Hospital-Based Medicine

Leaders who elevate diverse employees create psychological safety

Policy

December 15, 2022

When I transitioned into a new role as a training faculty member at an academic medical center a few years ago, it didn’t take long to realize that the program had a problem with psychological safety. There wasn’t much.

As I got to know the trainees and heard specific feedback, I began to understand why. The trainees felt criticized and unsupported by the training faculty. And every time there was a …

Physician secrets that nurses need to know

Ronald Hirsch, MD

Physician

December 12, 2022

There is no one prototypical physician. Every physician has their own practice style, their own knowledge base, and their own preferred method of communication. In my role as medical director for case management at my community hospital, I was given 30 minutes during new nursing orientation to provide nurses tips when communicating with doctors.

I put together this list of things that physicians wished hospital nurses knew about them, both good …

Communication protocols exist for a reason

Michael J. Grace, JD

Conditions

December 11, 2022

An excerpt from The Mumbo Jumbo Fix: A Survival Guide for Effective Doctor-Patient-Nurse Communication.

Team building is a popular trend in health care. It promotes cooperation, trust and respect, improves communication, and enhances patient outcomes. Most of the time.

But the camaraderie and familiarity of working with the same group of people …

All I ever wanted to be was a nurse [PODCAST]

The Podcast by KevinMD

Podcast

December 10, 2022

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

“As a nurse, I know how difficult and demanding the job can be. I’ve had patients try to physically attack me and it’s frustrating and disheartening to face such hostility. When I talk to people outside of the health …

If the hospital CEO emailed employees like Twitter’s CEO

Jennifer Lycette, MD

Physician

December 7, 2022

To: [Group: all employees]

From: Office of the CEO

Subject: A fork in the road

Going forward, we will need to be extremely hardcore to streamline a restructured Health care 2.0 and succeed in an increasingly diseased world. This will mean working even longer hours at high intensity. Only exceptional performance will justify a new N95 mask each week.

Health care will also be much more profit-driven. Physicians and nurses will still be very …

Bring the real You to your workplace

Randall S. Fong, MD

Physician

December 3, 2022

Life is short, so make yours extraordinary. Capitalize on what makes you, YOU, and be your own unapologetic self.

The Almighty designed us as unique but imperfect and flawed individuals, prone to sin and blundering error. But that’s the great part of being human; we’re expected to sin, blunder, and make mistakes. We’re made to err for the sake of learning and growth; otherwise, we’d wither into uninspiring nothingness. Keep this …

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Bring the real You to your workplace

Why is collaboration missing in health care?

Paul Pender, MD

Physician

November 20, 2022

An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.

Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise …

Why we should end gendered titles

Deepak Gupta, MD

Physician

November 18, 2022

The question of addressing physicians by name has been addressed again. Yet the question about names has not been addressed.

Before addressing the name question, I will talk about how I have evolved with time.

In India, I have been used to formally addressing everyone as either “Sir” or “Madam” during in-person meetings and in virtual communications when I have known them — “Sir/Madam” or rarely …

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Why we should end gendered titles

Leaving The House of God

Elizabeth LaRusso, MD

Physician

November 17, 2022

To paraphrase Fat Man’s Law Number Three, “At a code, the first pulse you take is your own.”

Enduring advice, as true today as it was in the early ’70s when Roy G. Basch, MD, and his gang of hapless interns roamed the airless wards of The House of God, the mythical hospital in the infamous novel by Samuel Shem, although almost everything else about practicing medicine seems …

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Leaving The House of God

Institutional betrayal vs. courage

Susan MacLellan-Tobert, MD

Physician

November 10, 2022

The pandemic has brutalized health care such that the term “institutional betrayal” (IB) is becoming part of the physician vernacular. This cringe-worthy term is being used to point a finger of shame at health care leaders and systems who presumably are failing to support and protect their workers adequately.

Indeed, we depend on our employers for our safety and well-being. With staffing shortages, lack of supplies and lower revenue, employees bear …

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Institutional betrayal vs. courage

Caregiver? Learn how to support older relatives at doctor’s appointments.

