Posts by Bob Wachter

Announcing This Year’s Hospital Medicine CME Course – With a Keynote by Captain Sully!

A quick note to let you know about my 13th annual Hospital Medicine CME course, September 24-26 at the Fairmont Hotel in SF. The big news this year is the keynote speaker: Captain Chesley “Sully” Sullenberger, the pilot who landed US Airways Flight 1549 in the Hudson River.Many folks have asked me how I managed to line up Captain Sully for the conference. Here’s the story: As soon as CNN reported the miracle "Landing on the Hudson," they flashed Sully’s now-familiar picture and described him as living in the Bay Area and being involved in training people from other industries about safety and reliability. A quick Google search found a company named “Safety Reliability Methods” of Danville, CA; its website included an email address for the company’s principal, Captain Sullenberger. His description on the web read:Recognized pioneer and expert in Safety, High Performance, High Reliability, Leadership and Culture Change.  Airline…

A Remarkable Interview: Obama on Healthcare

I hope you had a chance to read David Leonhardt’s interview with President Obama in last Sunday’s NY Times Magazine. The feel was that of hanging out with two really smart friends discussing the issues of the day over beers. What a treat! In addition to Obama’s intelligence and forthrightness (with the exception of one dollop of purposeful disingenuousness, which I’ll get to later), I was floored by his personal knowledge of and passion for healthcare issues – particularly the increasingly contentious comparative effectiveness question (by the way, this week’s NEJM had several excellent pieces on CE – here, here and here).In reading the interview, it was obvious that B.O. knows healthcare. In addition to his personal experiences caring for sick family members, Michelle’s job before becoming First Lady was VP for Community Affairs at the University of Chicago Hospitals. And Barak’s best pal is my old UCSF resident Eric…

Welcoming UCSF’s New Chancellor, My Friend Sue Desmond-Hellmann

Reunions are fun, but they can make you feel old. I remember strolling around Penn’s campus for my 25th reunion, and seeing several buildings named for people I knew in college. Wow, I thought, that’s when you know you’re ancient.Another way is when the chancellor of your university – the senior official at UCSF – was your chief resident. Despite the exaggerated creakiness that I'm feeling in my bones, I’m thrilled that a few hours ago, University of California President Mark Yudof named Sue Desmond-Hellmann to be UCSF’s next chancellor, succeeding Nobel Prize winner Mike Bishop, who is retiring.Sue was a resident, chief resident, heme-onc fellow, and junior faculty member at UCSF in the 1980s and early 90s. After a brief stint at Bristol-Myers Squibb, in 1995 she joined Genentech, the South San Francisco biotech giant founded in the 70s by UCSF’s Herb Boyer and venture capitalist Robert Swanson. Although…

Hilarious Medical Transcription Snafus: My Faves and Yours

This is my 100th blog posting, so it seemed like a good time to get a bit frivolous. The NY Times recently ran a front page story about websites that collect user-submitted triviata – such as “Pets Who Want to Kill Themselves” (pictures of bulldogs wearing bunny ears or cocker spaniels in Yoda costumes) – and are later repurposed into bestselling books. Just as I was thinking about that, I happened upon a medical chart with one of the funniest dictation snafus I’d ever seen, and I got to thinking… Every doc knows that transcripts of medical dictations can be glitchy. After all, we do them in the car, or with Colbert on in the background, or frantically between patient encounters. We talk a mile-a-minute, and our word salad is chock-full of obscure medical terms. The transcriptionists charged with making sense of it all vary in skill and experience; these…

On Quality Measurement, Babies, and Bathwater

Quality Measurement mavens are reeling these days, as a result of the air being let out of high-profile measures such as tight glucose control, door-to-antibiotic time, and beta-blockers. Some critics have even suggested that we put a moratorium on new quality measures until the science improves.I hope we don't. I think we’re seeing a natural, and fairly predictable, ebb and flow, and our reaction – even to these significant setbacks – should be thoughtful and measured. Here's why:The publication of the IOM’s Quality Chasm report (and McGlynn's findings that we adhere to evidence-based practice about half the time) generated intense pressure to launch transparency and pay-for-performance initiatives. Finding virtually no outcome measures ready for prime time (the data collection burden was too large and the science of case-mix adjustment too immature), policymakers and payers logically looked to process measures (aspirin, ACE inhibitors, pneumovax) for common diseases (MI, CHF, pneumonia), delivered…
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