Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.

Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.

Leadership in graduate medical education: eleven steps instrumental in recovering residency programs after a disaster.

BACKGROUND: A disaster such as Hurricane Katrina can result in extensive devastation to graduate medical education programs. While clinical services largely determine the recovery of each residency program, program director leadership is important. METHODS: A qualitative survey of program directors was conducted to determine the leadership lessons most instrumental after a disaster. RESULTS: Gaining control, establishing communication, designing a vision for the recovery, maintaining physical accessibility, and identifying leaders within the program were identified as critical leadership attributes associated with a residency program's recovery. Understanding the logistics and finances of resident placement was also important. CONCLUSIONS: Preparing for a disaster is the best approach, but where a disaster policy is incomplete or inadequate, it will be the leadership skills of the program's director that will define the success of failure of the residency program.