Pharmacists

Saying “No” While Being NICE

A wise man once quipped that saying that we may need to ration healthcare is like saying that we may need to respect the laws of gravity. In other words, when societies have more healthcare needs and wants than resources (and all societies do), rationing is inevitable. The question of how to ration used to be the stuff of academic parlor discussions between health policy wonks and ethicists. But it now occupies center stage in the schoolyard brawl that passes for political discourse in today's America. Exhibit A, of course, was Sarah Palin's fear-mongering over “Death Panels.” Exhibit B: the Right's christening of Don Berwick as "Rationer-in-Chief" (and a communist, for good measure) because he had once expressed his admiration for the British National Health Service. At IHI last week, a newly unplugged Berwick -- fresh from his resignation as Medicare chief -- spoke passionately of solving our healthcare cost…

Leaders and Leadership in Hospital Medicine: The Story Behind the IPC-UCSF Fellowship

This is a tale of leaders and leadership. And about keeping an open mind. I first met Adam Singer in 1996, when the hospitalist field still had its training wheels on. A pulmonary/critical care physician by training, Adam had become a physician-entrepreneur and was now focused on making his new enterprise, IPC, the nation’s preeminent hospitalist company. I found him engaging and energetic, but also brash and opinionated. He had strong views—on how hospitalists should be organized, what the field’s professional society should be doing, and what a hospitalist really was—and he shared them often and vigorously. I admired his moxie and drive, and I’m pretty sure he admired my academic contributions, but our styles and ambitions diverged sufficiently that we didn’t interact much for the next dozen years. But I couldn’t help but notice IPC’s meteoric growth, culminating with its initial public offering—it’s now the only publicly traded hospitalist…

A Game-Changing Statistic: 1 in 250

Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each day. Come to think of it, the quality movement also gelled after the publication of Beth McGlynn’s 2003 NEJM study, which produced its own statistical blockbuster: American medical care comports with evidence-based practice 54% of the time, a number close enough to a coin flip to be unforgettably disturbing. These two examples demonstrate the unique power of a memorable statistic to catalyze a movement. Last month, my colleague Rebecca Smith-Bindman, professor of radiology, epidemiology, and ob/gyn at UCSF and one of the nation’s experts…

“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…

UCSF Benioff Children’s Hospital: A Tale of Great Leadership in Three Acts

This is an amazing tale of leadership – by my hospital CEO, our former chancellor, and, most importantly, a remarkable philanthropist. I’ll start with the latter, veer off to describe the former two, and then return, on this special day, to the philanthropist.The first time I met Marc Benioff – in 2007 – he was not a happy guy. A adult relative of his was hospitalized at UCSF, night had fallen, and Benioff – the billionaire founder of cloud computing pioneer Salesforce.com – was growing concerned about the slow pace of the workup and the seeming absence of Gray Beards there to supervise the trainees. I received a call from our dean, David Kessler, asking if I could help. I came into the hospital, spent some time discussing the case with Marc and his relative, and things went well.Over the next couple of days in the hospital, Marc asked me…
12345...