start with the latter, veer off to describe the former two, and then return, on this special day, to the philanthropist.The...

It’s that time again – here’s the brochure and course information for the Management of the Hospitalized Patient (MHP) conference, October 14-16 at the Fairmont Hotel in beautiful, fog-free (at least in October) San Francisco.This will be our 14th annual...

As a member of the executive committee of the American Board of Internal Medicine, I can’t provide too much of the inside scoop, so I’ll mainly point you to the published descriptions of a remarkable case: that of one Dr. Arora, who ran an ABIM board...

This past Monday was a sad night for me: no “24” on Fox, and no more installments in the works until the (inevitably disappointing) movie comes out. Watching Jack Bauer's derring-do with my sons has been one of my can’t-miss-it rituals for nearly a decade....

You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness. The piece, written by the Times’ Jane Gross, profiled...

Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I...

A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb. A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t...

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.In...

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors,...

I vividly recall attending a faculty meeting at San Francisco General Hospital in the mid-1990s, soon after I joined the UCSF faculty. Our late, great chief of medicine Merle Sande was chronicling all the recent and predicted changes in the healthcare...

A quick note of thanks: The annual list of the "50 Most Powerful Physician Executives in the U.S." was released today by Modern Healthcare magazine, and yours truly clocks in at number 10, just behind the Surgeon General and the heads of the NIH, CDC,...

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical...

The Blogosphere Rumor Factory is heating up with reports that Don Berwick, the world’s most prominent advocate for healthcare quality and safety, will be the next administrator of the Centers for Medicare & Medicaid Services (CMS). (Take this with...

Heading into the final weekend of Mr. Toad’s Wild Ride, who could have guessed that in a year that brought us Death Panels, Pickup Trucks, “You Lie”, The Cornhusker Compromise, Bart Stupak (boy, that must have been a tough name to grow up with), and the...

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...