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Hospital Medicine

Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

Tech

Administrative bloat in hospitals is a design choice

The secretary who became fifteen executives' assistant A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel…

The secretary who became fifteen executives’ assistant

A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel went through an agency. Over the next twenty years, email replaced the mail, voice recognition replaced the typist, and a website replaced the travel agent. By the time he retired, one …

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Administrative bloat in hospitals is a design choice

Physicians

A national hotline could track bias in physician discipline

Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training…

Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training routinely extends well beyond a decade after college.

The investment is financial, professional, and deeply personal. Medical graduates routinely carry substantial educational debt, spend thousands of hours studying, take licensing examinations, …

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A national hotline could track bias in physician discipline

Physicians

Observation status is a clinical choice, not a billing one

One night, during cross coverage with residents, I was called to provide clinical oversight for a frail older woman admitted from the emergency department. She had multiple comorbidities and a deteriorating clinical picture, but she had been placed under observation…

One night, during cross coverage with residents, I was called to provide clinical oversight for a frail older woman admitted from the emergency department. She had multiple comorbidities and a deteriorating clinical picture, but she had been placed under observation status. I was perplexed.

When I asked residents why observation was so often selected, the answer was usually some version of this: “It is easier to change the patient to inpatient …

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Observation status is a clinical choice, not a billing one

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Physicians

Fragmented care made my family her care coordinator

I recently read Kara Wada's September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer. When my wife Kathy was dying, nobody did. Kathy…

I recently read Kara Wada’s September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer.

When my wife Kathy was dying, nobody did.

Kathy was not the victim of one catastrophic mistake. There was no single dramatic error that changed the course of her illness. What I witnessed instead was something more common and, in many …

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Fragmented care made my family her care coordinator

Conditions

Overtreatment at the end of life is a spiritual problem

My name is Tony Grandelis. I'm an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what the principles of addiction recovery (honesty, surrender, humility, community) can…

My name is Tony Grandelis. I’m an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what the principles of addiction recovery (honesty, surrender, humility, community) can teach us about fixing a broken health care system. Recovery gave me something medicine never did: a framework for sitting with what cannot be fixed, for accepting what cannot be …

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Overtreatment at the end of life is a spiritual problem

Conditions

How does the halo effect in medicine harm patients?

I have spent decades in health care. I know how much physicians rely on clinical judgment, pattern recognition, and experience. Those skills matter, and they also carry a risk: The human brain is constantly filling in gaps, and sometimes the…

I have spent decades in health care. I know how much physicians rely on clinical judgment, pattern recognition, and experience. Those skills matter, and they also carry a risk: The human brain is constantly filling in gaps, and sometimes the story we create about a patient can become more powerful than the information the patient is trying to give us.

I experienced this recently during a telehealth visit with a physician …

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How does the halo effect in medicine harm patients?

Physicians

The grief health care workers carry after maternal death

She was a young mother. We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped. CPR began immediately. The obstetric…

She was a young mother.

We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped.

CPR began immediately. The obstetric team delivered the baby while compressions continued. Thirty minutes passed. No pulse. We kept going. Every voice in the room was thinking out loud. What are the reversible causes? Keep going. Don’t …

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The grief health care workers carry after maternal death

Conditions

The true meaning of compassion in health care

The most profound lessons in compassion did not come from textbooks or training. They came from the patients who invited me into their stories. "Will you stay for a little while?" A patient asked me this question after receiving news…

The most profound lessons in compassion did not come from textbooks or training. They came from the patients who invited me into their stories.

“Will you stay for a little while?”

A patient asked me this question after receiving news that would change the course of her life. I had no medical solution to offer. I could not take away her fear or change her diagnosis. All I could do was pull …

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The true meaning of compassion in health care

Conditions

Care orchestration should start in the patient portal

After years of working with numerous health systems and my own experiences as a patient and caregiver, I have come to realize how challenging it can be to manage one's own care. Care doesn't stop when patients leave a health…

After years of working with numerous health systems and my own experiences as a patient and caregiver, I have come to realize how challenging it can be to manage one’s own care. Care doesn’t stop when patients leave a health care facility. It is often just the beginning of a long journey for them. Most often, after a doctor visit or surgical procedure, a patient has an extensive to-do list: …

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Care orchestration should start in the patient portal

Physicians

Is racial bias in physician discipline being measured?

The central limitation in evaluating racial parity in physician discipline is not the absence of concern, but the absence of standardized upstream data. Existing national systems primarily capture terminal outcomes. The National Practitioner Data Bank (NPDB), for example, receives reports…

The central limitation in evaluating racial parity in physician discipline is not the absence of concern, but the absence of standardized upstream data. Existing national systems primarily capture terminal outcomes. The National Practitioner Data Bank (NPDB), for example, receives reports of certain adverse clinical-privileges actions, including review actions restricting privileges for more than 30 days and certain surrenders while under investigation. It does not comprehensively capture the discretionary …

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Is racial bias in physician discipline being measured?

Conditions

A second opinion abroad should clarify, not just differ

The messages usually arrive with the same tension: "My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?" Patients who contact us for second opinions abroad are rarely looking for a medical…

The messages usually arrive with the same tension: “My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?”