Miles J. Varn, MD

Physician

November 8, 2022

As a caregiver or support person for an older parent, partner, or relative, you may be involved in helping that person with medical appointments, perhaps even helping them manage care from several different health care providers. There are a number of strategies that can help you be an effective, respectful advocate for your loved one. These strategies also help ensure that your family member gets the care she or he …

Breaking the cycle of violence in hospitals: the role of trauma-informed care

Jenica W. Cimino, Lyza Hiltner, RN, Katie E. Raffel, MD

Policy

November 7, 2022

“We use a punishment mindset that exacerbates the trauma (people have already suffered). We have to change that.”
– Bryan Stevenson, Director of the Equal Justice Initiative

In the months preceding the COVID-19 pandemic, our quality improvement team was discussing the safety of providers and staff on a weekly basis. This was not in the context of a communicable disease or sufficient personal protective equipment but instead related to another insidious health …

There is no cure for your disease

Houda Bouhmam, MD

Physician

November 5, 2022

I shall translate.

This is her big day! She is meeting with her specialist for the first time, excited to finally hear that she will be cured from her annoying disease.

I am there to interpret back and forth between her and her doctor to eliminate the language barrier.

She has been suffering from this terrible disease affecting multiple organ systems in her frail body for a long time.

Today, she is done!

With her …

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There is no cure for your disease

The merry-go-round of rounding

Maha Al-Ghafry, MD

Physician

November 3, 2022

You start off your morning by receiving the patient handoff, then you “pre-round” on the EHR (furiously scribbling down information), then you physically pre-round on patients (or at least the “sick” ones), then you move onto some form of “proper” rounds that are generally attending specific (walk rounds, sit-down rounds, family-centered rounds, etc.), with the aid of the EHR or flying by the seat of your pants (a.k.a. depending on …

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The merry-go-round of rounding

Speak up for safety in health care

Karolina Brook, MD, Aalok Agarwala, MD, MBA, and Emily Methangkool, MD, MPH

Physician

November 1, 2022

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

A nurse is assisting the attending physician in placing a central line in the intensive care unit.

It’s 3 a.m., and the attending is clearly tired, having admitted eight patients so far on her shift. The nurse notices the physician pushing her eyeglasses up her nose – after …

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Speak up for safety in health care

A hospitalist’s struggle to find teamwork in academic medicine

Fareeha Khan, MD

Physician

November 1, 2022

After a couple of hours of back and forth, I can finally complete an oxygen assessment on a patient ready to be discharged home. The conversation had concluded on a somewhat sarcastic note. I was left feeling guilty of having almost coerced someone to stay beyond their designated duty hours to attain a desirable outcome for a patient. While this was not entirely true, the encounter had brought forth a …

Leading an organizational culture change? Consider an apology first.

Beth Boynton, RN, MS, CP

Conditions

October 27, 2022

Leading an organization from a culture of bullying or blaming to a culture of safety is a daunting initiative. Unhealthy alignments are deeply embedded in toxic cultures, and informal power dynamics may influence how people behave. Instead of respectful communication where giving and receiving constructive feedback is ongoing, common behaviors include:

gossip
exclusion
humiliation
sabotage
withholding

All of which perpetuate a cycle of broken trust and poor conduct.

While patients, the workforce, …

On my hard days, my patients are my heroes

Saba Fatima, MD

Physician

October 24, 2022

I was standing outside the patient room, feeling slightly restless that day. A few days ago, I had just received some news from my doctor that I was not expecting. My mind sifted through the various possibilities and directions this could take me. When will I get to see my doctor to discuss this? What does this mean? As my brain was walking through the various unknowns, my physical body …

We need to talk about the bullying in health care

Aldebra Schroll, MD

Physician

October 20, 2022

As we continue our third year of the pandemic, there have been reports of hostile treatment directed at public health officials and medical personnel. This is escalating a crisis of burnout among health professionals, but there is an insidious, chronic hostility that lurks within hospitals between those who are supposed to be on the same team.

Bullying within health care has been a longstanding challenge. It is pervasive enough that the …

What hospitals can learn from the RaDonda Vaught case

Carmen Presti, DNP, APRN

Policy

October 10, 2022

In response to a medication administration error that led to the death of a 75-year-old patient, RaDonda Vaught, a registered nurse working in Tennessee, was recently found guilty of criminally negligent homicide and gross negligence of an impaired adult.

As a result, she was sentenced to three years of probation with the promise that her criminal record would be expunged if she successfully completes the sentence.

Months after this …