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 writing so lyrical and memorable. Whether you write ...

A couple of weeks ago, I had the chance to visit Tokyo and Singapore – the former to speak at a conference on “Training of the Generalist Physician,” and the latter as visiting professor at Singapore General Hospital. Today: some observations on the medical scene in Japan; tomorrow, the same viz Singapore. The Tokyo conference was the brainchild ...

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites. Although we hated to be skunks at ...

Sticking with my recent hand hygiene theme, an interesting study came out last week demonstrating that outpatients were willing to help audit their providers’ hand hygiene practices. The patients felt that snooping on their docs didn’t poison the physician-patient relationship. Moreover, their observations were accurate and the program was dirt ...

If for some reason you haven't gotten enough of me on Wachter's World, I just did a long, fun interview with Matthew Holt on the always-interesting THCB. We cover patient safety, the future of IT, the demise of primary care, Death Panels, and more. I began the interview an optimist and finished it a pessimist, as I reflected on the ongoing ...

I like readmissions. Well, that didn’t come out quite right, did it? What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions, thereby improving quality and lowering costs. And compared to mortality (the other hot outcome measure), the need for ...

My father, who celebrated his 79th birthday yesterday, is many things: eccentric, nearly deaf (though he attributes this to my mom being a “low talker”), hilarious, crotchety, and a true mensch. But he’s neither incontinent nor impotent. It might have been otherwise. Like most men over 50, he began having yearly PSAs checked about 20 years ago, ...

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin? What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite ...

I recently heard from a UCSF physician who was flabbergasted when he sought an appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived. I’ve written about the roots of the problem previously, and won’t ...

I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between units. One of my colleagues, quite sensibly, asked, “but who will be accountable for that?” ...