Archive for October 2007

Should We Retrofit our Buildings or our Healthcare System?

Last night, my house shook for 10 seconds or so in a 5.6 earthquake. I've felt a couple of dozen of them since moving to San Francisco in the mid-80s. When the rumbling begins, the thought chain is always interesting. It goes like this:Initial Thought: Hey, is that an earthquake, or is the subway going by?Seconds 2-4: Oh yeah, the subway is more than a mile away.Seconds 5-7: So it must be an earthquake.Second 8: Wow, that’s pretty cool.Second 9 and Beyond: I’m not 100% sure I’m not about to die (this stage ends either when the quake stops or you’re dead).That’s what happened last night (I’d just entered Stage 5 when it stopped). Turned out to not be The Big One, things settled down, the dogs stopped barking, the kids went back to whatever it is that they do when they’re supposed to be doing their homework, and I…

Rating Doctors Like Restaurants

So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics?Whatever you think of Zagat’s cross-dressing, it again demonstrates the bottomless market for doctor rankings. HealthGrades, the Colorado company that breathlessly delivers its “200,000 Americans died from medical errors in 200X!” pronouncements every year (grabbing a bunch of headlines, despite the fact that this report is based on measures that were not intended for this purpose and really aren’t measuring deaths from errors), appears to be doing quite well, thank you, largely fueled by its doctor ratings. And every metropolis’s city magazine has its “[Your City’s Name Goes Here]’s Best Doctors” issue, based almost entirely on peer surveys. Most docs scoff at these ratings (particularly docs like me who haven’t made their city’s list), but they clearly move magazines.…

Are Hospitalists Killing Primary Care, Redux

The comments to my original post on this topic are so striking and passionate that I wanted to answer them in a new post rather than as another comment. First, "LPrieto" wrote, "I think the death of outpatient general Internal Medicine is inevitable."  Then "C33333" wrote that 16/17 of his or her (hard to sort out the gender of people named C33333) residents this year chose to go into hospital medicine.All I can say is, Wowza! That'll cheer all the hospitals and staffing companies who are in perpetual hospitalist recruit mode. But it is a remarkable statement re: the future of primary care.Won't that be ironic – if docs who chose hospital medicine over primary care are forced back into the office because there is no one else who wants to do the job. For hospitalists who are now in a cold sweat, having left their office practice vowing never…

Canadian Hospitalists: A North-of-the-Border Lesson in Negotiation

In late September, I had the honor (or honour, I guess) of speaking at the 5th Annual Canadian Hospitalist Conference, held in beautiful Vancouver. It was an eye-opener.About 150 hospitalists from all over Canada were there, and they really are delightful people: enthusiastic, energetic, and really jazzed about doing something new and important.Whereas in the U.S., hospital medicine was initially catalyzed by the economic advantages that accrued to managed care organizations and hospitals for safely shortening LOS and lowering hospital costs, those haven’t been the key issues in Canada. Instead, family physicians – their dominant providers of primary care – have all-but-fled from Hospital-World, leaving a gaping hole. Who filled the gap? In the U.S., nearly 90% of hospitalists are internists, mostly general internists who found the opportunity to focus on hospital care attractive. However, in Canada, there are very few general internists – the tradition (as in the UK)…

The Santa Barbara RHIO: An Impressive Post-Mortem

One of the more interesting recent concepts in the healthcare IT world is that of the “RHIO”: a Regional Health Information Organization. The idea is that – while we’ll never overcome the legal and privacy concerns to create a single national electronic healthcare record (at least not in my lifetime) – we might be able to create one within a region. In 1997, my friend David Brailer (an extraordinarily smart guy who later became the U.S. government’s IT Czar and now runs a $700 million healthcare investment company) pitched the idea of using his company at the time, CareSciences, to build a RHIO in Santa Barbara, California, that sun-kissed village of mansions, wineries, and Botox about an hour north of LA. It seemed a great test case – a community with hospitals and clinics that played well together; small enough to get it done (only 3 main hospitals in the…
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