Archive for January 2014

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…

Do You Want Us to Do Everything, Or…

“One more question:  do you want us to do everything, or do you just want palliative care.”  The first syllable of the word “palliative” emphasized, drawn out, left hanging.  This is one version of the five-second, halfhearted code status discussion for seriously ill patients being admitted to the hospital with either a new disease or an exacerbation of an existing one.  We all have phrases that grate on our nerves, and this is one of mine. There are similar statements that are not much better.  “Well, we’ve done all we can, how about palliative care?”  Or, “You know, I think it’s time to go the palliative route.”  These are sometimes said as providers are backing out the door, mentally and physically disengaging from their patients. We have a problem in our culture with discussions about end-of-life and advanced care planning.  Politicians and pundits use distrust of the healthcare system to…

Super Bowl & State of Hospital Medicine

by Dr. William "Tex" Landis, FHM It’s Super Bowl time and that means it's time to complete the State of Hospital Medicine Survey, the biennial survey of hospitalist practices.  Discussions abound about who is the best football quarter back.  Is it Peyton Manning, Russell Wilson, Tom Brady, or somebody else?  What are the stats?  What does each individual and team do well?  How do they stack up against one another?  How will championship caliber football teams perform?  Who will be the MVP? This time of year, as hospitalists, we should be even more concerned about the performance of our hospital care teams.  The State of Hospital Medicine Survey helps us gather information about the specialty of hospital medicine so that we can compare our performance to other hospitalist groups.  What is the best source of information to help us perform successfully?  While I am not going to come down on…

Keeping Academic Hospitalists Academic

I recently visited the Montefiore hospitalist program under the direction of Dr. Will Southern and met a great group of junior hospitalists in academia who are beginning to build their academic careers in medical education.  Later that afternoon, I joined SHM’s Physicians in Training Committee for a lively discussion on early career hospitalists.  While hospitalists are now an ever-present and growing fixture in academic teaching hospitals, they are often viewed as “clinical workhorses” and could get easily overlooked for positions in medical education.  It is clear that now is the right time to get hospitalists to the right place, specifically the nexus of current forces at play in medical education and hospital care that make hospitalists natural allies to medical school deans and residency program directors.  So for any early career hospitalists looking to “break in” to medical education, here are a few tips on getting to the “right place”.…

My ACA Holiday

I’m not sure if they were inspired by all of the commercials encouraging families to “talk about healthcare coverage” during holiday get-togethers, but clearly my family and friends were interested to find out what I thought about the Obamacare rollout and about the Affordable Care Act in general.  This is not surprising as there has been so much in recent news about healthcare and it had been quite awhile since we had all gotten together.  And of course they know that I have been involved in the healthcare policy world both through my work at Cogent and through SHM, spending the last several years steeped in both the practical and the more arcane features of the subject. Hoping to avoid talking shop (and doing my best to avoid the always dangerous political discussions at holiday dinners) I tried to evade answering by describing the subject as complicated, multifaceted and not…
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