Bob’s Biases

Although my tombstone may well say (on front and back), “he saw both sides of every issue,” I do have some biases that you might want to be aware of.

First, the traditional ones. I’m past-chair of the American Board of Internal Medicine (ABIM), which certifies internal medicine physicians, and am a past president of the Society of Hospital Medicine (SHM). I receive significant funding from the Agency for Healthcare Research and Quality (AHRQ) to edit two patient safety websites. SHM, working with its publishing partner Wiley, is hosting and promoting this blog (for which I am grateful), but the Society has no editorial control, including no pre-post peeks – the opinions expressed in this blog are mine alone.

I presently have (or have had in the past two years) relationships with a few companies: IPC (I have helped to run a leadership development course for their practice group leaders for the last several years, and joined the company’s board in August, 2013), QuantiaMD (I’ve developed several educational modules on patient safety); I’m also on the scientific advisory boards of four companies: PatientSafe Solutions, CRISI, SmartDose, and EarlySense. If I have anything to say that relates to the products of these companies, I’ll remind you of these relationships. I am compensated for all of these corporate relationships, the money paid to the University of California. Assuming I’m in good standing at UCSF, I keep about 80 percent of it, the university keeps 20 percent to support its academic mission.

Perhaps more importantly, I harbor these more subtle biases:

  • I believe that most clinicians and administrators are in the field for the right reasons and are well trained, work hard, and generally do wonderful, often miraculous, things.
  • I also believe that the quality and safety of American healthcare are often embarrassingly poor – all-the-more remarkable when you realize that we spend one out of six dollars on medical care.
  • I believe that the costs of healthcare are bankrupting many businesses and governments, and that they must be controlled. But I understand how tricky this will be (for many reasons, not the least of which is that one person’s waste is another person’s mortgage payment).
  • I believe that we will lurch – with lots of missteps – toward value-based purchasing, and the winning hospitals, physicians, and organizational models will be those that can produce the highest quality and safest care at the lowest cost. Without minimizing the challenges, I think this is the right way to go.
  • I believe our priorities are out of whack. It’s a disgrace that we deliver palliative chemotherapy to 90-year-olds and non-evidence-based surgeries or procedures at staggering costs while not providing universal healthcare insurance and decent access to primary care, housing the homeless, or fixing the public schools.

Politically, as you might have guessed, I see myself as a pragmatic Democrat, a bit to the left of center for the United States, which places me slightly to the right of center in my hometown of San Francisco. For you New York Times readers, I’m more Tom Friedman than Paul Krugman or Bob Herbert.