The Health Care Blog

Is Healthcare IT Ready for its Big Coming Out Party?

By BOB WACHTER In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat...
October 25, 2009 in Bob Wachter | Permalink | Comments (10)

Physician Accountability for Violation of Safety Rules: The Time For Excuses Has Passed

By BOB WACHTER In a recent New England Journal, Peter Pronovost and I make the case for striking a new balance between “no blame” and accountability. Come on folks, it’s time. At most hospitals, hand hygiene rates hover between 30-70%,...
October 14, 2009 in Bob Wachter, Physicians | Permalink | Comments (11)

Another Look: Incident Reporting Systems

By BOB WACHTER When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons...
September 28, 2009 in Bob Wachter, Patient Safety | Permalink | Comments (4)

The Speech: Could this have been what he planned all along?

By BOB WACHTER White House Photo A conventional look at The Speech: Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not...
September 11, 2009 in Bob Wachter, Obama, Reform, The Speech | Permalink | Comments (17)

Death Panels, Palliative Care, and the Dangers of Modern McCarthyism

By BOB WACHTER It’s time to fight back. The “death panel” nonsense is not a harmless and amusing political canard – it is modern McCarthyism: the shameless, heinous use of lies and distortions to scare and confuse people. The tide...
August 24, 2009 in Bob Wachter, Palliative Care, Reform, Sarah Palin | Permalink | Comments (43)

Explaining Runaway Costs: The Lobster or the Salad?

By BOB WACHTER Have you found yourself ‘splaining to friends and family why the healthcare system is so damn expensive? I’ve been teaching health policy for a couple of decades, and I’m surprised that my two favorite stories haven’t yet...
July 28, 2009 in Bob Wachter, Comparative Effectiveness Research, Consumers, Costs | Permalink | Comments (52)

A Brief History of the R Word

By BOB WACHTER Princeton ethicist Peter Singer’s article in this week’s NY Times Sunday Magazine is creating lots of buzz. It is a classic utilitarian description of the case for rationing – QALYs and all – and a plea for...
July 22, 2009 in Bob Wachter, History, Media, New York Times, Rationing | Permalink | Comments (64)

Op-Ed: The Unintended Consequences of “No Pay for Errors”

By BOB WACHTER Medicare’s policy to withhold payment for “never events” – the first effort to use the payment system to promote patient safety – remains intriguing and controversial. To date, most of the discussion has focused on the policy...
July 21, 2009 in Bob Wachter, evidenced-based medicine, Medicare, Patient Safety, Quality | Permalink | Comments (3)

As Medical Tourism Grows, Hold On We're In For a Wild Ride

By Bob Wachter Until now, medical tourism has been a curiosity, iconic “Wow, Look How Flat the World Is Becoming,” fodder for stories on 60 Minutes. But as health insurers and employers get into the act, get ready for some...
January 17, 2009 in Bob Wachter, Health Plans, International, Physicians, The Industry | Permalink | Comments (25)

Can the physical examination save us from the dehumanization of medicine?

By ROBERT WACHTER In last week’s NEJM, physician-author Abraham Verghese paints a disturbing picture of a medical world in which technology has morphed from tool to object, the patient relegated to a supporting role. To me, Abraham has nailed the...
January 2, 2009 in Bob Wachter | Permalink | Comments (5)

Resident Duty Hours and Patient Safety: Did The IOM Get It Right?

By Bob Wachter The Institute of Medicine just released its long-awaited report on trainee duty hours. It is well researched and balanced, and its recommendations appropriately reflect what we know vs. what we believe. Now the fun begins. Let’s start...
December 9, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians, Quality | Permalink | Comments (1)

Are Hospitalists Recession Proof?

By BOB WACHTER Hospitals aren’t the first businesses hurt when the economy sours, but they get hurt nonetheless, as an article in last week’s NY Times points out. But hospitalists have never lived through a massive downturn. What happens to...
November 17, 2008 in Bob Wachter, Hospitals | Permalink | Comments (1)

Can a Hospital Afford to Share Its Warts with the Public?

By BOB WACHTER Paul Levy, the blogging CEO at Boston’s Beth Israel Deaconess Medical Center, has staked his – and his hospital’s – reputation on a culture of transparency. Although no doubt partly driven by Paul’s ethical compass, he must...
November 3, 2008 in Bob Wachter, Patient Safety | Permalink | Comments (3)

Overregulating patient safey

By Bob Wachter In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has....
October 21, 2008 in Bob Wachter, Patient Safety | Permalink | Comments (3)

Shout out to Adam Singer, physician entrepreneur of the year

By Bob Wachter Modern Physician just named Adam Singer, the founder of IPC -- The Hospitalist Company, its first annual Physician Entrepreneur of the Year. Adam and I don’t always see eye to eye, but I want to congratulate him...
October 7, 2008 in Bob Wachter, Physicians, Technology | Permalink | Comments (1)

Big administrator is watching you

By Bob Wachter Last week, came the announcement that Suzanne Delbanco, founding director of the Leapfrog Group, has assumed the presidency of a company that tracks compliance with safety and quality practices via remote video. Big Brother, meet the Joint...
September 29, 2008 in Bob Wachter, Patient Safety, Quality | Permalink | Comments (4)

Creating a Facebook-like medical record

By Bob Wachter The explosive growth of Facebook and MySpace illustrates the market for electronic tools to enhance communication and collaboration. Could there possibly be another workplace more in need of social networking tools than the modern hospital? If you...
September 11, 2008 in Bob Wachter, Electronic Medical Records, Health 2.0, Hospitals | Permalink | Comments (11)

Medicare hospital quality reporting steps up in sophistication

By Bob Wachter Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR's "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it -- on...
September 2, 2008 in Bob Wachter, Hospitals, Medicare, Quality | Permalink | Comments (2)

Health care in the YouTube era

By Bob Wachter August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering...
August 19, 2008 in Bob Wachter, Consumers, Patient Safety, Quality | Permalink | Comments (5)

Knol and web publishing challenge medical journals' stronghold

By Bob Wachter Yesterday, Google launched Knol, immediately branded as Google’s answer to Wikipedia. As health care adviser to the project, I’ll say a few words about Knol, but focus on how it – and other forms of electronic self-publishing...
July 25, 2008 in Bob Wachter, Google, Web/Tech | Permalink | Comments (7)

Another case of wrong-site surgery: are we averting our eyes from the root causes?

By Bob Wachter 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...
July 10, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians, Quality | Permalink | Comments (8)

How preventing infections rose to the forefront of the patient safety movement

By Bob Wachter The Joint Commission just released its 2009 National Patient Safety Goals, and –- no surprise –- they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control...
June 24, 2008 in Bob Wachter, Hospitals, Patient Safety, Quality, The Industry | Permalink | Comments (0)

Why diagnostic errors don't get any respect and what can be done about it

By Bob Wachter I gave a keynote yesterday to the first-ever meeting on "Diagnostic Error in Medicine." I hope the confab helps put diagnostic errors on the safety map. But, as Ricky Ricardo said, the experts and advocates in the...
June 2, 2008 in Bob Wachter, Hospitals, Patient Safety, Physicians | Permalink | Comments (3)

The Technology Hype Cycle: Why bad things happen to good technologies

By Robert Wachter Fresh on the heels of my recent bar coding epiphany comes another “unintended consequences” article. It turns out that the whipsawing that accompanies the adoption of new technologies is completely foreseeable, the “Why doesn’t this thing work...
May 19, 2008 in Bob Wachter, Technology | Permalink | Comments (4)

Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

By Robert Wachter Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted? The motivation to include patient satisfaction data comes from...
April 15, 2008 in Bob Wachter | Permalink | Comments (4)

Average Time of Discharge: Why a Hospital is Not a Hilton

By Robert Wachter Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours...
March 26, 2008 in Bob Wachter, Consumers, Hospitals | Permalink | Comments (6)

Look at How Safe [Fill in the Blank] Is by Bob Wachter

But is it as simple as that really? Perhaps not. In the commentary that follows, Bob Wachter has a very different take on the airline analogy. Analogies are useful things, true, he argues. But perhaps not as useful as the...
December 29, 2007 in Bob Wachter, Hospitals, Patient Safety | Permalink | Comments (2)

Rating Doctors Like Restaurants, by Bob Wachter

Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term "hospitalist" in an influential 1996 essay in The New England Journal of Medicine. His most recent...
December 4, 2007 in Bob Wachter, Health 2.0, Quality, Technology | Permalink | Comments (19)

HOSPITALS: Dennis Quaid's Kids - Are VIPs Safer? By Bob Wachter

Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Robert Goldman, he coined the term "hospitalist" in an 1996 essay in The New England Journal of Medicine. His most recent book,...
November 26, 2007 in Bob Wachter, Patient Safety | Permalink | Comments (6)

When is a Medical Error a Crime? by Bob Wachter

Bob Wachter is one of the nation's leading experts on medical safety and one of the pioneers of the hospitalist movement. And now he's descending into the mire of blogging! So we're pleased to cross post one of the more...
November 16, 2007 in Bob Wachter, Hospitals, Patient Safety | Permalink | Comments (17)