Posts by Bob Wachter

Crowdsourcing My New Book on How Computerization is Changing the Practice of Medicine in Surprising Ways

I have been in blog-silence mode of late, for which I am sorry. Rumors that I’ve taken my Elton John act on the road are, I’m pleased to assure you, incorrect. [caption id="attachment_2406" align="alignleft" width="240"] 7 yr old's depiction of MD visit (Toll, JAMA 2012)[/caption] Instead, I’ve been hard at work on my new book, tentatively titled “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.” I’m about one-third finished, and am on my way to Boston for a six-month sabbatical at the Harvard School of Public Health to keep working on it. This is the most journalistic book I’ve ever attempted. I’ve already completed about 25 interviews for the book, and will do about 30 more by the time I’m done. And they have all been fascinating. It seems a shame to leave so much great stuff on the cutting room floor. So for…

Hospitalist Potpourri

I’m just back from the annual meeting of the Society of Hospital Medicine and, as usual, I was blown away. I’ve not seen a medical society meeting that is remotely like it. As Win Whitcomb, who co-founded SHM, wrote to me, the meeting is “a mix of love, deep sense of purpose, community, mission, changing-the world, and just plain sizzle,” and I completely agree. I was also amazed by the size: having hosted the first hospitalist meeting in 1997, with about 100 people, seeing an audience of 3,600 fill a Las Vegas mega-ballroom was just plain awesome. This enthusiasm did not equal smugness. Folks know that change is the order of the day, and with it will come upheaval and some unpleasantness. But the general attitude I sensed at the meeting was that change is likelier to be good for patients – and for the specialty – than bad. Whether…

Patient Safety’s First Scandal: The Sad Case of Chuck Denham, CareFusion, and the NQF

In retrospect – always in retrospect – it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right. In a remarkable number of cases of medical errors, it’s clear – again, in retrospect – that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want to be branded a troublemaker by speaking up…. Part of the work of patient safety has been to alert us to this risk, to get us to trust our internal “spidey-sense.” When something seems wrong, we tell front-line clinicians, speak up! It’s fitting, then, that the first major scandal in the world of patient safety has a similar subtext. The scandal, which broke two weeks ago, involves a $40 million fine levied by the Department of Justice against a…

Global Health Hospitalists: Strange but Noble Bedfellows

As my Division of Hospital Medicine has grown – now to about 60 faculty – I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretsky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently. The story of how we became the nation’s leading program for “global health hospitalists” is a very different tale. I’ve just returned from visiting our program in Haiti with three of our faculty members and two fellows, and so it seems like a good time to tell this story. Since we created our hospitalist program nearly two decades ago, we’ve pushed our faculty to find an area of interest beyond their clinical work. (Our former chair Lee Goldman, a cardiologist, dubbed these areas “diastole” and the name has stuck.) This has been…

Lights, Camera, Action… In Healthcare

About eight years ago I was desperate to improve my golf game. I just couldn’t straighten out my drives or hit my irons crisply. (Yes, I’m fully aware that this is a First World problem). I decided to try golf camp in Palm Springs for a few days. My sensei, a crusty ex-touring pro named Artie McNickle, watched me hit several dozen balls on the driving range, video recorder running. “So, did you figure it out?” I asked with hint of sarcasm after my last shot. I thought I was a hard case. “Sure.” “How long did it take you?” I asked. “One or two swings. But you looked like you were having a good time, so I didn’t have the heart to stop you.” Artie patiently told me what I was doing wrong. Though it made sense in theory, when I tried to follow his directions, I didn’t get…