Robert Wachter , MD

In this talk, I review the brief history of the quality and safety movements, the new push for “value” (quality + safety + patient satisfaction divided by cost), and how all of these levers (accreditation, regulation, transparency, payment changes) are combining to create unprecedented pressure on caregivers and delivery organizations to change their ways of doing business. Rather than being depressed, audiences leave with a deep understanding of healthcare’s new landscape, and a roadmap (and some optimism) for success in this new world.

The title is a riff off a famous Seinfeld episode, one in which Jerry convinces George to try the opposite of his every instinct. In healthcare, physicians have been taught to be individualistic, to think about individual patients (vs. systems), to look outside their institution for answers, and to be unable to consider resource allocation tradeoffs. In this talk, I talk about the imperative to move in new directions, but provide some cautionary notes about what may be lost if the pendulum swings too far.

All of us had high hopes that computers would be the solution to medical mistakes. Using a dramatic case in which a child received a 38-fold overdose of a common antibiotic, this talk explores some of the unforeseen consequences of information technology – including the movement to hire scribes so doctors and patients can look each other in the eye again, alert fatigue, and the tendency for clinicians to defer to a new kind of authority: an electronic one. The topic will be the subject of my new book, to be published spring 2015.