Readers of this blog know that I am a fan of public reporting of performance data. I believe that data transparency helps fulfill an obligation to our patients to be honest about the care we provide, and is also a potent stimulus for improvement. There are obvious conditions that ought to be met before any sort of data – about quality, patient experience, finances or anything else – is shared in this way. The data should be meaningful (pertaining to something that patients are likely to care about), valid (the data actually measure what we say it measures), reliable (vary consistently with performance) and presented in a way that patients can easily make sense of it.
Our own efforts to report the patient satisfaction scores of Northwell Health Physician Partners physicians has been well received by our members and the press because it meets all of these criteria.
Some of the other public reporting efforts, such as recent reporting of surgical complications by Pro Publica, have been criticized for failing to meet the standards of validity and reliability, although I and others have been supportive of their efforts.
Continue reading More Public Reporting
My first posting on this blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of leaning in, touching the patient, listening, concentrating, and interpreting is a powerful metaphor for the entire clinical encounter: getting close to the patient and listening.”
It is therefore no wonder that I was really pleased to read “The Physical Examination and the Fifth Maneuver” by Thomas Metkus in a recent issue of the Journal of the American College of Cardiology. The piece appeared in the “fellows in training and early career page” in the Journal, which regularly features articles by trainees about their experiences, and was a mature and robust defense of the importance of developing auscultatory skills. Metkus alludes to Osler’s model of physical diagnosis, the first four maneuvers of which are inspection, percussion, palpation and auscultation. The fifth – and arguably most important – is cognition, the intellectual exercise of putting it all together.
Continue reading Listen More
Every so often I come across a research paper that leaves me feeling as if I am glimpsing the future. I had that experience when I came across the work of Cingolani and colleagues in the December 23 issue of the Journal of the American College of Cardiology (volume 64, no. 24). The paper, entitled “Engineered electrical conduction tract restores conduction in complete heart block: from in vitro to in vivo proof of concept” details a new approach to an old problem.
Here’s the problem. Many people develop serious disturbances of the heart rhythm based on deterioration or destruction of specialized “conduction tissue” within the heart. This tissue is responsible for transmitting the electrical impulses that govern the beating of the heart. In the case of the dysfunction of conduction tissue between the atria and ventricles, the chambers become electrically and mechanically dissociated – a condition termed complete heart block, and generally treated with an implanted pacemaker.
Continue reading Department of Really Cool Ideas
Several medical journals that I receive (if not read) regularly have a section devoted to interesting images. The New England Journal has “Images in clinical medicine,” Circulation has “Images in cardiovascular medicine,” and the Journal of the American College of Cardiology has “Images in cardiology.” Each generally contains a short case description, along with one or more images – photographs of patients, histologic sections, radiographs, MRI images, and the like. Continue reading Images in Medicine