Wachter's World

Berwick, Pronovost, and the Non-Scalability of Charisma

2010-07-23T16:10:00Z

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 have picked up tremendous steam over the past decade, but they haven’t yet hit that self-sustaining tipping point. Last week, there were two things that reminded me of this: the announcement of a new leader of the Institute for Healthcare Improvement...(read more)

Why Obama Made the Right Call on Berwick

2010-07-08T17:25:00Z

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 Obama to avoid a lengthy and exasperating re-litigation of the healthcare reform debate. Death Panels. Been there, done that. So I'm going with Choice #2.The right side of the blogosphere has erupted, painting Berwick as an effete academic who would...(read more)

Dr. Rand Paul: Not All Board Certifications Are Created Equal

2010-06-24T20:33:00Z

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 boards are created equal: the ABIM, like all the members of the American Board of Medical Specialties (ABMS), is frequently challenged by organizations that call themselves boards and offer “certification” but whose rigor is questionable. This is...(read more)

Today’s Big ACGME and Joint Commission Announcements: The Courage To – and Not To – Change

2010-06-23T18:18:00Z

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 Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the Joint Commission (TJC) and the Accreditation Council for Graduate Medical Education (ACGME) – announced bold new policies. To their credit, both organizations...(read more)

UCSF Benioff Children’s Hospital: A Tale of Great Leadership in Three Acts

2010-06-17T07:33:00Z

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 first time I met Marc Benioff – in 2007 – he was not a happy guy. A adult relative of his was hospitalized at UCSF, night had fallen, and Benioff – the billionaire founder of cloud computing pioneer Salesforce.com – was growing concerned...(read more)

Announcing This Year’s UCSF Hospital Medicine CME Course and Hospitalist Mini-College

2010-06-14T15:57:00Z

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 hospital medicine conference; the first, attended by about 100 hardy hospitalist pioneers and a few homeless folks wandering into a seedy downtown Holiday Inn, launched the National Association of Inpatient Physicians (which later became the Society...(read more)

Cheating on the ABIM Boards

2010-06-12T06:39:00Z

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 review course with a difference. The difference was that attendees of the Arora Board Review were allegedly shown actual questions from past exams, fed to Dr. A from prior test takers – who shared dozens, and, in some cases, hundreds of questions. After...(read more)

Dave Barry On “24” And Our Healthcare System

2010-06-02T21:48:00Z

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. I’m well aware that this cannot have been healthy, or moral, but it was exciting and, at times, awfully amusing.Over the last several years, one of the best parts of watching “24” was following along with Dave Barry’s “24 Blog”. Barry is one of...(read more)

The Times Hits the Right Notes on Hospitalists

2010-05-28T07:05:00Z

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 Dr. Subha Airan-Javia, a young hospitalist at the Hospital of the University of Pennsylvania. While Dr. Airan-Javia spends about half of her time in administrative, largely IT-related roles (like many of my faculty), the article (and an accompanying...(read more)

In Defense of Paul Levy

2010-05-24T06:07:00Z

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 now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and – while the episode represents a lapse in judgment that deserves censure – he should not lose his job. Let’s start with some background. Paul took the helm...(read more)

Badness in Baltimore: Can Peer Review Catch Rogue Doctors?

2010-05-11T05:42:00Z

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 need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual blockage was trivial – more like 10 percent.Disgusting, I thought… if the reports...(read more)

What's Behind Today's Primary Care Crisis: You Don't Know the Half of It

2010-04-28T09:00:00Z

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 today’s issue of the New England Journal of Medicine, internist Rich Baron chronicles the work of his 5-person Philadelphia office practice during the 2008 calendar year. Rather than “Why am I not losing weight?”, Rich’s study aims to answer the...(read more)

The New Joint Commission: Much Improved, With Room for More

2010-04-23T05:06:00Z

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, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the medications, and the floors were slippery as hell). After arriving, the inspectors spent most...(read more)

Hope for the Future: The Society of Hospital Medicine’s Annual Meeting

2010-04-17T10:13:00Z

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 landscape: managed care, more transparency, new regulations, and more. The meeting turned glum; we were not a change-oriented crowd, and this was a lot to swallow. When Mel Cheitlin, a beloved senior cardiologist, took the floor, everyone hushed – Mel...(read more)

#10

2010-04-13T03:37:00Z

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, FDA, AHRQ, and Joint Commission. In fact, #10 makes me the top ranked academic physician on the list... and, more importantly, the top blogger! While I assume that my family (particularly the folks in Boca) voted early and often, I’m certain that the...(read more)