I’m on clinical service now and my patients are dying left and right. And I’ve never been prouder of my own care, and that delivered by my colleagues and hospital. When I was in training, a patient’s death was invariably considered a medical failure, and thus an occasion for shame and silence – the Outcome-That-Must-Not-Be-Named. We treated it ...

As I mentioned in my last post, these should be the best of times for ''Infection Preventionists'' (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally arrived. But they are far from a joyful bunch. Why?In my talk to 4,000 members of the ...

Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now.In a sophisticated study in today’s Annals of Internal Medicine, Levy and colleagues mine a decade-old, 100-hospital, 123-ICU ...

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 the Institute of Medicine’s inclusion of “patient-centeredness” as one key component ...

Today my pals Peter Lindenauer and Andy Auerbach (and colleagues) published the largest hospitalist outcomes study to date, in the New England Journal of Medicine. It is a rigorous, important piece of work. Let me try to add a bit of context.First, the What’s What. Using the massive database of the Premier system (which Peter has mined to ...

Stuff this week that caught my eye: Does medical tourism harm the natives? Are all those CT scans destroying more than our budgets? Are nocturnalists at risk for more than decubs? Will Medicare need to cut hospital payments to fuel P4P? Answers: yes, yes, probably, and duh.Yesterday, NPR’s All Things Considered described the dark side of medical ...

Last year, I (with Peter Pronovost) wrote the toughest paper of my life – one that critiqued the Institute for Healthcare Improvement’s 100,000 Lives Campaign. This is the healthcare equivalent of criticizing both Mother Teresa and your local food bank in a single sitting (you can also read Don Berwick and his team’s response here). Although some ...

While driving into work earlier this week, I heard a wonderful interview with Jim Dierke, principal of Visitation Valley Middle School here in San Francisco. VV is one of the poorest neighborhoods in the city, and this gentleman – who recently won a national middle school “principal of the year” award – has managed to increase attendance rates ...