Posts by Chris Moriates

Should Resource Overutilization Be Considered an Adverse Event?

We have all seen the Choosing Wisely lists and the new “Things We Do for No Reason” section in the Journal of Hospital Medicine. We have heard a lot about common areas of overuse in hospitals. Sure, there have been some success stories of hospitalists leading projects to decrease an area of overuse, but when you get down to it, have we really done much to not just recognize overuse but to actually decrease it? Think about the patient safety movement over the last two decades. Telling horrifying stories of wrong-limb surgeries may have caught headlines, but that did not do much to stop the problem from still happening. The medical world had to shift our thinking from one of individual blame to recognizing the role of systems and environments in creating these problems. We had to put structures in place, such as safety review committees and mandated processes for…

3 Tips for Bringing Doctors and Data Specialists Together

By: Victoria Valencia, MPH, Assistant Director of Healthcare Value Christopher Moriates, MD, Assistant Dean of Healthcare Value Dell Medical School at The University of Texas at Austin With tele-machines beeping, robots rolling by and so many different people rotating in and out of rooms, the hospital environment can be chaotic. Similarly, the data environment of many of our electronic health records (EHRs) can be quite unruly. EHR systems are not always designed for clinicians to input data in a way that can be researched and used in quality improvement. Just as hospitalists become comfortable working amongst the whir of the wards, data specialists learn how to handle the thicket of data libraries. Report writers and clinicians who request reports often have little to no experience with the workflow and context of the other. It’s no wonder why it often feels like we are speaking different languages and why the reports…

How I Realized QI Could Be a Dirty Word

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?” Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and then spent the first 4 years of my post-residency career at UCSF, where quality improvement (QI) was well established and celebrated. Sure, I suppose there were some eye rolls from a few surgeons, or…

More and More and More about Overuse

You probably feel like you have been reading a lot about medical overuse these days. You are right. The number of articles in academic journals addressing overuse has nearly doubled this past year compared to 2014. A recent systematic review published in JAMA Internal Medicine uncovered 821 articles on medical overuse in academic literature during the 2015 calendar year. That doesn’t even include all of the editorials and articles that have been popping up in our trade journals and in popular magazines and newspapers. What’s more, I don’t think this is the peak yet. In fact, research on overuse is basically just getting started. Why is medical overuse such an important issue? Overuse is not only expensive; it is a patient safety issue, since it leads to serious patient harms and downstream consequences. As hospitalists, we know this all too well. We are the ones that take care of the…

Respect the Body You Are Trying to Heal

“You must respect the body you are trying to heal.” I heard this said twice into my headphones, the second time more slowly and firmly than the first, while I sat on the runway about to take off. It continued to echo in my head over the course of the flight. As a physician, the reference to healing a body has obvious resonance. However, as I embarked on yet another gathering of healthcare leaders discussing how to make our healthcare system better, this assertion took on a broader significance. Clinicians often hear about – and experience daily – our “broken healthcare system.” There is little doubt that our system is sick, but it is not yet terminal. Physicians understand the art of treating a diseased person, bringing together clinical science and knowledge with emotional empathy and respect. Yet, when we become healthcare leaders, managers, or administrators and turn our sights…
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