Archives

San Francisco General Hospital has a rich history. Pieces of it come to light every day as the heavy equipment unearths remnants of old foundations, water systems, ceramic tiles, walkways, etc. in preparation for the construction of a new building. It's a veritable archaeological dig out there.

Perhaps inspired by all the rebuild activity, a few of us have started talking about organizing some type of hospital archives. In offices and labs all over campus there are stashes of historic photos, art work, old lab notebooks, scrapbooks, and file folders containing newspaper clippings and other memorabilia that will be lost unless we take steps to collect and preserve them now.

Our unofficial archives committee is working on a plan to archive this material in some yet-to-be-determined format. Maybe it will be a presentation scrapbook to be used for fund raising, maybe it will be a digital archive accessible online for all to see. Maybe it will include materials we haven't yet identified as important, and maybe it will be organized in a way we haven't even thought of yet. It's definitely a work in progress, and will probably always will be...because that's the nature of an archive.

Postcard from edge...

From the edge of Lake Mudd, that is. The landscape outside the library's workroom windows in Building 30 changes dramatically every day, and although we're growing weary of weeks of rain, the bad weather has brought us a new water feature to look at...Lake Mudd. Perhaps later in the year, we'll rename it Lake Dust. Then, if all goes according to plan, it will become even deeper and lined with cement, rebar, pilings, tie-backs etc., the foundation of the new hospital. This is exciting business. We never know exactly what landscapes will confront us when we come to work in the morning.

Baaaaad Thoughts

While Twittering this morning I came across a report that brings scientific evidence to the proposition that bad thoughts cause bad outcomes. DO NOT have these thoughts, or have as few of these thoughts as you possibly can.

Reading Books on Teeny Screens: Good Idea or Health Hazard?

I attended a Medical Library Association-sponsored webcast last week, "Cutting the Cord: connecting to our Mobile Users". It was about providing electronic content to users via their mobile devices such as iPhones, PDAs and other handhelds. One thing I was surprised to learn was that people are actually reading books on devices with little bitty screens such as iPhones and iPod Touchs. I can understand Kindles and Netbooks, but iPhones?

Just to prove how ridiculous the idea was I went to the iPhone app store and installed both Amazon's Kindle and Lexcycle's Stanza (both free apps) and downloaded a book (free, of course) from each to see how I liked it. Surprise...I liked it! I don't particularly like reading on my desktop monitor, but this is different, and I'm not sure why. Now I can read books on my iPhone while I'm on Muni trying to ignore the shootings and muggings. Just have to remember not to read while driving. Someone might video me and put it on YouTube.

Health Journalism and the Patient Safety Movement

UCSF's own Robert Wachter has published another well-written, thought-provoking commentary, this time on the contribution that the media makes in the patient safety effort. Titled "The media: an essential, if sometimes artibrary, promoter of patient safety", it appears in AHRQ's Morbidity & Mortality Rounds on the Web and includes an interview with Charles Ornstein, Pulitzer prize-winning health care journalist.

Especially interesting to me was Ornstein's explanation of how health care reporters get their leads and how good journalists provide balance and perspective (how bad is this compared to other hospitals?) as well as just getting the facts straight on what are often very complex topics.

Front Lines

I visited one of our primary care clinics today with the goal of showing the physicians and nurse practitioners how to register for our Loansome Doc service, a full text document delivery service that's built into PubMed. As long as I don't get too long-winded (a temptation) I'm well received during these visits because what is being offered is a quick, easy-to-use service at no charge to the individuals or their clinics. Gotta like it.

Here's a secret: although I make clinic visits under the guise of registering clinicians for Loansome Doc, I always manage to propagandize a bit for some of our other library services, including my absolute all-time favorite resource: Da-da...DynaMed. Click the DynaMed link on our home page to take a look.

DynaMed is a point-of-care tool that is in a good position, I think, to knock off the current king of the hill, UpToDate. Unlike UTD, DynaMed has clearly explained graded levels of evidence, great navigation, clickable reference links to full text articles AND a very usable version for PDAs, including smart phones. Not to mention the fact that it costs approximately 1/10th of what an UTD site license costs. If you are a SFGH clinician and would like to get access to DynaMed, please contact me, jgraham@sfghdean.ucsf.edu. I'll send you the information you need to get started.

Oh yes, this post was supposed to be about Loansome Doc. You can contact me at that same email address if you want to register for Loansome Doc.

Blame vs. Accountability

This week's New England Journal of Medicine contains an article by UCSF's Robert Wachter about the delicate balance between the "no blame" approach and the sometimes overlooked need for physician accountability in regards to patient safety issues. The authors suggest that because physicians are not hospital employees they are subject to only weak enforcement of safety standards. Not wanting to alienate physicians and lose the business they bring in, hospitals have been reluctant to play the enforcer.



Citing the "no-blame" approach as the wrong tool for mature patient-safety practices, Wachter and co-author J. Pronovost (Johns Hopkins) get down to brass tacks by suggesting the circumstances under which physicians should be chastised for lack of adherence to patient safety practices and giving specific punishments such as loss of privileges and education for specific transgressions.



I imagine this article will generate a few letters to the editor, but because it bridges the gap between theory and practice, it's a valuable contribution to patient safety literature and a good starting point for further discussion.