I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do [...]
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Pay for Performance in Healthcare: Do We Need Less, More, or Different?
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical. Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that it doesn’t. We’ve [...]
Denying Reality About Bad Prognoses: Not a Benign Problem
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 [...]
Gregory House, MD, RIP
The final episode of the show House, MD airs on FOX tonite. I wrote the following op-ed piece for USA Today; it’ll appear there tomorrow morning and is reproduced here with permission. Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the [...]
Digital Distractions: Time for a Diet
It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must [...]
Saying “No” While Being NICE
A wise man once quipped that saying that we may need to ration healthcare is like saying that we may need to respect the laws of gravity. In other words, when societies have more healthcare needs and wants than resources (and all societies do), rationing is inevitable. The question of how to ration used to [...]
Rip Van Doctor: Observations On An Academic Medical Service After A Ten-Year Absence
Cindy Fenton is one of the best doctors I know, a superb clinician-educator who was directing the UCSF Department of Medicine’s educational programs when, in 2001, she stepped off the academic treadmill to raise her three children. With her youngest now in first grade, I recently managed to coax her back into clinical medicine. In [...]
“If There’s a Doctor on Board, Please Ring Your Call Button”
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 out: “If there’s a doctor on board, please ring your call button!” If you’re old enough to remember [...]
Atul Gawande and the Art of Medical Writing
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 techniques Gawande uses to make his [...]
Dr. Rand Paul: Not All Board Certifications Are Created Equal
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 [...]
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