Without much ado, let’s dip into the mailbag and see what readers are thinking:

Regular columnist David Ollier Weber penned an interesting commentary on the need for clinicians to embrace etiquette-based medicine. Alan Rosenstein agreed:

Great commentary. Just to reinforce the importance of good "bedside manners," we are spending more time working with physicians and their organizations on improving their "emotional intelligence" and overall communication and collaboration skills. In today's demanding, highly complex health care world, taking a step backward to remember why we went into the profession and to reinforce that the importance of sensitivity, empathy, and compassion will not only improve healing, it will also improve relationships among physicians, staff, patients and their families, which will increase the quality of clinical outcomes and overall satisfaction with care.

Kristin Baird liked Weber’s column as well, but offered this perspective:

David, you make excellent points here. Getting back to the first question in the article about which surgeon I would prefer, my answer is neither. Consumers are tired of having to choose between competent and nice. We want and expect both. Anything less will result in a poor experience either clinically or emotionally. Physicians must accept that it's no longer an either/or proposition. It's both/and. Health care organizations must expect providers to deliver competent and collaborative care in partnership with patients and the rest of the care team. The word value in value-based purchasing is evaluating on both and so is the consumer.

In late July, I wrote a blog about a series of recommendations that an IOM committee made regarding the future of graduate medical education. Greg Bazylewicz, M.D., of Lahey Health, Burlington, Mass., sees the need to incorporate ambulatory training in physician education, although not to the same scale as the IOM panel suggests.

Having practiced family medicine for over 30 years before becoming an administrative SVP in a large integrated system, I appreciate the importance of teaching in an ambulatory setting, and have done so with medical students over time. However, the move to ambulatory settings does not apply to all areas of training focus and not to all specialties. The better focus would be specialty-specific changes. Family medicine, primary care, internal medicine and community-based pediatrics all have the ambulatory setting as their home base; they need the training to focus there. Other specialties need to retool as necessary to provide quality ambulatory- and day-service-based procedures and ongoing care, focused on the Triple Aim. To do a heavy-handed and sudden change will likely be detrimental through any change period. A transitional approach would be far more effective in the long run.

Paul Barr continued to examine the need for hospitals to embrace the call for better antibiotic stewardship. His August 13 blog reported on calls from the CDC for hospitals to create stewardship programs, as well as a new AHA toolkit aimed at helping hospitals do just that. His blog drew this response from Douglas Hough at Johns Hopkins University-Bloomberg School of Public Health:

What you are saying about the need for stewardship over antibiotic use makes sense, lots of sense. But that may be part of the problem. What is a physician to do when a patient presents with bronchitis and demands an antibiotic? The physician knows full well that only 5 percent of bronchitis is bacterial. Yet, 73 percent of the time they will prescribe an antibiotic.
Why? Well, explaining that viral bronchitis will not respond to antibiotics and over-prescription of antibiotics will lead to drug-resistant strains and … takes time (which the physician does not have, and is not paid for) and the patient will probably not be convinced.
Not that hospitals should do nothing, but the problem lies in both incentives for physicians and our inherent bias to DO SOMETHING!
Just a thought.

In this video interview, Inspira Health Networks’ Steven Linn, M.D., and John Glaser, Siemens Healthcare, discussed how hospitals can get smart about using data as they take on more risk. Hank C., liked what he heard:

It's really interesting what Dr. Linn says about population health management with risk stratification. If 45 percent of costs go toward 3 percent of the public, then imagine what we can do if we can drastically improve the health of that 3 percent? Even if we can cut that huge expenditure by 20–30 percent, we'd take a huge bite out of what it costs to keep people healthy. These are really exciting concepts. Great video!

And lest you think that our mailbag is just a giant lovefest, Carol Bradley was disappointed in the makeup of an expert panel we put together a few months ago to discuss delivery system transformation.

I read this article with interest because of the topic. However, I was sorely disappointed that H&HN would attempt this discussion without a nursing leader included. I also continue to be disappointed in the lack of diversity your panels represent when you are representing an industry with a workforce that is predominantly female.

Exercising a bit of editorial discretion, I’d like to point out that we do aim to diversify our panelists on our Executive Dialogue series, such as this one on technology and big data, with several female hospital leaders, a couple of whom are nurses, or this one on managing a multigenerational workforce.

As always, we welcome your thoughts. Comment below or directly to me via emailTwitter or Google+.