Hospital medicine

5,188 articles · Since 2004

Articles, page 102

Our veterans deserve so much better than the VA

June 19, 2014Jun 19, 201412

After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA. Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is…

Let’s start with the computer system. The VA medical record system has been held up as an example of an effective EMR system, in which …

Conditions and diseases

Hospital bills should not outlive our loved ones

Nadi Nina Kaonga

June 18, 2014Jun 18, 201417

In 2010, I lost my mother to cancer. She was a fighter and had survived well past her prognosis, but her hospital costs outlived her. Let me go back to late 2004. That was the year the doctors suspected she…

In 2010, I lost my mother to cancer. She was a fighter and had survived well past her prognosis, but her hospital costs outlived her.

Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the …

Health policy

Should physicians work for hospitals?

Angelo Falcone, MD

June 17, 2014Jun 17, 201410

A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation.

Richard Gunderman, writing for the Atlantic, tackled …

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Should physicians work for hospitals?

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Health care is too nuanced for lengthy scripts

Peter Pronovost, MD, PhD

June 17, 2014Jun 17, 20145

Recently in one of the Johns Hopkins Hospital's intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s…

Recently in one of the Johns Hopkins Hospital’s intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s family — two daughters and a husband — suffered at her bedside, Mandy saw their need for comfort, and she responded. Although she was busy with nursing tasks, she delved …

Physician voices

Optimize nurse partnerships to improve patient care

Val Jones, MD

June 12, 2014Jun 12, 20144

As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and they are therefore …

Health policy

The outrage over how much hospital administrators make

Janice Boughton, MD

June 11, 2014Jun 11, 20142

I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies…

I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.

Hospital administrators and insurance company executives …

Physician voices

Secrets of the VA that aren’t being reported

Chris Porter, MD

June 11, 2014Jun 11, 20147

I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA…

1. The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of …

Physician voices

5 ways to improve the healing environment of hospitals

Suneel Dhand, MD

June 10, 2014Jun 10, 20144

The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …

Medical education

A parting gift from my grandfather

Natalia Birgisson

June 9, 2014Jun 9, 20142

Recently, I began to think of death as a friend. My grandfather was hospitalized on Mother’s Day, and by the time my parents called me on Monday morning they couldn’t tell me anything more than, “He’s in the ICU with multiple seizures. They’re taking him off ventilation tomorrow.” Reaching for the knowledge I’ve spent all year chipping away at textbooks to acquire, I asked about neurologic exams, autonomic drugs and …

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A parting gift from my grandfather

5 things physicians need to know about a business plan

John W. Mitchell

June 8, 2014Jun 8, 2014

Dr. Arlen Myers, president of the Society of Physician Entrepreneurs, can give you ten good reasons why doctors make great entrepreneurs. However, in my many years of working with physicians, I have learned when it comes to a business idea,…

For example, I remember the conversation with an ED medical director about the importance of using “ER” …

Health policy

Walter White and the narrow networks of Obamacare

Brian C. Joondeph, MD

June 7, 2014Jun 7, 201415

As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.” The New York Times observed, “No matter what kind of health plan consumers…

As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.” The New York Times observed, “No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider …

Physician voices

Why the ER admits too many patients

Michael Kirsch, MD

June 6, 2014Jun 6, 201422

Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …

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Why the ER admits too many patients

Health technology

What is the source of deteriorating patient care?

Val Jones, MD

June 6, 2014Jun 6, 20145

For the past couple of years I’ve been working as a traveling physician in 13 states across the U.S. I chose to adopt the locum tenens lifestyle because I enjoy the challenge of working with diverse teams of peers and…

For the past couple of years I’ve been working as a traveling physician in 13 states across the U.S. I chose to adopt the locum tenens lifestyle because I enjoy the challenge of working with diverse teams of peers and patient populations. I believe that this kind of work makes me a better doctor, as I am exposed to the widest possible array of technology, specialist experience, and diagnostic (and logistical) conundrums. …

Physician voices

What paying it forward in health care looks like

Peter Pronovost, MD, PhD

June 4, 2014Jun 4, 2014

The doughnut shop I pass on my drive to the hospital isn't the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from…

The doughnut shop I pass on my drive to the hospital isn’t the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle.

One Sunday before Valentine’s Day, the line to get served there was long, checkered …

Physician voices

A requiem for handwritten admitting orders

Janice Boughton, MD

June 4, 2014Jun 4, 2014

When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …

Health technology

How to improve computerized physician order entry

Suneel Dhand, MD

June 2, 2014Jun 2, 20143

Computerized physician order entry (CPOE) is being rolled out across our nations’ hospitals. The old days of written, and often illegible, orders from doctors are fast becoming a thing of the past. The potential for this measure to improve patient…

As a physician who has worked in several different hospitals since finishing my residency, my time in practice has coincided with the new age …

Health policy

Implementing lean: A hospital case study

Kim Barnas

June 1, 2014Jun 1, 201433

An excerpt from Beyond Heroes: A Lean Management System for Healthcare. Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002.…

An excerpt from Beyond Heroes: A Lean Management System for Healthcare.

Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002. By this time, I was a vice president with operational responsibilities in the hospitals for obstetrics, cancer care, and surgery, in addition to the philanthropic foundations, so I …

Physician voices

Physicians are noncompliant too

Elaine Khoong, MD

May 30, 2014May 30, 201418

Patient noncompliance. I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time. We particularly like using it as…

Patient noncompliance.

I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.

We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …

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Physicians are noncompliant too

Physician voices

Preventing doctors from practicing at the top of their license

Karen S. Sibert, MD

May 29, 2014May 29, 201415

The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively and not …

Health policy

The salaries of health executives: What can doctors do?

Kevin R. Campbell, MD

May 29, 2014May 29, 201460

Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for…

Today, many remain uninsured and the majority that have signed up for the exchanges are simply …

Hospital medicine

Articles, page 102

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