Fixing health care

Safety, quality and inadequate time – hat tip to Mt Doc

November 28, 2010

Mt Doc wins my esteem for the most important comment in some time.  He finishes the comment with this paragraph: In my humble opinion, the way to be safe is to allow people to be focused and not rushed. "Haste and error go hand in hand." A system which prevents unnecessary interruptions, that assures adequate [...]

Read the full article →

More thoughts on safety

November 26, 2010

First, I was very careful to not invoke never events or 100,000 deaths.  Both ideas detract from the important conversation. Central line infections actually are the best example.  As Peter Provonost has proven, we can greatly limit central line infections.  Using the checklist that he developed minimizes these infections to a very small number.  We [...]

Read the full article →

Health care and the role of federal government

November 23, 2010

As often happens when I blog, I learn a lot from the responses, and my posts stimulate a continued thought process about the topic.  Both factors helped my understanding that the health care reform discussion really is a discussion about the role of the federal government. If one studies political history, the debate started prior [...]

Read the full article →

Health care reform opponents do not understand each other

November 22, 2010

That is a harsh title, but I will try to convince you that it is true.  I spent the weekend discussing internal medicine with colleagues from around the country.  Of course the health care reform issue arose often.  Readers know that I do want all Americans to have some coverage.  My reasoning is that appropriate [...]

Read the full article →

Is it time to reinvent medicine?

August 13, 2010

Two recent pieces struck a chord with this blogger.  While they seem disparate, I believe they represent 2 sides of the same issue. Yesterday morning I read a wonderful piece by Abraham Verghese.  As I read the piece, I wondered if he read this blog on a regular basis.  I suspect that he has never [...]

Read the full article →

Costs – simple principles

December 9, 2009

We all agonize over the cost of health care.  Each Senator has a unique, uneducated perspective on health care costs. Controlling costs can be done once we all understand that someone must ration care. Yes, we cannot control costs if we indiscriminately order every possible test, every new expensive drug, and provide futile care.  We [...]

Read the full article →

Money matters

September 1, 2009

Making rounds this morning, we went to see a patient who had a stent placed yesterday (right circumflex). I sat down to discuss the implications of a diagnosis of coronary artery disease. I started with the statement that she would be talking 4 drug classes – aspirin, ACE inhibitor, beta blocker and statins. As I [...]

Read the full article →

If I were health czar – steps to decrease health care costs

January 13, 2009

  First, I would not want to be the health czar.  I like my current position.  Still, it is fun to provide advice from the sidelines. Our job is to consider health care costs and which are unnecessary.  I have some candidate categories for potential health care savings. Our biggest hurdle remains the privacy issue.  We [...]

Read the full article →

Quality improvement is a misnomer

November 30, 2008

  Readers know that I am obsessed with semantics.  I know that words are powerful.  Oft times words are labels.  Too often people use words to obfuscate meaning.  My hypothesis is that quality improvement is an obfuscating phrase. The key here is the definition of quality.  How does one measure quality?  Opinion leaders have made [...]

Read the full article →

Fixing health care – Time

March 11, 2008

“Time is more valuable than money. You can get more money, but you cannot get more time.” Our favorite retired doc has a great post today – Patients value “thoroughness” in their docs. This post reinforces a point that I make repeatedly.  Patients want our time and are willing to pay for that time. What [...]

Read the full article →

← Previous Entries