My husband and I both like to run. I run about 3 miles once or twice a week — if the weather’s not too bad, and if I don’t have something else going on. Keith, on the other hand, runs half marathons. He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week. He runs in the heat, rain …
Quality improvement is a marathon, not a sprint
You know the story. It goes something like this:
On an ordinary September morning in 1928, Alexander Fleming, a Scottish bacteriologist working at St. Mary’s Hospital in London, came back from vacation to find that one of his Petri dishes containing Staphylococcus aureus growing in culture had been contaminated by greenish mold.
Instead of throwing a fit, Fleming grew curious over this finding. After …
Can serendipity be engineered?
In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately affect those …
Hospital closures affect the safety net. Here’s how.
A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could …
Physicians are treating the well, and nurses are treating the sick
As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.
In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …
Why teaching anatomically correct words matters
This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals?
Full transcript:
The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would …
End the human rights abuse of medical students and doctors
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
Two patient result letters: Which one did this physician send?
“There was one time when I wasn’t here for seven months in a row,” ”Pam” told me.
I sat with Pam in her third floor hospital room — the floor on which she always stays when admitted to the inpatient medicine service — as nurses, doctors, and janitors poked their heads in the door to say friendly hellos and “Nice to see you again, Pam!” A dining facility staff member entered …
Hotspotting: The power of storytelling cannot be underestimated
One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.
I began to understand this paradox clearly when I listened to my friend’s anguish.
She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …
Medicare’s perverse incentive to keep patients on dialysis
CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …
Medicare will pay for care coordination. Should doctors take the money?
You treat a disease: you win, you lose. You treat a person, I guarantee you win – no matter the outcome.
– Patch Adams
Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. …
Regulations are changing the very heart of medicine
The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting.
The theory behind this push, which is part of the federal government’s meaningful use policy, …
3 ways to make health IT work better for nurses
When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to …
Everyone cries when they bury their dead
ADVERTISEMENT
If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team.
I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own.
Admittedly, it’s not quite the surgeon general who …
The surgeon general in limbo: It’s time that he be freed
The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.
Fine motor skills and concentration can be correlated with a positive …
Consider the lipstick sign in your next physical exam
The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp.
As an OB/GYN I want to tell you how bad this actually is.
The …
The sterilization deaths in India: It’s worse than you think
Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential …
Trivializing the significance of losing one’s hair during cancer treatment
Each year, over 20,000 U.S. students begin medical school. They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000. That’s a lot of money. But for some who pursue careers in medicine, the financial cost has been considerably greater. Melissa Chen, 35, a final-year radiology resident at the …
$2.6 million: Is the cost of becoming a doctor worth it?
Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients. Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice. I agreed to the terms and conditions of any large …
When joining a medical practice: The importance of autonomy
I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together.
When I first worked here, 2 years ago, they …
Should hospitals manage hospitalist programs?
Get free updates delivered free to your inbox.
