Robert Wachter, MD

Articles, page 3

May 22, 2010May 22, 20105

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the…

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.

Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the …

Medical education

Residency team changes can improve education and patient care

Robert Wachter, MD

May 3, 2010May 3, 2010

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.

When I took over our residency in 1992, …

Health policy

Don Berwick to lead Medicare and Medicaid

Robert Wachter, MD

April 6, 2010Apr 6, 20102

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS). Under the legislation, CMS is now far freer to undertake a variety of pilot…

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).

Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …

Physician voices

Jargon dominates medicine and how doctors verbalize nouns

Robert Wachter, MD

March 28, 2010Mar 28, 20108

One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.”

Say whaa?

I’m pretty sure that the most valuable thing I’ve done …

Health policy

Healthcare reform is an achievement but isn’t perfect

Robert Wachter, MD

March 21, 2010Mar 21, 201010

Heading into the final weekend of Mr. Toad’s Wild Ride, who could have guessed that in a year that brought us Death Panels, Pickup Trucks, “You Lie”, The Cornhusker Compromise, Bart Stupak (boy, that must have been a tough name to grow up with), and the Senate Parliamentarian-as-Rock-Star, we would be on the cusp of passing a perfectly …

Physician voices

Atul Gawande’s The Checklist Manifesto reviewed

Robert Wachter, MD

February 24, 2010Feb 24, 20107

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___”…

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

Medical education

How to make your medical grand rounds thrive

Robert Wachter, MD

January 27, 2010Jan 27, 20103

Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected …

Physician voices

How root cause analysis can improve patient safety

Robert Wachter, MD

January 19, 2010Jan 19, 20106

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Analysis enterprise on steroids. This is what we did at UCSF Medical Center, and it was the most important change we’ve made in our safety journey. Here’s the story, …

Physician voices

Should health care workers go to jail for medical errors?

Robert Wachter, MD

December 11, 2009Dec 11, 200911

Two years ago, I wrote about the case of Julie Thao, the Wisconsin nurse sent to prison for a medication error. I argued then that – although Julie bypassed some safety rules – she most certainly did not deserve jail…

Along comes another case involving jail time for a medical mistake, this one featuring an Ohio pharmacist named Eric Cropp. I became aware of Eric’s case through the efforts of …

Health technology

Implementing an EMR or health IT system is harder than it looks

Robert Wachter, MD

October 31, 2009Oct 31, 200917

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 for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.

Although we hated to be skunks at the IT party, we felt that the facts spoke for …

Health policy

Is incident reporting effective in reducing medical errors and increasing patient safety?

Robert Wachter, MD

October 6, 2009Oct 6, 20098

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 – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.

But one lesson from …

Physician voices

How hospitalists can provide high quality patient care at the lowest possible cost

Robert Wachter, MD

September 3, 2009Sep 3, 200911

Much has been made of the superior performance – on both cost and quality – of integrated health care organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated history, few believe that the rest of us – namely the docs and hospitals that provide the bulk of American health care – can quickly achieve such seamless …