There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians. “Obs status” began life as Medicare’s way of characterizing those patients who needed a little more […]
I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate. “The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get […]
Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare. Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the […]
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 […]
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 […]
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 […]
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 […]
During my med school psychiatry rotation, I was taught not to shy away from discussing suicide with a depressed patient. “You won’t be suggesting something they haven’t thought about,” my professor told me back in 1982. “By not raising it, you add to the sense of stigma and it just becomes the elephant in the […]
I began thinking about – and yes, advocating for – the concept of hospitalists in the mid-1990s, when I became convinced that having separate inpatient and outpatient physicians would improve the quality, safety, and efficiency of healthcare. A study in today’s Annals of Internal Medicine reports that, while hospitalists did cut hospital lengths of stay […]
At the Society of Hospital Medicine’s annual meeting last week in Dallas, Lenny Feldman of Johns Hopkins presented the results of a neat little study. His hypothesis: physicians given information about the costs of their laboratory tests would order fewer of them. Feldman randomized 62 tests either to be displayed per usual on the computerized […]
- Lights, Camera, Action… In Healthcare October 19, 2013
- Diagnostic Errors: Central to Patient Safety, Yet Still In the Periphery of Safety’s Radar Screen October 9, 2013
- #MomInHospital August 17, 2013
- Medicare’s Most Maddening Policy… and Why CMS’s Attempts to Improve It May Make it Worse July 31, 2013
- william reichert: A very important point. In my experience the stuff...
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- Ronald HIrsch, MD: Dr Wachter- I'll be at UC Davis and Dameron Hospi...