Physician Drug Testing

The New York Times reported last week on a ballot initiative in California that would mandate random routine drug and alcohol testing of physicians, and targeted testing after major adverse patient events. The full text of the proposal is available here.

Proponents of the measure (Proposition 46) highlight the danger posed by impaired physicians and the ubiquity of drug testing for other professionals such as airline pilots and public safety officers. Continue reading

Is there a doctor on-board?

I was recently on a commercial airline flight when I noticed a bit of a commotion across the aisle. Two flight attendants were responding to the situation, which was triggered when one of the passengers in that trio of seats reached over and started eating the food of her fellow traveler. They quickly moved “the victim” out of the way, and were struggling to manage “the perpetrator.” I overheard them agree that they were concerned about the medical condition of the passenger, and moments later, one of the flight attendants used the public address system to ask if there was a doctor on board. Continue reading

The Next Wave

I was traveling recently and, as I typically do, I bought a copy of Fast Company magazine to read on the plane. I don’t subscribe, but I find that it often has interesting articles on the intersection of technology and business. In the July/August issue, there was an article about GE and its CEO Jeff Immelt that I think has important parallels with the current transformation of healthcare delivery. Continue reading

More on Physician Autonomy

Last week, inspired by the Independence Day holiday, I wrote about the important distinction between independence and autonomy. I made the case that professional autonomy is not about each doctor doing as he pleases, but about physicians as a group taking responsibility for shaping medical practice.

I was pleasantly surprised over the holiday weekend when I came across a recent paper in Health Affairs that illustrates how effective physician leadership (autonomy) can reduce unnecessary practice variation (independence) and improve clinical care. The paper also reinforced some of my earlier thoughts about the central role that physicians must play in redesigning systems of care. Continue reading

Independence and Autonomy

With the approach of the 4th of July, I have had “independence” on my mind. In my professional role, I always have “autonomy” on my mind, since it is often at the top of the list of things that doctors care deeply about, and I have been kicking around how the two relate to one another.
Webster’s (OK, the on-line Merriam-Webster dictionary) defines “independence” as “freedom from outside control or support” and offers up “self-sufficiency” and “self-reliance” as synonyms. “Autonomy” is defined as “the quality or state of being self-governing” and suggests “self-determination” among the synonyms. Continue reading

Looking for the Pony

There is an old gag about an intensely optimistic child whose bright outlook on life is so irrepressible that when he is presented with a room full of manure for Christmas, he screams with delight, convinced that there “must be pony in there someplace.” Continue reading

Recognizing Excellence

I am a big believer in celebrating success and recognizing excellence. I find that doing so motivates people to achieve even more, and it helps maintain a healthy sense of organizational optimism. I also believe that one of the keys to making this work is to set high standards, so that only truly high performers get the accolades. Continue reading

Practice Guidelines and Quality Care

As I have noted previously I have a “love-hate” relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based. Continue reading

More Sunshine

I wrote recently about the release of physician billing information by CMS  and noted that news organizations had quickly provided tools to look-up individual physicians. Propublica  an “independent, non-profit newsroom that produces investigative journalism in the public interest” has gone one better. In keeping with their mission to “expose abuses of power and betrayals of the public trust… through the sustained spotlighting of wrongdoing” they recently posted a more powerful online tool for analyzing and viewing  the CMS data along with a companion story of what they found by using it. Continue reading

Memorial Day

What do you associate with Memorial Day? The unofficial start of Summer? Traffic heading east on the LIE? Barbeques?  The Indianapolis 500? Sales at your favorite retail store? How many of us think first of what the day is named for – honoring the memory of those who fell in the service of our country? Continue reading