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I left a pharma-sponsored research project. My reasons for doing so may be instructive.

  Not long back, I departed a pharma-sponsored research project.  I based my decision to leave in something I occasioned over a decade ago.  I thought it was time to share the episode and the lessons learned given the attention being paid to physician conflict of interest nowadays (as well as the annual Open Payments review and dispute period approaching). When I finished training, very few docs practiced hospital medicine—or even knew what the term hospitalist meant.  Several forward-thinking medical centers hitched their wagons to the hospitalist model, as did some astute information technology and staffing companies. However, few healthcare players embraced the hospitalist movement in a serious fashion like the pharmaceutical industry.  They realized hospitalists prescribed a narrow band of products, in big lots, within a centralized location.  The higher ups in the pharma sector saw the benefits in directing reps our way. Consistent with those goals, a physician…

Recidivism

  You might wonder why “recidivism” in the subject line. In the context of readmissions, the word comes up often—and in particular, those who cycle from shelters to the street to the ER. Rinse. Repeat.  I focus on the Northeast, but my guess is your regional experience is like mine. You have noticed over the last two to three years, big cities, and NYC in particular, have seen a marked uptick in the number of people sleeping on the sidewalks. The causes of the increase stem from budget cuts, the economy and myriad other factors you can probably surmise. (more…)

Maintaining Balance

I’m not much for New Year’s resolutions. They seem to be too easy to break and lead to disappointment. But my birthday and New Year’s are close together, and they do provide convenient markers to reflect on life, health, and balance. Every day I round in the hospital I find myself discussing healthy lifestyle habits with my patients. Take time to exercise. Eat healthier and eat fewer processed foods. Drink more water. Cut back on the caffeine, alcohol, and soda. Try to control portion size on your plate.   Slow down. Reduce stress. Do as I say, not as I do. When working on the wards, nearly every one of these recommendations go out the window.   Busy days go like this: I get to the hospital too early to do a morning work-out (at least, I don’t pull myself out of bed early enough). Once I’m off and running, I have…

Book Review: When Breath Becomes Air

by Christopher Moriates, MD
by Chris Moriates, MD Paul Kalanithi was a neurosurgeon and writer. He was not a neurosurgeon who just so happened to write. And he was certainly not a writer who just so happened to perform craniotomies. He spent a life devoted to developing both sides of his brain – exercising them rigorously, never letting one side atrophy from the other, like one may perform an even number of arm curls in the gym – resulting in a remarkable mastery of both the literary and the scientific. What a rare and precious gift. You could easily turn to his many impressive credentials, degrees, and awards that prove this dual mastery, or you could simply just read the first few pages of his book, When Breath Becomes Air (Random House, January 2016). In case you don’t know, the past tense is because Kalanithi died this past year. At the age of 37.…
Christopher Moriates, MD is a hospitalist and assistant professor at the University of California at San Francisco, Director of the Caring Wisely program for the UCSF Center for Healthcare Value and Director of Implementation Initiatives at Costs of Care. He co-authored the book Understanding Value-Based Healthcare (McGraw-Hill, 2015), which Atul Gawande has called “a masterful primer for all clinicians,” and Bob Wachter said is “essential reading for everyone who care about making our system better.” This post is part of a series for The Hospitalist highlighting topics or lessons from this book.

A “Never Event” Happened to My Family Member. Don’t Let It Happen to You.

It is odd being on the other end of the doctor/patient interaction and having a surgeon calling me in the middle of the night apologizing for a mistake. I was scared and then I started to feel anger creeping in. How could this happen? Swiss cheese models and checklists danced in my brain. The analytical part of me was appreciative of the straight-forward manner the surgeon spoke to me, holding nothing back and owning up to the mistake, telling me the hospital would be investigating and assuring me that my family would incur no costs due to the error. He had performed an unnecessary abdominal surgery, a Never Event in the lexicon of patient safety. As you may know, Never Events are loosely defined as events that should never happen. The history of Never Events is rooted in the patient safety and quality revolution of the last two decades. In 1999 the Institute of Medicine produced…