Patient Safety

My Interview With Health Policy Expert Mark Smith

Mark Smith, MD, MBA, was the founding CEO of the California HealthCare Foundation; he served in that role for 17 years before stepping down last year. I’ve known Mark since we were residents together at UCSF in the mid-1980s, and both of us were influenced by training at the epicenter of the AIDS epidemic. Mark continues to see AIDS patients at San Francisco General Hospital one day each week. He was the lead author of Best Care at Lower Cost, a major Institute of Medicine report, published in 2012. Mark is one of those rare people who can take complex and politically charged concepts and distill them into sensible nuggets – while managing to be hilarious and profound at the same time. In the continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are…

Crowdsourcing My New Book on How Computerization is Changing the Practice of Medicine in Surprising Ways

I have been in blog-silence mode of late, for which I am sorry. Rumors that I’ve taken my Elton John act on the road are, I’m pleased to assure you, incorrect. [caption id="attachment_2406" align="alignleft" width="240"] 7 yr old's depiction of MD visit (Toll, JAMA 2012)[/caption] Instead, I’ve been hard at work on my new book, tentatively titled “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.” I’m about one-third finished, and am on my way to Boston for a six-month sabbatical at the Harvard School of Public Health to keep working on it. This is the most journalistic book I’ve ever attempted. I’ve already completed about 25 interviews for the book, and will do about 30 more by the time I’m done. And they have all been fascinating. It seems a shame to leave so much great stuff on the cutting room floor. So for…

Patient Safety’s First Scandal: The Sad Case of Chuck Denham, CareFusion, and the NQF

In retrospect – always in retrospect – it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right. In a remarkable number of cases of medical errors, it’s clear – again, in retrospect – that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want to be branded a troublemaker by speaking up…. Part of the work of patient safety has been to alert us to this risk, to get us to trust our internal “spidey-sense.” When something seems wrong, we tell front-line clinicians, speak up! It’s fitting, then, that the first major scandal in the world of patient safety has a similar subtext. The scandal, which broke two weeks ago, involves a $40 million fine levied by the Department of Justice against a…

Lights, Camera, Action… In Healthcare

About eight years ago I was desperate to improve my golf game. I just couldn’t straighten out my drives or hit my irons crisply. (Yes, I’m fully aware that this is a First World problem). I decided to try golf camp in Palm Springs for a few days. My sensei, a crusty ex-touring pro named Artie McNickle, watched me hit several dozen balls on the driving range, video recorder running. “So, did you figure it out?” I asked with hint of sarcasm after my last shot. I thought I was a hard case. “Sure.” “How long did it take you?” I asked. “One or two swings. But you looked like you were having a good time, so I didn’t have the heart to stop you.” Artie patiently told me what I was doing wrong. Though it made sense in theory, when I tried to follow his directions, I didn’t get…

Diagnostic Errors: Central to Patient Safety, Yet Still In the Periphery of Safety’s Radar Screen

In 2008, I gave the keynote address at the first “Diagnostic Errors in Medicine” conference, sponsored by the Agency for Healthcare Research and Quality (AHRQ). The meeting was filled with people from a wide variety of disciplines, including clinical medicine, education, risk management, cognitive science, and informatics, all passionate about making diagnosis safer. The atmosphere was electric. My lecture was entitled, “Why diagnostic errors don't get any respect” (I wrote up the speech in my blog and a Health Affairs article, shown) My talk was, admittedly, a downer. Highlighting the fact that diagnostic errors are arguably the most important patient safety hazard (they accounted for 17% of the adverse events in the famous Harvard Medical Practice Study and are usually the number one cause of harm in malpractice cases), I pointed out that from the very start of the patient safety field, relatively little attention had been paid to them.…
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