Category Archives: Uncategorized

Charlotte Nash

My mother died last week. This is about her.

She was born in New York City, raised as an only child on the Lower East Side, and was the proud product of city public schools and City College. She was an accomplished student and, as was common in those days, was accelerated through grade school, so that she graduated high school at the top of her class at age 16 and college at age 20. As was also common in those days, she married my father of blessed memory the same year she graduated from college, in August of 1949.

She and my father lived with her parents for a bit, with her teaching in the NYC public schools and then went off to Boston, where my father went to graduate school, and she taught 2nd grade in the Brookline public schools. When her father – a grandfather I never met, and for whom I am named – became ill, they moved back to NY, eventually becoming part of the great migration from the LES to Kew Gardens, Queens, and then, in 1960 with 2 little boys to Merrick, Long Island. She used to like to tell the story that she voted for JFK in the morning, and moved in that afternoon.

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Hippocrates and the Internet

The Hofstra Northwell School of Medicine recently graduated its second class. The commencement was a wonderful “feel-good” event, complete with beautiful weather, happy graduates and proud families. The ceremony closed with the newly minted physicians rising to their feet and reciting the oath of the physician. In a nice touch, the other physicians in the audience were invited to renew their commitment to the profession by joining in. I found the whole thing joyous, and the opportunity to publically take the oath again was a moving reminder of what doctoring is all about.

Coincidentally, I also had the opportunity this week to lead one of the sessions in Northwell’s Physician Leadership Development Program,  part of a half-day session with Sven Gierlinger, our organization’s Chief Experience Officer, and Jill Kalman, the Medical Director of Lenox Hill Hospital, devoted to the voice of the patient.  My bit was about our “transparency project”to publish our physicians’ patient experience scores on our public website.  I used the story of how and why we did that as a case study that tied together the themes of physicians driving change and of improving the care we provide to patients and their families.

It was only after the fact that it occurred to me that there was a profound connection between the two events.

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Reflection on Thanksgiving

I love Thanksgiving. It is my favorite holiday – quintessentially American, and celebrated nearly universally across what are often divides of age, ethnicity, religious background, income and region. Somehow Thanksgiving always renews my love of country and faith in its future.

This year, it also got me thinking about being truly thankful for good things, large and small, that surround all of us. It is easy, of course, to get caught up in the day to day, and to focus more on the annoyances and challenges each of us faces instead of on the joy or beauty. Maybe it is even basic human nature to do so. But a recent piece in the New York Times made a pretty compelling case that gratitude is a path to happiness. Conscious efforts directed at appreciating the good make us feel better, so that we can, in a sense, train ourselves to be happier.

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Patient Safety, Swiss Cheese and the Secret Service

I was listening to the news on my way to work last week, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the building before he was stopped? The answer, according to NPR’s reporting of the Department of Homeland Security investigation is that a whole sequence of events made it possible:

It turns out that the top part of the fence that he climbed over was broken, and it didn’t have that kind of ornamental spike that might have slowed him down. Gonzalez then set off alarms when he got over the fence, and an officer assigned to the alarm board announced over the Secret Service radio there was a jumper. But they didn’t know the radio couldn’t override other normal radio traffic. Other officers said they didn’t see Gonzalez because of a construction project along the fence line itself. And in one of the most perhaps striking breaches, a K-9 officer was in his Secret Service van on the White House driveway. But he was talking on his personal cell phone when this happened. He didn’t have his radio earpiece in his ear. His backup radio was in his locker. Officers did pursue Gonzalez, but they didn’t fire because they didn’t think he was armed. He did have a knife. He went through some bushes that officers thought were impenetrable, but he was able to get through them and to the front door. And then an alarm that would’ve alerted an officer inside the front door was muted, and she was overpowered by Gonzales when he burst through the door. So just a string of miscues.

The explanation rang true. Of course it was no “one thing” that went wrong; it was a series of events, no one of which in isolation was sufficient to cause a problem but, when strung together, led to a catastrophic system failure. The explanation also sounded familiar. It is a perfect example of the “swiss cheese” conceptual model of patient safety.
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This is not your father’s (or your) Medical School

I recently served as a preceptor for first year students at our Hofstra – NSLIJ School of Medicine who were doing one of their “RIA” (reflection, integration and assessment) sessions. The students do these sessions every 12 weeks, and are generally scheduled with the same preceptor over time. It may be routine for the students, but I found it absolutely remarkable. Continue reading This is not your father’s (or your) Medical School

Why does ICD-10 feel so bad?

It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this. Continue reading Why does ICD-10 feel so bad?

Planning for the future

I have a pretty well-rehearsed answer for anyone who asks me what my role is all about. For those unfamiliar with the North Shore-LIJ Health System, I rattle off a few key statistics (16 hospitals, $7 billion in revenue, 48,000 employees) and then give a brief description of our clinical service lines, the ambulatory services division, which provides operational and back-office support to our physician practices, and the medical group, which integrates clinical services. Continue reading Planning for the future

Thanksgiving

Thanksgiving is my favorite holiday. It straddles the secular and spiritual, and has evolved into a celebration of family in a way that our other national holidays have not. The food is great too!

For many years, my wife and I have happily traded the work of hosting for the hassle of travel, and we have developed our own family traditions. Among them is a reading, right before we dig in to dinner, of something evocative of the meaning of “thanksgiving.” Continue reading Thanksgiving

Raising Daughters

I have always thought that I have learned more from raising two kids with my wife than I have from anything else I have ever done, including the study and practice of medicine. I suspect that many parents feel the same way, since it is pretty common for people to speak of the transformative impact of parenting.

A lot of my lessons have been generic – what really matters to me, what it means to take responsibility – but as my children have grown, I have also learned some very specific lessons. One such important lesson I attribute entirely to having daughters, and to having grown up in a household with a brother and no sisters. I have learned about what it means to grow up female. And as my children have become adults, I continue to learn about what it means to be female in our society and in the workplace. Continue reading Raising Daughters

Patient Satisfaction

There is a lot of talk these days about patient satisfaction. For several years, hospitals have been mandated by CMS to survey their discharged patients about their experiences. The results have been publicly reported and payments are tied to performance. This approach, including the use of a federally mandated standard questionnaire and the linking of payment by CMS to scores, is also planned for physician practices. These policies, which are being adopted by private insurers as well as government payers, have been credited with forcing hospitals and doctors to be more attentive to “customer service.”

It is hard to argue against the need for better service, and for better attention to patients’ comfort, and these programs seem to be working (registration required). But a couple of things about this whole approach leave me feeling more sad than inspired.
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