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Physician burnout is an obstacle to patient safety

Physician

March 11, 2013

These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one focused on volume to one that rewards performance. The new system (currently a work-in-progress) promises to put skin in the patient safety game as never before.

Yet I’ve never been more worried about the safety movement than I am …

Media and our kids: Are pediatricians out of touch?

Claire McCarthy, MD

Physician

March 11, 2013

Recently I’ve been wondering if pediatricians are out of touch when it comes to media and kids.

Our messaging is pretty straightforward: turn it off. The recommendation of the American Academy of Pediatrics is that children under the age of 2 should not watch TV at all, and everyone else should watch no more than 2 hours a day. And when we talk …

The condolence letter: A dying tradition among doctors

Ishani Ganguli, MD

Physician

March 11, 2013

When a patient dies in the hospital, we go through a checklist that has become eerily mundane. Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere …

Primary care trends in the health reform era

Matthew Mintz, MD

Health Policy

March 11, 2013

As a physician who is involved in educating medical students, I am often asked for career advice. Medical students are by nature smart and ask very good questions. “Will I be able to pay of my student loans if I choose primary care?” “Will I have a balanced lifestyle if I decide to go into primary care?”

I try to be both encouraging and realistic. However, far too often I have …

How Obamacare penalizes safety net hospitals

Jeffrey Parks, MD

Health Policy

March 11, 2013

shutterstock_39558046

The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and doctors for having poor HCAHPS scores has reaped its own set of unforeseen complications.

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the Press-Ganey …

Let no broken hip go unfixed: When a surgeon fails to communicate

John Schumann, MD

Physician

March 10, 2013

She was 94-years old with advanced Alzheimer’s. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip.

She’d fallen at her assisted living facility. It was the second time in as many months. She’d broken her collarbone on the previous occasion.

Over the past year, she’d lost 30 pounds. This is natural in the progression of …

Caring for the emotional needs of a cancer patient

Miranda Fielding, MD

Conditions and Diseases

March 10, 2013

Multi-tasking has never been my forte and so I like to keep my schedule organized. Mondays, I see all of my on-treatment patients. Tuesdays and Thursdays I see new patients in consultation. Wednesdays are reserved for treatment planning and research projects. But Fridays—well, Fridays are usually the best day of the week. Not only is the weekend approaching, with time to spend on my menagerie and the ever present home …

Soft drinks and obesity: What do we want from Coca-Cola?

David L. Katz, MD

Physician

March 10, 2013

Responding to our justifiably increasing preoccupation with widespread obesity, the Coca-Cola Company has released a masterful television ad on the subject. They characterize their own efforts, and invite us all to “come together” to combat this scourge. The whole “come together” concept receives great emphasis, with evocative images from the (presumably) good old days of: “I’d like to buy the world a …

EMRs cannot fix the financial and physical health of the nation

Margalit Gur-Arie

Health Technology

March 9, 2013

Somewhere between the 20th century bank ATM and the 25th century Tricorder, lays the EMR that we should have today. Somewhere between the government-designed meaningful use EMR and the holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains.

We must …

The hospital has a circadian rhythm of its own

Laura Webb, RN

Physician

March 9, 2013

It wasn’t until I became a nurse that I realized how long a hospital hall could be! And, whether we are walking, rolling, or running down those halls, our steps can seem endless.

Oh sure. Current hospital halls may be relatively short, compared to the immense and cavernous wards of days gone by. But hospital halls have an open and hollow resonance of …

Reducing medical errors: What we can learn from the Dreamliner

David B. Nash, MD, MBA

Health Policy

March 9, 2013

If you think that medical errors are a thing of the past, you are mistaken.

It has been 14 years since the Institute of Medicine’s report “To Err Is Human” shattered the myth that most, if not all, physicians are all-knowing practitioners with flawless skills and infallible judgment.

The story of what happened in the report’s wake was predictable:

Where the healthcare industry failed to …
Read more…

Reducing medical errors: What we can learn from the Dreamliner

MKSAP: 54-year-old woman is evaluated during a routine examination

mksap

Conditions and Diseases

March 9, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels like she “just doesn’t want to be touched.” She used to enjoy intercourse and does not know why she feels this way now, but she acknowledges that it is causing …

When it comes to medical residents, patients have a choice

Shirie Leng, MD

Medical Education

March 8, 2013

A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at …

When end of life approaches: 2 pathways of care

Jordan Grumet, MD

Physician

March 8, 2013

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity.

The woman lying on the gurney was motionless. Her chest moved up and down with a timid but halting regularity. The calmness of her face was in sharp contrast to the panicked despair of the …

Oprah should devote a show to vaccine safety

Jennifer Gunter, MD

Medications

March 8, 2013

oprah

I am sure Oprah had spectacular ratings for her Lance Armstrong interview and so, in the spirit of truth-telling, I have another mea culpa show for Ms. Winfrey to consider: vaccine safety.

Until Jenny McCarthy got major air time the link between vaccines and autism was relatively fringe. But with Oprah in September of 2007 McCarthy, and by extension Andrew Wakefield, the erroneous link …

One day of a psychiatrist with a homeless outreach team

Maria Yang, MD

Physician

March 8, 2013

A sample agenda as the consulting psychiatrist with a homeless outreach team:

8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day.

8:55am. Walk with a case manager to the ferry terminal meet Paul (note: all patients described here are composites of people I have …

A prayer for the patient

Stephen W. Leslie

Patient

March 8, 2013

I was startled awake at 3:40 am by a loudspeaker blaring “Code Blue … Code Blue.”

As the hospital’s newly hired chaplain intern, I’d been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my pajamas, I made sure to put on my hospital badge.

I made my way to the hospital’s “Z” building, where the ICU was located, and took the elevator to the fourth floor. …

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A prayer for the patient

Cookbook medicine can make doctors clinically lazy

David Mokotoff, MD

Physician

March 7, 2013

Juan Gonzales, (not his real name), is a somewhat demented elderly Hispanic male, who I met last week in an intensive care unit. He spoke little English, and I spoke limited Spanish. His devoted family was at the bedside, and fortunately his daughter was able to provide some history. He was admitted with palpitations and dizziness and atrial fibrillation with a rapid response.

His family had just moved him from Miami, …

The fine line between compassion and detachment

Christine A. Garcia, MD, MPH

Physician

March 7, 2013

I’m told every doctor has their list of unsolved patient mysteries. Those patients where something terribly awful or something miraculous happens for which you lay awake at night trying to understand. The nature of doctors is to want solve problems and figure out medical mysteries in sleuth-like Sherlock Holmes fashion. It’s these unsolved mysteries that you remember as they perplex you for days, weeks, possibly years after.

For me, it happened …

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