In a “Clinical Problem Solving” session at my annual Hospital Medicine conference last week, I presented a fiendishly hard case to Gurpreet Dhaliwal, a UCSF associate professor of medicine based at our San Francisco V.A. You can imagine how hard this is for the discussant: he’s hearing a case for the first time, absorbing and [...]
Acute Physicians: Hospitalists Bounded by Time and Space
Besides studying patient safety and watching all five seasons of The Wire, my other major goal for my London sabbatical was to understand the way the Brits organize hospital care. Mirroring the U.S. hospitalist movement, a new field—called “acute medicine”— emerged about 15 years ago and became the country’s fastest growing specialty. But there is [...]
Patient Safety in the US and UK, Part II: Top-Down vs. Bottom-Up
In my last post, I discussed the role of physicians in patient safety in the US and UK. Today, I’m going widen the lens to consider how the culture and structure of the two healthcare systems have influenced their safety efforts. What I’ve discovered since arriving in London in June has surprised me, and helped [...]
Patient Safety in the US and UK, Part I: The Doctors
A little more than a decade ago, the patient safety movement hit both the United States and the United Kingdom like twin avalanches. In both countries, high profile cases of medical mistakes led to growing anxiety, and early research outlined the vast scope of the problem and identified some solutions. All this was prelude to [...]
Important Notice For Email Subscribers To Wachter’s World
Dear Readers: Later today, Wachter’s World will get a facelift, as we migrate to a new “platform” (don’t ask me what that means but the good folks at Wiley, and your teenage children, will know). This will make the website more stable, give it better graphics, and prevent it from crashing and blocking comments, as [...]
Summer in London: First Impressions
First of all, let’s get the important stuff out of the way. Mom, I’m fine. Thanks for your concern. Really. I’ve now been in London for about 6 weeks on my sabbatical. The recent riots here are all folks are talking about and the trauma is real. One wonders whether the inevitability of budget cuts, [...]
Hospitalists and Squeezed Balloons
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 [...]
The July Effect: “Don’t Get Sick In July” Is Not An Answer
“Don’t get sick in July!” We’ve all heard patients and family members say this – part declaration, part wishful thinking – in reference to the perceived summertime risks of teaching hospitals. When I hear it, I usually respond with comforting bromides like “robust supervision” and “cream of the crop.” But deep down, if I had [...]
Am I A Socialist?
Am I a socialist? I don’t think so, but I did inch in that direction during the four days I spent in northern Norway last week, visiting the local hospital in Bodø and speaking to about 20 of the nation’s hospital CEOs. Here’s what I learned. First, a word on visiting northern Norway – above [...]
Never Say Never (Events)
Earlier this month, the National Quality Forum released its revised list of “Serious Reportable Events in Healthcare, 2011,” with four new events added to the list. While the NQF no longer refers to this list as “Never Events,” it doesn’t really matter, since everyone else does. And this shorthand has helped make this list, which [...]
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