Hospital medicine

5,188 articles · Since 2004

Articles, page 104

There can be no global health without local staff

April 13, 2014Apr 13, 2014

There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase -- “tet chaje” -- which literally means “head charged.” More accurately, it describes…

There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase — “tet chaje” — which literally means “head charged.” More accurately, it describes a sense of being overwhelmed or conveying disbelief or frustration. Based on my limited experiences in the field, I can only begin to imagine the burnout that local providers face …

Health policy

Growing hospital networks create a tension for health reformers

Kevin Pho, MD

April 13, 2014Apr 13, 20142

A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog. To remedy our fragmented health system, reformers want to consolidate health care. President Obama, for instance, has praised integrated health systems…

A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog.

To remedy our fragmented health system, reformers want to consolidate health care. President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform. To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices. Today, about 39% …

Physician voices

Some people will be hospital-dependent despite our best efforts

Janice Boughton, MD

April 11, 2014Apr 11, 20142

The New England Journal of Medicine recently published an article by David Reuben, MD and Mary Tinetti, MD, both academic gerontologists, about patients who are unable to stay out of the hospital. The two physicians study the problems of old…

The New England Journal of Medicine recently published an article by David Reuben, MD and Mary Tinetti, MD, both academic gerontologists, about patients who are unable to stay out of the hospital. The two physicians study the problems of old people, and are of the opinion that most of these “hospital dependent” patients are elderly. Certainly some of them are, but in my experience a surprising number are just chronically ill, …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Medical education

The alarming decline of internal medicine recertification pass rates

Kevin Pho, MD

April 9, 2014Apr 9, 201416

Let's talk internal medicine maintenance of certification (MOC). I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I'm good until 2022. Since then, the American Board of Internal…

Let’s talk internal medicine maintenance of certification (MOC).

I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I’m good until 2022.

Since then, the American Board of Internal Medicine has made maintenance of certification a more “continuous” process, and is sparking some outcry among physicians. Wes Fisher has multiple posts …

Health policy

Why the future of health care can be found in the Cayman Islands

Robert Pearl, MD

April 9, 2014Apr 9, 201413

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status. While it lures many tourists and big banks, it’s…

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status.

While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon.

Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering …

Physician voices

We must place a higher value on discharge paperwork

Suneel Dhand, MD

April 8, 2014Apr 8, 201412

The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very …

Health policy

Differences between banning bossy and true leadership in health care

Alene Nitzky, RN, PhD

April 5, 2014Apr 5, 20147

There's been a lot of hype about the "Ban Bossy" campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously "bossy,"…

There’s been a lot of hype about the “Ban Bossy” campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.

I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, “You …

Physician voices

4 reasons why patients may become angry

Arshya Vahabzadeh, MD

April 3, 2014Apr 3, 201422

Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face. The first step for a…

The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several …

Read more…

4 reasons why patients may become angry

Physician voices

Introducing yourself to patients is a patient safety issue

Peter Pronovost, MD, PhD

April 3, 2014Apr 3, 201411

One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …

Physician voices

An ICU physician’s work is never done

Harlan R. Weinberg, MD

April 2, 2014Apr 2, 2014

If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …

Read more…

An ICU physician’s work is never done

Physician voices

Developing bedside manner comes from understanding who the patient is

Robert Centor, MD

April 1, 2014Apr 1, 20142

Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …

Physician voices

Hospital medicine doctors are key to improving patient satisfaction

Suneel Dhand, MD

March 31, 2014Mar 31, 2014

Improving patient satisfaction and enhancing the hospital experience is all the buzz today in health care. Every hospital executive across the country is talking about it, and coming to terms with how their organization’s reimbursements will be directly tied to…

A decade ago, none of us had ever heard of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, the core metric by which health …

Medical education

Did the NEJM publish a bad study about checklists?

Josh Herigon, MPH

March 30, 2014Mar 30, 20143

Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on…

Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on the subject, quickly wrote a rebuttal on the Incidental Economist. He writes, “I wish the Ontario study were better,” and I join him in that assessment, but want to take it a step further.

Gawande first criticizes …

Physician voices

Unexpected lessons from an unexpected patient

Chiduzie Madubata, MD

March 29, 2014Mar 29, 2014

“I’m so sorry, but it looks like the cancer has spread.” As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that…

“I’m so sorry, but it looks like the cancer has spread.”

As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that I was talking to. I looked at his face and saw that he was trying to remain strong, but in his demeanor, it was apparent that dreams were crushed and that …

Health policy

The whole critical access system needs to be reconsidered

Janice Boughton, MD

March 25, 2014Mar 25, 2014

My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated "critical access" by Medicare because it is felt to be necessary to the health care of the community. Critical…

My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated “critical access” by Medicare because it is felt to be necessary to the health care of the community. Critical access is a designation which was introduced in 1997 when modernization of Medicare payment systems threatened to close a large proportion of hospitals in small communities which were unable to …

Health technology

Why the days of the stethoscope are numbered

Suneel Dhand, MD

March 24, 2014Mar 24, 2014

The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today.

A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and …

Physician voices

Patient experience is not to be confused with patient happiness

David Tilstra, MD

March 22, 2014Mar 22, 2014

I hear providers groan when we talk about the patient experience and some even tell me that they have no impact on the patient experience, that’s an administration problem. Nothing is further from the truth. If you interact with patients,…

Some providers think a full waiting room is a measure of patient satisfaction. Actually, it’s a measure of how long patients will tolerate a long waiting …

Physician voices

Patient satisfaction: Hospitals are not like car dealerships

David Mokotoff, MD

March 22, 2014Mar 22, 201420

Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital -- ever. (I am retiring from medicine in ten weeks.) I certainly wasn't there for the food, although the fare was much better…

Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital — ever. (I am retiring from medicine in ten weeks.) I certainly wasn’t there for the food, although the fare was much better than the daily servings in the doctors’ lounge. Part of the night’s agenda was a rousing talk by the hospital’s new chief medical officer (CMO). A retired surgeon, the CMO …

Physician voices

Discussing financial issues before medical issues: Be more thoughtful

Steven Reznick, MD

March 19, 2014Mar 19, 2014

Well over a year ago, I advised my 80-year-old patient and her children that due to progression of her Parkinson’s disease. Because of her frail nature, she needed a higher level of assistance and care if she wished to remain in her home. She was extremely unsteady walking and several courses of physical therapy had not improved the situation. The patient was feisty and would only allow help to come …

Health policy

How do we avoid initiative fatigue?

Peter Pronovost, MD, PhD

March 18, 2014Mar 18, 20144

Frontline caregivers across the United States -- and in many other countries, no doubt -- are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other…

Frontline caregivers across the United States — and in many other countries, no doubt — are bombarded by multiple quality improvement (QI) projects. A clinical unit might simultaneously be engaged in efforts to reduce readmissions, eliminate hospital-acquired infections and other complications, increase hand-hygiene compliance, improve performance on core measures, and enhance the patient experience. The demands brought by participating in all of these efforts risk overwhelming health care professionals, who …

Read more…

How do we avoid initiative fatigue?

Hospital medicine

Articles, page 104

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular