A response to my recent post, The malpractice system doesn’t improve patient safety.
by Brian Nash
In his blog, Dr. Kevin acknowledges that in the “world of medical error, truth is often clouded in secrecy.” He then points out that “… taking the bold step of publicly describing your mistake is a brave one. Some would say it’s long overdue.”
Well so far, Dr. K, we’re on …
Open dialogue on medical malpractice and patient safety
I told a friend what I did recently to get in to see a dermatologist and she was shocked.
“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”
You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …
Choose your primary care physician with particular care
Year: 1993
Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron
Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …
Waste at hospitals in developing countries
Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?
Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.
The …
Educate the patient about their disease and discharge plan
The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.
On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome …
Suspicious withdrawal of a publication from an academic journal
by Rosemarie Nelson, MS
Everyone is trying to “do more with less” and concerns about the economy add fuel to that fire! But, when done with purpose and thoughtfulness, you can manage vendor relationships so that you’ll deliver successful negotiations that will get the most bang for the buck for any medical practice, small or large, multispecialty or single specialty.
Preparation and setting objectives well before contract …
How your medical practice can manage vendor relationships
I’m not sure about the validity of this study: Free Access to U.S. Research Papers Could Yield $1 Billion in Benefits.
Quantifying how much money will be saved by increased efficiency due to open access seems like fuzzy math at best. However, we do need better access to medical journal articles. As a researcher, I’ve constantly fought the battle against firewalled journals. I am fortunate to be part of a university …
Paying for access to medical journals
Everyone one knows ER docs work shifts. Many places though have each doc doing a set schedule. Such as 1 day, 1 evening, 1 overnight or one week with days, one with evenings, and one with nights.
Others, like my hospital, it is a mass jumble. We work all sorts of random shifts at random times, so long as it evens out at the end of the 6 week block that …
Shifts and making switches in the ER
No shows. It seems that no matter what we do, we always have them.
Despite the fact that we call every single person on the schedule to remind them of their appointment the day before (the staff personally makes the call. We don’t use an automated system) we found that in 2009, we had 389 no-shows.
Slicing the data
Is 389 a high number of no-shows? I guess it depends on the size …
Should patients be charged for no shows?
Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.
Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, …
How small private practices can still thrive
The life of a general surgeon is one fraught with contingency, soul-crushing doubt, unexpected disaster, and overwhelming stress. I wouldn’t wish it upon my worst enemy. Fortunately, I was brainwashed to a sufficient degree during residency such that I actually don’t mind my job.
One of the reasons general surgery is so tough is that it is nearly impossible to map out your week according to a strict schedule. Maybe at …
There is no routine procedure in general surgery
As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center.
Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …
Will primary care be saved by the community health center?
by Shawn Vuong
Some time in the years 2002-2005, cardiothoracic surgery hit the wall.
The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over trained surgeons who were no longer in demand. The interventional cardiologist had come along and started stenting coronary arteries, saving patients from the chest opening …
Cardiothoracic surgery has a shortage of surgeons
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by Lyle Denniston
Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …
When does the duty to provide emergency medical care end?
A malpractice lawsuit claims that a doctor treated a patient negligently and that this treatment caused harm, and it seeks monetary compensation. Negligence means that a physician failed to provide the standard of care expected by the prevailing medical custom. Juries decide cases that are tried, but most cases are settled or dropped. Lawyers get paid (typically 35 percent) only when they win or settle a case.
A successful malpractice system …
Our malpractice system needs to focus on patient safety
On my drive in to work this past week I came across this:
A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these moving billboards without paying much attention. But this time I immediately got excited, whipped out my cell phone and snapped …
How the health care industry competes for patients
by Steve P. Sanders, DO, MBA
Are hospitals coming clean? An article recently published in Health Affairs reveals details of a government–required survey conducted in 2008 and 2009.
The Hospital Consumer Assessment of Healthcare Providers and Systems survey or CAHPS is required of all hospitals receiving and hoping to continue to receive federal funding. Analysts compared CAHPS responses between 2008 and 2009 and gleaned what they believed …
CAHPS measures are as important as profit and loss for hospitals
President Bush once said something along the lines of, “We do have universal health care in this country — just go to the emergency room.”
EMTALA. The law requiring emergency rooms to treat everyone’s emergent conditions, a well meaning act that has had disastrous consequences for hospitals’ bottom lines. A disgustingly flawed law on many levels.
How do you prove it is not an emergency condition? You work it up. …
EMTALA threatens the safety net of community care
Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.
These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.
In 1941, following studies that demonstrated …
How dietary guidelines can help prevent disease
She was like … Superwoman. A strapping medical visionary probably in her forties. Gray long coat falling below the knees. She strode confidently down the hallway towards the elevator, a father hurrying beside her with his young lanky daughter cradled in his arms. The girl’s head nuzzled into her father’s shoulder. She was old enough to walk by herself…but clearly she was sick. Unable.
Undoubtedly they were headed from the medical …
Why patients are leaving our practices
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