Viewpoints in This Issue of JAMA


Teaching Physicians to Care Amid Chaos

Allan S. Detsky, M.D., Ph.D., of the University of Toronto, and Donald M. Berwick, M.D., of Harvard Medical School, Boston, examine the changes that have taken place in patient care in recent decades. “In 2013, inpatient medical care in teaching hospitals is different: far more complex, more intense, and, simply put, faster.” One of the results of these changes is that “inpatient care in teaching hospitals has become a relay race for the responsible physicians and consultants, and patients are the batons.”

In this Viewpoint, the authors offer suggestions on how to address the issues of rapid turnover and diffused responsibility among hospital staff.

“We are certain that today’s trainees are not a whit less dedicated to their professional mission than those of an earlier era were at their best, but we cannot help wonder whether the very definition of caring changes in undesirable and unintended ways when responsibility becomes a rapidly revolving door. If that risk exists, it warrants conversation.”

(JAMA. 2013;309[10]:987-988. Available pre-embargo to the media at


Putting Health IT on the Path to Success

William A. Yasnoff, M.D., Ph.D., of NHII Advisors, Arlington, Va., and colleagues discuss the problems with the current approach to health information technology (HIT), and suggest an alternative that is “simpler, scalable, less expensive, and more secure and can provide lifetime records: patient-centric community health record banks (HRBs).”

“The idea of HRBs is not new. What is new is appreciating how HRBs can help achieve the HIT vision while most current health information exchange (HIE) pursuits cannot. It is time for physicians to insist that HIT be pursued with realistic, achievable, and measurable goals that will produce readily available, comprehensive electronic records that can actually improve patient care. To do so requires implementation of model health record banks and then refinement of those models to allow them to achieve the sustainability and scalability that have prevented the success of distributed HIEs. Otherwise, HIT may become its own sociopolitical, legal, and economic disease.”

(JAMA. 2013;309[10]:989-990. Available pre-embargo to the media at


Improving the Electronic Health Record— Are Clinicians Getting What They Wished For?

James J. Cimino, M.D., of the Laboratory for Informatics Development, National Institutes of Health Clinical Center, Bethesda, Md., examines the “promise and perils” regarding the increase in adoption of electronic health records (EHRs).

“EHRs had to start someplace, and they have delivered the wishes of many. Rather than complain about the challenges they have introduced, clinicians should recognize that current EHRs are illuminating the opportunities for the next generation of systems that will support clinicians as active partners across the spectrum of health care settings and tasks. The resulting improvements in documentation will, in turn, support patients, administrators, and researchers as we move towards a true learning health system.”

(JAMA. 2013;309[10]:991-992. Available pre-embargo to the media at


Helping Smokers Quit Around the Time of Surgery

In this Viewpoint, Dhruv Khullar, B.A., of the Yale University School of Medicine, New Haven, Conn., and colleagues discuss the reasons many physicians do not routinely counsel patients to stop smoking before an operation or do not refer them to appropriate cessation services.

“As accrediting agencies and public and private payers search more intensely for value in health care, surgeons must aim to improve postoperative outcomes. An effective strategy will be to encourage patients to stop smoking preoperatively, thereby potentially reducing postoperative complications and length of hospital stay. Collaborations with primary care physicians, anesthesiologists, nurses, and others can facilitate smoking cessation and the delivery of better surgical care.”

(JAMA. 2013;309[10]:993-994. Available pre-embargo to the media at

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

 # # #