Information Technology

“What is… Wegener’s Granulomatosis?”

A terrific article in The New York Times Magazine this summer described the decade-long effort on the part of IBM artificial intelligence researchers to build a computer that can beat humans in the game of “Jeopardy!” Since I’m not a computer scientist, their pursuit struck me at first as, well, trivial. But as I read the story, I came to understand that the advance may herald the birth of truly usable artificial intelligence for clinical decision-making. And that is a big deal. I’ve lamented, including in an article in this month’s Health Affairs, on the curious omission of diagnostic errors from the patient safety radar screen. Part of the problem is that diagnostic errors are awfully hard to fix. The best we’ve been able to do is improve information flow to try to prevent handoff errors, and teach ourselves to perform meta-cognition: that is, we can think about our own…

What’s Behind Today’s Primary Care Crisis: You Don’t Know the Half of It

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.In today’s issue of the New England Journal of Medicine, internist Rich Baron chronicles the work of his 5-person Philadelphia office practice during the 2008 calendar year. Rather than “Why am I not losing weight?”, Rich’s study aims to answer the question, “Why does my work day feel so bad?” The answer: an enormous amount of metaphorical snacking between meals. In the NEJM study, Rich (who is a dear friend – we served together on the ABIM board for several years) found that each of the physicians in his practice conducted 18 patient visits per day (a total of 16,640 visits over the year for…

Verb-alizing

One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.” Say whaa?I’m pretty sure that the most valuable thing I’ve done in my 15 years running UCSF’s inpatient service has been to convince the hospital to hire a discharge scheduler, Yolanda Jones, a delightful woman with a big smile and the world’s most thankless job. When a patient is ready for discharge, the interns send Yolanda a note with a list of follow-up appointments, radiology studies, and other outpatient tests that need to be scheduled. She makes all the appointments, then calls the patient and intern with the info. Our…

Substituting Coffee Cake for Journal Articles: Another Unforeseen Consequence of IT

Late February is the pits for interns – the novelty of being a real-live MD is long gone, and the rebirth of residency is too far beyond the horizon to see. The other day, my wonderful resident Anna brought a coffee cake to my ward team's post-call rounds, partly to psych up the troops. This triggered a funny set of memories, memories of how residents showed their love for their interns and students during my training era, the 1980s. We handed them journal articles! For those of you whose academic mother’s milk is Google Scholar and UpToDate, let me tell you how this went, back in The Day. After receiving our copies of the major journals in the mail (remember mail?), conscientious residents would tear out the full articles that were “keepers,” placing them in manila folders in the ugly steel filing cabinets we all owned. For other articles that…

Why I Refused to Let Our Medical Grand Rounds Die Off

Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected response. Talmadge and I looked at each other with equally stunned faces, but for another reason. Nearly simultaneously, we said, “How the hell did they get 250 people to come to Medical Grand Rounds?!” Grand Rounds has a storied tradition in medicine, dating back to Osler’s case presentations at Johns Hopkins, where real patients were wheeled into the lecture hall to be interviewed and discussed by The Professor. And the iconic Surgical Grand Rounds, where audiences, seated in an amphitheater above the OR, actually…
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