Ambulatory/Primary Care

The Long Awaited Crisis in Primary Care: It’s Heeere!

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 restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show's website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.First, it is true – MGH is not accepting any new primary care patients.…

Google Health: A View From the Inside

Google Health launched on Monday, which sent the world’s Google-watchers into a tizzy. I serve on Google Health's Advisory Council – which met all day Tuesday – and so here’s a bit of inside dish, along with my impressions of the site and the company.FYI, my work on the Council is covered by a Non-Disclosure Agreement, so I won’t reveal anything that isn’t publicly known regarding Google’s products or intentions. Also, in the interest of full disclosure, you should know that I am compensated for my Google service. (No stock options, darn it.) With that as background, here’s the scoop. Google began working on its version of the personal health record a couple of years ago, after the company realized that a remarkably high percentage of searches were for health information (I know, if that’s going to be how priorities are set, you’re wondering if Google Sex is next). Google…

Can Medical Errors Be Funny? You Betcha.

All medical mistakes are problematic. A few are truly tragic. But every now and then, a medical error comes along that is downright hilarious. From AHRQ WebM&M, the case-based Web journal I edit for the federal government, here are two of the latter kind. They are a hoot.We published the first about three years ago and called it “Allergy to Holter”:A 52-year-old man was admitted for palpitations and chest pain. As part of the evaluation, on hospital day 4 the patient was sent to the cardiac clinic to start a continuous recording of his electrocardiogram via Holter monitor.Since the patient was ambulatory and had gone for other tests on his own, he was told to go to the cardiology clinic for a check-up of his heart rhythm. He was handed a "Request for Consultation" form, on which there was only one word: "Holter." The form did not state the patient's…

Fixing Fumbled Handoffs

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?”  “Exactly!” I said. “You’ve put your finger on why we stink at handoffs. If transitional glitches were measured, and if botching them carried consequences, every hospital in the country would identify an accountable person in a nanosecond.”Get ready to clear out the corner office of the C-Suite for the Chief Transitions Officer.Although we’re not very good at washing our hands, we are terrific at washing our hands of patients who leave our medical radar screens. Just consider these scary facts:Half of all medical patients experience at least one error in the post-discharge…

Today’s New England Journal Hospitalist Study

Today my pals Peter Lindenauer and Andy Auerbach (and colleagues) published the largest hospitalist outcomes study to date, in the New England Journal of Medicine. It is a rigorous, important piece of work. Let me try to add a bit of context.First, the What’s What. Using the massive database of the Premier system (which Peter has mined to tremendous advantage, such as in this study and this one), they compared the hospitalizations of nearly 80,000 adult inpatients with 7 disorders at 45 hospitals. They chose these disorders (things like pneumonia, CHF, and COPD) because they are common and are cared for by hospitalists, general internists, and family physicians. They found that hospitalists had a length of stay 0.4 days below that of non-hospitalists, a 12 percent reduction that was highly significant. Patients cared for by hospitalists also had lower hospital costs ($268 lower than internists, $125 lower than FPs); this…
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