Ambulatory/Primary Care

A Week in Asia: Today, Japan; Tomorrow, Singapore

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 of Dr. Shigeaki Hinohara, chairman of the board of St. Luke’s International Hospital, one of Japan’s finest. Dr. Hirohara gave the opening address, speaking thoughtfully for 15 minutes, rarely glancing at his notes. He walked slowly and was a bit stooped – I guessed he was in his early 80s. Not exactly – he’ll celebrate his 100th birthday in two years! A brief aside about Dr. Hinohara… after meeting him, I came to learn that he may well be the most prominent physician in Japan – Dean Ornish, Mehmet Oz, and Zelig rolled…

Is Healthcare IT Ready for its Big Coming Out Party?

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 the IT party, we felt that the facts spoke for themselves. While decent computerized provider order entry (CPOE) systems did catch significant numbers of prescribing errors, we found no studies documenting improved hard outcomes (death, morbidity). More concerning, virtually all the research touting the benefits of HIT was conducted on a handful of home-grown systems (most notably, by David Bates’s superb group at Brigham and Women’s Hospital), leaving us concerned about the paucity of evidence that a vendor-developed system airlifted into a hospital would make the world a better place.Since…

Can Patients Help Ensure Their Own Safety? More Importantly, Why Should They Have To?

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 (probably the wrong word) cheap, less than a quarter per observation.This study falls under the broad umbrella of: “What can patients do to ensure their own safety?” Because this is the safety-related question that I’m most commonly asked by media and the public, I’ve given it quite a bit of thought.I've found it tricky to formulate a pithy response to this question, since the obvious and PC answer (a full-throated endorsement of patient and/or familial hyper-vigilance) is probably wrong. Surely, the ethical virtues of an informed and participatory patient or family are unassailable. And, from a patient safety perspective, an…

An Overlooked but Dangerous Handoff… of One Million Patients at a Time

A quick heads up on an article written by a very talented UCSF psychiatrist named John Young, which I had the opportunity to co-author. John observed that, despite all the recent literature about handoffs (such as here and here), no one has given much thought to the Mother of all Handoffs: the transition of outpatient panels from graduating residents to brand new interns that happens around July 1st every year.In the article, in this week’s JAMA, we point out that the “year-end handoff” carries a number of additional risks above and beyond the usual threat of fumbles. For example,Most handoffs involve two providers of comparable knowledge and experience. The year-end handoff involves a handoff from a seasoned expert (the graduating resident) to a novice (the brand new intern, who was a med student a week earlier);The volume is huge: for an individual resident, the handoff may involve as many as…

My Interview on The Health Care Blog

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 debate over healthcare reform.  If you have a little time (it's about 35 minutes), check it out here!
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