reprinted from Issue 24, Spring 2017 of Frontiers of Medicine (PDF)
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Robert M. Wachter, MD, who was appointed the chair of the UCSF Department of Medicine last October, has had an astonishingly diverse and influential career.
“It’s what happens when a political science major becomes an academic physician,” said Wachter, who holds the Holly Smith Distinguished Professorship in Science and Medicine and the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. “Every eight to 10 years, I have been able to jump into a really interesting issue and make a contribution.”
His first book, The Fragile Coalition: Scientists, Activists, and AIDS, chronicled the contentious Sixth International Conference on AIDS held in San Francisco in 1990, and through it, the influence of patient activism on health care policy. In 1996, Wachter and then-Chair of the Department of Medicine Lee Goldman, MD, co-authored a New England Journal of Medicine article that coined the term “hospitalist,” describing a new kind of expert who specializes in the care of hospitalized patients. With about 50,000 hospitalists in the U.S. today, hospital medicine is the fastest growing specialty in the history of modern medicine.
In 1999, after an Institute of Medicine report estimated that nearly 100,000 people died annually due to medical errors, Wachter wrote two bestselling books, Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes, and Understanding Patient Safety, urging systemic changes to prevent mistakes.
“I try to listen and learn, see the big picture, and tell a story that helps people better understand something that’s important,” said Wachter.
Reimagining Health Care
His most recent efforts have focused around the promise and perils of the digital health revolution. Several years ago, Wachter found himself pitching stories to his wife, author and New York Times journalist Katie Hafner, about how health information technology was radically changing the practice of medicine. Then Wachter learned about an egregious medication error at UCSF Medical Center: a teenager received a 39-fold overdose of a common antibiotic, ordered through the computerized prescribing system. “That error wouldn’t have happened if we were still paperbased,” he said. “I came home and said, ‘Honey, I need to write a book about this.’”
That book, published in 2015, is The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. “Just six or seven years ago, health care was primarily an analog, three-ring-binder industry, and now we’re primarily a digital industry,” said Wachter, noting that this huge shift includes both the widespread adoption of electronic health record systems as well as consumer-facing devices and software, such as Fitbits and smartphone apps. “At the same time, we’re under massive business pressures to make patient care better, safer, more satisfying and less expensive.”
Medical informatics is potentially an invaluable tool for increasing health care value, but the field is still in its infancy. “I don’t think we have any idea what the end of the movie looks like,” said Wachter. “The disruption in industries like print journalism, taxis and hotels was massive, and people in those industries didn’t know what hit them until it was too late. UCSF’s excellence, impact and reputation will increasingly be determined by the ability to use information technology to enhance and transform our work across all of our missions.”
Some of UCSF’s strengths in this area include its excellence in digital health, leadership role in precision medicine, and strong history of industry partnerships, whether with biotechnology firms or technology startups. Add to that UCSF’s proximity to leading technology companies in San Francisco and Silicon Valley, its participation in a UC-wide data sharing network, and its history of innovation, and Wachter sees the Department of Medicine’s potential to become an international leader in applying digital tools to advance clinical care, research and training.
Rather than just digitizing analog processes, Wachter sees this as an opportunity to reimagine the entire process of health care. “Instead of just taking a paper chart and creating a digital version, we should be thinking, ‘Is this the right way to record data about patients?’” he said. “Where things get massively better is when people say, ‘Let’s do this in an innovative way that takes advantage of new digital tools.’ That’s the core job we all have, and we’re in an incredibly good position to do that.”
Finding Joy at Work
Growing up on Long Island, Wachter was inspired by his father, a successful small businessman who did not attend college. “He was really funny, cared deeply about people, and had boatloads of emotional intelligence,” said Wachter. “One of the things I learned from him is if you’re not having fun, you’re not getting it right. I want to promote an environment in which people take their work seriously, but can also say, ‘I had fun and did something interesting and important today.’”
Wachter received his undergraduate degree in political science and govern-ment from the University of Pennsylvania, then earned his medical degree from Penn’s Perelman School of Medicine. He completed residency and chief residency in internal medicine at UCSF and a Robert Wood Johnson Clinical Scholar fellowship at Stanford, then joined the UCSF faculty in 1990, based at Zuckerberg San Francisco General Hospital and Trauma Center. He served as internal medicine residency director from 1992 to 1995, then ran the medical service at UCSF Medical Center. He was founding chief of the Division of Hospital Medicine, which grew from its first faculty member in 1995 to about 70 today.
“My overall vision is that our department should be the world’s leader in providing better, safer and more efficient care at the lowest cost, producing trainees that are excellent in all those things, and having a research agenda that advances our ability to deliver that and advances the science of medicine and health,” said Wachter. “My fundamental job as a leader is to create an environment where spectacular people want to be here and are inspired to do their best work. So much of the work is about listening to people, forging relationships and gathering consensus.”
One of the biggest challenges he sees for the Department of Medicine is its sheer size. “I am excited about using new tools to communicate,” said Wachter, who was an early adopter of Twitter and blogging. He also looks forward to simultaneously pursuing the multiple missions of patient care, education and research, particularly with UCSF Health as a robust partner. “I love interesting challenges that require a lot of balancing in an environment that’s rapidly changing,” he said.
Wachter will continue to serve as an attending physician on the hospital wards four weeks per year. “It allows me to write and speak effectively about the health care system, plus it energizes me tremendously,” said Wachter. “Our housestaff and students are so smart, and the patients are fantastically interesting.”
Outside of medicine and politics, Wachter’s passions include golf, piano and tweeting (@Bob_Wachter). He and his wife have three grown children: Doug, Benjy and Zoë.