Archive for July 2008

Will Knols and Blogs Upend the Cozy World of Medical Publishing?

Yesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As healthcare advisor to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing – may signal the end of medical publishing as we have known it.First, a word about Knol (the name is short for “a unit of knowledge”). Google’s vision is that providing a tool for people to write about “things that they know” will make the world a better place. Unlike Wikipedia’s anonymous, collaborative writing/editing process, Knols have authors, with names, faces, and reputations. (Authors can choose to have their identity verified, through a cross-check on their credit card or phone records.) Google provides Knolers a tool; authors enter their content and click “publish.” And poof, there it is, on the Web. Users can rate and comment on Knols, send them to friends, and suggest…

The Long Awaited Crisis in Primary Care: It’s Heeere!

I recently heard from a UCSF physician who was flabbergasted when he sought an appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show's website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.First, it is true – MGH is not accepting any new primary care patients.…

Another Case of Wrong Site Surgery: Are We Averting Our Eyes From Some of the Root Causes?

Yet another case of wrong-side surgery, this one at Boston’s Beth-Israel Deaconess Hospital. Though CEO Paul Levy does a nice job discussing the case on his blog, I’ll focus on two aspects Paul neglects: the role of production pressures in errors, and the tension between “no blame” and accountability.First, I hope you’ll read Paul’s piece (on his always-interesting blog), which includes a courageous memo he and BI-D’s chief of quality Kenneth Sands sent to the entire community describing the case (within the boundaries created by HIPAA). In laying out the "how could this happen," they say this:It was a hectic day, as many are. Just beforehand, the physician was distracted by thoughts of how best to approach the case, and the team was busily addressing last-minute details.Surprised? Hardly. How many days in my hospital and yours don’t look like that?The concept of “production pressure” is an important one in safety.…

Door to Antibiotics Time in Pneumonia: Lessons from a Flawed Quality Measure

In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary tale.As I’ve discussed previously, the biggest surprise of the last decade in the quality field has been this: public reporting alone (even without pay-for-performance) leads to huge changes in the behavior of providers and healthcare organizations… even though there is virtually no evidence that patients are reading or acting on the reports. In other words, shame and pride are powerful forces for change.That’s great, but it means that the stakes are high – those developing and promoting publicly reported quality measures have to get it right, since front line folks are likely to respond to them by changing their clinical practice.I won’t go through all the flaws in the Time…