Patient

Doctors dealing with difficult patients, is it the fault of young physicians?

Kevin

Patient

March 6, 2009

A study released last week reported doctors found that one in six patients were “difficult.”

In addition, physicians who reported these difficult encounters tended to be young and female, leading to a 12-times increased risk of burnout.

Like any relationship, be it a marriage, job, or one between a physician and a patient, not all encounters are going to go smoothly. The editorial commenting on …

Using checklists in the ICU, a real world patient safety success story

Kevin

Patient

March 1, 2009

Initially skeptical of using seemingly commonsense checklists in the intensive care setting, an infectious disease specialist is now a convert supporting the practice.

In his regular Washington Post piece, Manoj Jain writes about his hospital’s initiative in conjunction with patient safety guru Donald Berwick. The program, instituted in 2002, required checklists to be followed prior to common ICU procedures, such as the insertion of central lines, endotracheal …

Should hotels be required to have AEDs?

Kevin

Patient

February 27, 2009

If your heart goes into ventricular fibrillation in a hotel, shouldn’t an automatic external defibrillator (AED) be on hand within minutes?

Surprisingly, that isn’t the case in the majority of hotels. A recent story in the WSJ points to the fact that no more than 20 percent of hotels have such devices.

The reason? Liability, and the questions surrounding Good Samaritan laws, which some lawyers …

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Should hotels be required to have AEDs?

Patient burns from a hospital visit, and fires in the operating room

Kevin

Patient

February 25, 2009

When undergoing a procedure in the hospital, the last thing most patients suspect would be sustaining burns from medical equipment or carelessness of the medical staff.

Thankfully, such instances are rare, but they do occur. As the WSJ reports, the oxygen-rich environment of an operating room can increase the risk of flames, from say, a stray spark of an electrocautery device.

Furthermore, medication patches, like nicotine …

Child mauled by a pit bull, but the ER sends the kid home

Kevin

Patient

February 23, 2009

Trying to find ways to decompress its crowded emergency department, the University of Chicago is “re-directing” non-urgent cases to community centers or clinics.

However, as emergency physician Shadowfax notes, you better be careful who you turn away, because as this case shows, doing it poorly results in a public relations nightmare.

Will those on Medicaid, or without insurance, be preferentially “re-directed” to safety net hospitals? In …

The privilege of being at a patient’s bedside

Kevin

Patient

February 22, 2009

The bedside exam has become increasingly irrelevant, as technology and tests have largely supplanted physical diagnosis skills.

Pauline Chen interviews Stanford’s Abraham Verghese, who also wrote last year’s excellent NEJM piece on the demise of the physical exam, and he provides some provocative insight.

Dr. Verghese calls the physical exam “an important ritual” that still matters to patients. “If as a doctor you shortchange the ritual, …

How to survive heart disease requiring quintuple bypass surgery, did continuity of care care help?

Kevin

Patient

February 22, 2009

Author Jay Neugeboren presented with shortness of breath after exertion, and eventually was diagnosed with coronary artery disease requiring an emergent quintuple-bypass.

How did two doctors, including a cardiologist, miss the urgency of his symptoms? It probably was because they didn’t know the author, whereas his lifelong friend, who turned out to also be a doctor, was able to “place [his] new symptoms in the context of [his] …

When should you keep your sick child away from school?

Kevin

Patient

February 17, 2009

It’s an age-old question that many parents still ask.

Pediatrician Perri Klass gives her take in a NY Times column. In general, you can’t prevent every child who’s shedding virus from going to school, as “that’s everybody all winter long.”

The only confirmed way to prevent the transmission of infection is hand-washing, a habit that should be regularly taught and enforced.

Dr. Klass’ bottom …