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 [...]
“Unaccountable”: An Important, Courageous, and Deeply Flawed Book
In his new book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, Johns Hopkins surgeon Marty Makary promises a “powerful, no-nonsense, nonpartisan prescription for reforming our broken health care system.” And he partly delivers, with an insider’s and relatively unvarnished view of many of the flaws in modern hospitals. Underlying [...]
In Today’s JAMA: Abraham Verghese and I Discuss the Changing World of Ward Attendings
Senior attendings like to quip that the medical students seem to be getting younger every year. They’re not. But the attendings on the wards of American teaching hospitals actually have gotten younger. At UCSF Medical Center, for example, about 90% of our ward attending-months are now staffed by hospitalists, about half of them physicians in [...]
Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem
A colleague recently sent me a remarkable video – of Professor Lawrence Weed giving Medical Grand Rounds at Emory University in 1971. It’s fun to watch for many reasons: the packed audience composed mostly of white men in white jackets and narrow ties, the grainy black and white images a nostalgic reminder of Life Before [...]
On Becoming Chair of the ABIM: Why the Board Matters More Than Ever
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 [...]
The US News “Best Hospitals” List: In God We Trust, All Others Must Bring Data
I knew it would happen sooner or later, and earlier this week it finally did. In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and [...]
Today’s Supreme Court Decision: My Two Cents
The United States government, for all its exasperating foibles and silliness, retains the capacity to surprise and even delight. Five years ago, who could have guessed that we would elect a centrist African-American president with a middle name of Hussein. Three years ago, who could have guessed that our deeply divided Congress would pass ambitious [...]
The New and Improved “Understanding Patient Safety” and the Evolution of the Safety Field
Let me get the Shameless Commerce portion of this post out of the way: the second edition of my book, Understanding Patient Safety, was published this month by McGraw-Hill. I hope you’ll consider picking up a copy. That done, I’ll turn to something more interesting: the rapid evolution of the safety field, as seen through [...]
Why the Supreme Court’s Healthcare Decision Will Mean a Lot… and Not So Much
Like waiting outside the Vatican for the puff of white smoke, the nation sits on edge awaiting the Supreme Court’s ruling on the Affordable Care Act. The ruling, which is likely to be announced next week, could toss out the entire healthcare reform bill, chop off one of its limbs (probably the so-called individual mandate), [...]
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