Patients who contact us for second opinions abroad are rarely looking for a medical argument to win. Most are trying to make a difficult decision without regretting it later. They want to know whether the diagnosis is complete, whether the proposed treatment is necessary, and …

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A second opinion abroad should clarify, not just differ

Conditions

Reduced to a diagnosis: I was the patient in bed 27

The longer I spent in the mental health system, the harder it became to remember who I was outside the pages of my medical record. Because when people stopped referring to me as the young girl I was, and instead…

The longer I spent in the mental health system, the harder it became to remember who I was outside the pages of my medical record. Because when people stopped referring to me as the young girl I was, and instead as a diagnosis or simply as “the patient in bed 27,” how was I supposed to remember who I was outside those hospital walls? The staff had read through my …

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Reduced to a diagnosis: I was the patient in bed 27

Conditions

Medical uniform design is quietly shaping the runway

Until recently, I believed I understood uniforms. For more than fifteen years, I covered the fashion industry, attending runway shows, interviewing designers, and writing about the ways clothing reflects culture. Fashion has always borrowed ideas from uniforms, whether military tailoring,…

Until recently, I believed I understood uniforms.

For more than fifteen years, I covered the fashion industry, attending runway shows, interviewing designers, and writing about the ways clothing reflects culture. Fashion has always borrowed ideas from uniforms, whether military tailoring, aviation jackets, or workwear. I thought I knew why.

Then, after a serious leg injury at Paraiso Miami Swim Week, I unexpectedly found myself in a hospital, not as a journalist, but …

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Medical uniform design is quietly shaping the runway

Policy

The question to ask after a hospital says it’s accredited

China now has more than 100 JCI-accredited hospitals, the same Joint Commission International standard many U.S. patients recognize from conversations about hospital quality. That number surprises people. It also invites a dangerous shortcut: "JCI-accredited" becomes shorthand for "safe," "excellent," or…

China now has more than 100 JCI-accredited hospitals, the same Joint Commission International standard many U.S. patients recognize from conversations about hospital quality. That number surprises people. It also invites a dangerous shortcut: “JCI-accredited” becomes shorthand for “safe,” “excellent,” or “the best place for my operation.”

Patients deserve a more careful answer.

JCI accreditation matters. I do not dismiss it. But it is not a guarantee of outcomes, technical skill, complication management, …

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The question to ask after a hospital says it’s accredited

Physicians

Who is your witness? A question for every patient

With three months left of intern year of internal medicine residency, I took the leap and adopted a dog from the Dallas Animal Services shelter. She is my SuperNova. Nova is a two-year-old Lab-Pitbull mix with big brown eyes that…

With three months left of intern year of internal medicine residency, I took the leap and adopted a dog from the Dallas Animal Services shelter. She is my SuperNova.

Nova is a two-year-old Lab-Pitbull mix with big brown eyes that hold your heart and a wagging tail that could power a small town. Her world is simple: following me from room to room, shaking with excitement when I pull out her …

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Who is your witness? A question for every patient

Physicians

Why AI may make hospitalists more essential, not less

For years, health care commentators have predicted that technology would reduce the need for hospitalists. The logic seemed straightforward: If artificial intelligence can analyze labs, interpret imaging, suggest diagnoses, and generate treatment plans, why would hospitals need thousands of physicians…

For years, health care commentators have predicted that technology would reduce the need for hospitalists. The logic seemed straightforward: If artificial intelligence can analyze labs, interpret imaging, suggest diagnoses, and generate treatment plans, why would hospitals need thousands of physicians whose primary role is coordinating inpatient care?

The prediction may have gotten it exactly backward.

Rather than making hospitalists obsolete, AI may accelerate a future in which hospitalists become the dominant physician …

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Why AI may make hospitalists more essential, not less

Conditions

Supporting night shift workers starts with one question

A few months ago, I had just completed another demanding overnight shift. As morning approached, I finished my documentation, prepared to hand off my patients to the day team, and looked forward to driving home. Before leaving, our hospital administrator…

A few months ago, I had just completed another demanding overnight shift. As morning approached, I finished my documentation, prepared to hand off my patients to the day team, and looked forward to driving home. Before leaving, our hospital administrator joined our morning huddle to thank both the day and night physicians for caring for patients around the clock. As our conversation came to an end, he smiled, looked at …

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Supporting night shift workers starts with one question

Physicians

Detachment is not strength: lessons from dying patients

They say a dying man doesn't lie. But have you ever wondered why? Is it a sudden surge of enlightenment? A newfound wisdom that only arrives when the clock begins to run out? Or is it something more visceral? The…

They say a dying man doesn’t lie. But have you ever wondered why?

Is it a sudden surge of enlightenment? A newfound wisdom that only arrives when the clock begins to run out? Or is it something more visceral? The experience of being brought face-to-face with every morally questionable choice, every “snoozed” priority, and every unspoken truth?

Many religions speak of a Judgment Day or a Karma, a moment where we are …

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Detachment is not strength: lessons from dying patients

Policy

Fragmented care is the gap digital health left open

One of the unintended consequences of digital health is that we became extraordinarily good at collecting information without spending nearly enough time teaching clinicians how to use it together. For years, health care informatics focused largely on documentation itself. We…

One of the unintended consequences of digital health is that we became extraordinarily good at collecting information without spending nearly enough time teaching clinicians how to use it together.

For years, health care informatics focused largely on documentation itself. We trained clinicians to click, complete, reconcile, acknowledge, and navigate increasingly complex systems. Conversations emerged around reducing clicks, decreasing documentation burden, and improving workflow efficiency. Those things matter.

But somewhere along the way, …

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Fragmented care is the gap digital health left open

Physicians

Why do physicians write fiction?

I remember the moment I understood I would have to write this story. I was in Berlin with my girlfriend, wandering the city hand in hand, stopping for coffee near the Tiergarten with no real plan. We decided to visit…

I remember the moment I understood I would have to write this story.

I was in Berlin with my girlfriend, wandering the city hand in hand, stopping for coffee near the Tiergarten with no real plan. We decided to visit the Jewish Hospital, the Jüdisches Krankenhaus. I had heard the name so many times in my family, and now I was just a few metro stops away.

We entered beneath the old …

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Why do physicians write fiction?

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