Explore the behavioral factors behind antibiotic misuse

Meds
August 1, 2017

None of us wants to live in a world without access to lifesaving antibiotics. No patient should be subject to an allergic reaction or organ dysfunction from these drugs. No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out healthy gut bacteria.

Yet, every day, patients are prescribed antibiotics that they did …

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Explore the behavioral factors behind antibiotic misuse

Revamp health regulations to reduce cost and improve patient safety

Policy
May 17, 2017

Johns Hopkins ophthalmologist Oliver Schein has found a simple way to save a half a billion dollars a year from our country’s health care bill, with no negative effect on patient health. The only thing standing in the way is a stubborn government requirement.

Seventeen years ago, Dr. Schein and colleagues published a study finding that cataract surgery patients who underwent routine preoperative testing — such as …

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Revamp health regulations to reduce cost and improve patient safety

How peer-to-peer review helps hospitals

Physician
March 25, 2017

The moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the wrong move or give a wrong answer, have them see rust on a ceiling sprinkler, …

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How peer-to-peer review helps hospitals

We need more science in hospital quality measures

Policy
January 6, 2017

If you understand statistics and possess the intestinal fortitude to examine a ranking methodology, you will recognize that it involves ingredients that have to be recombined, repackaged and renamed. It’s messy, like sausage-making.

This is not to say that the end product — hospital rankings — are distasteful. Patients deserve valid, transparent and timely information about quality of care so they can make informed decisions about whether and where to receive …

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We need more science in hospital quality measures

Surgery volumes should be made public. Here’s why.

Physician
December 16, 2016

Her voice cracked with strain. I could imagine the woman at the other end of the line shaking, overcome with remorse about the hospital where her husband had had esophageal surgery. Might he still be alive, she asked me, if they had chosen a different hospital?

The couple had initially planned to have the procedure done at a well-known medical center, but when she went online to do her homework, she …

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Surgery volumes should be made public. Here’s why.

We cannot ignore the dysfunctional systems at the heart of how we care

Policy
December 6, 2016

If we want to rein in the costs of the U.S. health care system — now equal to nearly 18 percent of the nation’s gross domestic product — we cannot ignore the fragmented technologies used to help heal and save lives.

At first glance, the devices, monitors, electronic health records and machines found in today’s hospitals might inspire awe. Look beyond the slick displays with blinking lights, however, and the picture …

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We cannot ignore the dysfunctional systems at the heart of how we care

It’s time to update the physical exam

Physician
November 16, 2016

In the technology-thick landscape of modern health care, the physical exam remains in a backwoods.

Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole, the exam has barely changed in the past century. Patients still open up and say “ah,” take deep breaths and gaze at a tiny light peering into the back of their eyes.

A well-done exam can still determine whether …

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It’s time to update the physical exam

Why the 15-minute doctor appointment is dangerous

Physician
May 13, 2016

How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …

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Why the 15-minute doctor appointment is dangerous

Maybe the key to patient care is a little love

Physician
May 3, 2016

Talking to health care professionals about the importance of loving your patients and colleagues — as I often do — might raise eyebrows.

How can we be expected to love our patients during a 15-minute clinic visit? How can love form among hospital teams coming together for a surgical procedure but then moving on to other work? Perhaps most importantly, how will this love make any difference in our patients’ lives …

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Maybe the key to patient care is a little love

It’s hard for patients to choose a good hospital. It shouldn’t be.

Physician
March 15, 2016

Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship.

The problem is that it’s extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn’t exist. In other cases, it’s hard or impossible for the public to find.

For instance, if you’re getting an esophagus resection …

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It’s hard for patients to choose a good hospital. It shouldn’t be.

Doctoring to the test: The unintended consequences of performance measures

Physician
March 1, 2016

As standardized exam scores increasingly define success for students, teachers and schools, parents worry about the dangers of “teaching to the test” — and of their children being judged by tests with low or unknown validity. We want our children to perform well on tests, of course, yet only if they measure something that students, patients, and teachers believe really matter. We also want the education system to inspire students …

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Doctoring to the test: The unintended consequences of performance measures

Why it’s time for doctors to ditch their white coats

Physician
January 5, 2016

Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?

After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily …

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Why it’s time for doctors to ditch their white coats

Change happens best when it’s done with clinicians and not to them

Policy
December 8, 2015

Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items — such as artificial hips and knees, surgical screws, stents, pacemakers and other implants — develop over time, perhaps out of habit or acquired during their training.

Of course, surgeons should have what they need to …

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Change happens best when it’s done with clinicians and not to them

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Here are 10 patient suggestions for hospitals. Let’s make them happen.

Physician
November 5, 2015

Since undergoing a double-lung transplant at the Johns Hopkins Hospital in December 2011, Podge Reed Jr. has had four medical admissions, two surgical admissions, eight outpatient procedures requiring anesthesia, more than 100 outpatient appointments, and 700 labs and other tests. He’s amassed enough experiences with the health care system to write a book. So far, though, he’s mostly kept it to two letters, totaling 12 pages, to our patient relations …

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Here are 10 patient suggestions for hospitals. Let’s make them happen.

The ProPublica Surgeon Scorecard: When journalists become scientists

Policy
October 9, 2015

Most of us would agree that there aren’t enough valid and meaningful health care quality measures to guide patients’ choices of hospitals and physicians. While the federal government has steadily expanded the number of publicly available measures on its Hospital Compare website, it still falls short of what many patients, payers, and providers would like. This is particularly true in the realm of outcomes such as …

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The ProPublica Surgeon Scorecard: When journalists become scientists

Here’s why clinicians should give shadowing a try

Education
October 2, 2015

How many of our conflicts could be handled better or averted if we had the opportunity to spend some time in the shoes of the person on “the other side”? When we experience a situation through another’s eyes, and when we understand their work and world, true empathy, understanding and trust can emerge.

This is certainly true in our hospitals, where the frenzy of patient care activities involves multiple roles — …

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Here’s why clinicians should give shadowing a try

Here’s a hospital taking patient engagement one step further

Physician
July 21, 2015

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Consider, for a moment, that you are a new physician. A patient, who is a lifelong smoker, comes to your clinic complaining of shortness of breath, and after conducting several tests you diagnose him with chronic obstructive pulmonary disease (COPD). Relying on your training, you prescribe medications, arrange for follow-up visits and describe activities that can help him better manage his breathing …

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Here’s a hospital taking patient engagement one step further

Can hospitals restrain themselves from doing low-volume surgeries?

Policy
June 23, 2015

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Imagine you were seeking major surgery, and the hospital’s consent form contained this surprise statement, which you were asked to initial: “I understand that this surgeon and hospital have not performed this procedure in the last 12 months. As such, I accept the greater risk of complications and even death.”

It’s hard to believe that you would sign the form and move …

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Can hospitals restrain themselves from doing low-volume surgeries?

How much more would you pay for hospital safety?

Physician
December 29, 2014

What is it worth to be treated in a hospital with a stellar patient safety record rather than one with lower performance?

For a large majority of survey participants in a recent study by researchers from the Altarum Institute and Drexel University, the answer is quite a lot. Published online last month in the Journal of Patient Safety, the study found that most respondents would choose a hospital with a …

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How much more would you pay for hospital safety?

Hospitals have to strive for zero harm

Physician
December 9, 2014

The safety concerns that keep clinicians awake at night often aren’t issues that you could fit onto a safety and quality dashboard. They aren’t the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so.

This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based …

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Hospitals have to strive for zero harm

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