Hospital medicine

5,188 articles · Since 2004

Articles, page 105

Why doctors shouldn’t bill for time

March 17, 2014Mar 17, 201413

As health care rightly moves towards a model of rewarding quality over quantity, the issue of how best to reimburse physicians is also taking a front seat. If not fee-for-service, then how best to judge and reward quality? In this…

In this new value-based system of the future, some members of the medical community have been increasingly advocating for billing purely for time. In fact, over the years I’ve heard many doctors (usually …

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Why doctors shouldn’t bill for time

Medical education

What spending time with critically ill patients taught me

Larry Istrail, MD

March 16, 2014Mar 16, 2014

A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic.

As …

Drugs and prescribing

Why isn’t tranexamic acid used more often in routine practice?

Janice Boughton, MD

March 13, 2014Mar 13, 2014

The other day at an interdisciplinary rounds meeting at the hospital, one of our nurses who is also an emergency medical technician mentioned that in Britain injured patients receive tranexamic acid before arriving at the hospital because it reduces death…

“What’s that?” I said.

I kind of barely remembered hearing this medication’s name associated with the treatment of a rare disease, but not treatment of trauma. So I was guessing …

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Health policy

Patient safety and the human toll of inaction

Ashish Jha, MD, MPH

March 12, 2014Mar 12, 20147

March 2nd through the 8th was National Patient Safety Awareness Week -- I don’t really know what that means either. We seem to have a lot of these kinds of days and weeks -- my daughters pointed out that March…

March 2nd through the 8th was National Patient Safety Awareness Week — I don’t really know what that means either. We seem to have a lot of these kinds of days and weeks — my daughters pointed out that March 4 was National Pancake Day — with resultant implications for our family meals.

But back to patient safety and National Patient Safety Awareness Week. In recognition, I thought it would be useful to …

Physician voices

Surrogate decision making: Families are much more than visitors

Ken Covinsky, MD

March 11, 2014Mar 11, 2014

An innovative study in JAMA Internal Medicine on surrogate decision making has profound implications for how we take care of older hospitalized patients. The study, by Lexy Torke and colleagues at Indiana University, systematically described the involvement of surrogates in…

An innovative study in JAMA Internal Medicine on surrogate decision making has profound implications for how we take care of older hospitalized patients. The study, by Lexy Torke and colleagues at Indiana University, systematically described the involvement of surrogates in decision making for hospitalized patients.

Surrogate decision making refers to the phenomenon in which someone other than the patient is making or helping to make the key medical decisions. In older …

Physician voices

We are in the age of copy and paste medicine

Heidi Roman, MD

March 10, 2014Mar 10, 201412

I’ve been working with the latest electronic medical record (EMR) for almost a year now. You know the one. There are many positive changes, to be sure. It has helped me more than a few times with calculating doses for kids’ medications. I can now easily check in on my patients’ progress when they are admitted to the hospital. And, of course, the notes are far more legible.

But what do …

Physician voices

4 things everyone should know about end of life planning

Anjali Dogra, MD

March 9, 2014Mar 9, 2014

A few years ago when I went skydiving for the first time, I learned about the backup parachute. This is a second chute, just in case the first one failed. While no one wants to think about the primary parachute failing, it was comforting to know we were prepared … just in case. That’s kind of how I see end of life care planning, while we don’t want to think …

Health policy

The consolidation of health care: 5 questions to ask

Rhea Boyd, MD

March 8, 2014Mar 8, 2014

Comcast recently announced it is merging with Time Warner, the 2nd largest cable company in the US. Together, this deal nets Comcast an estimated 57% of the cable subscriber marketplace and heralds a new oligarchy in US media and entertainment.…

Why?

Because both Comcast and Time Warner have been consistently rated the worst providers of customer service in the cable industry. Now as they …

Physician voices

The request to leave AMA is a signal for an honest conversation

Ishani Ganguli, MD

March 7, 2014Mar 7, 201418

His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual. I emerged from the elevator minutes later to find that the gaunt…

His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual.

I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse’s station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance …

Physician voices

A hospital stay provides new insights into the patient experience

Kevin R. Campbell, MD

March 5, 2014Mar 5, 20147

Communication is critical to success in medicine. Our patients depend on us to help them understand their disease and the risks that it may pose. In previous blogs I have commented on how vital effective communication can be in determining outcome — much of my writing has focused on the success associated with outpatient doctor-patient relationships. We now know that when doctors and patients engage, patients become invested in their …

Physician voices

Hospitalist groups can make or break hospitals

Suneel Dhand, MD

March 3, 2014Mar 3, 2014

Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come. The word “hospitalist” was first coined in 1996 when it was used in a New…

Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come.

The word “hospitalist” was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Back then, hospital medicine was a strange new phenomenon.

Fast-forward to today, …

Health policy

The scandal that rocked the patient safety movement

Michael L. Millenson

March 2, 2014Mar 2, 2014

You may never have heard the name of Dr. Charles R. Denham until the Justice Department alleged he took nearly $12 million in kickbacks from CareFusion Corp. to influence a national guideline for a product hospitals buy to prevent infections…

But you surely know the names the radiation-oncologist-turned-activist-and-entrepreneur rattles off as those with whom he has worked. They include organizations such as the Centers for Disease Control and Prevention, the Cleveland …

Physician voices

Don’t let small hospitals die

Edwin Leap, MD

February 28, 2014Feb 28, 20142

When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky. And over time, I came to truly appreciate the small, rural hospitals that called us for help …

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Don’t let small hospitals die

Physician voices

Can decision support tools actually harm patients?

Christine A. Sinsky, MD

February 28, 2014Feb 28, 201421

Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was…

This is the situation with my local medical institution’s “DVT Advisor,” a mandatory decision support screen for all patients.

DVT Advisor was implemented …

Conditions and diseases

Framing an ethical dilemma: 4 basic concepts of medical ethics

Christopher Johnson, MD

February 26, 2014Feb 26, 201432

It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has …

Health policy

Doctors need to stop working 24/7

Amy Edmondson

February 26, 2014Feb 26, 20143

8:00am Sunday: You glance over and notice an email from your boss while you’re eating breakfast and reading the paper. Ok, you think, I’ll respond later, maybe after my run. 8:10am: Ping! A text arrives. "I have a question about…

8:00am Sunday: You glance over and notice an email from your boss while you’re eating breakfast and reading the paper. Ok, you think, I’ll respond later, maybe after my run.

8:10am: Ping! A text arrives. “I have a question about the project.” Ok, you think, it’s Sunday, but sure, I’ll get back to him after breakfast.

8:20am: The phone rings. It’s him. “I’ll need that slide for tomorrow’s presentation. How soon can you get it to …

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Doctors need to stop working 24/7

Patient voices

When is the right time to die?

K.D. Hayes

February 19, 2014Feb 19, 20144

Uncle Walt died this morning. Finally. I say "finally" because I believed this day would come four months ago, when he had emergency bypass surgery. At the time, I didn't believe Walt would live; he was an ailing, seventy-seven-year-old man…

Uncle Walt died this morning. Finally.

I say “finally” because I believed this day would come four months ago, when he had emergency bypass surgery.

At the time, I didn’t believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, “With bypass surgery, you might live. Without it, you’ll be dead before the weekend is over.”

Walt’s …

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When is the right time to die?

Physician voices

5 straightforward ways to improve patient satisfaction in hospitals

Suneel Dhand, MD

February 19, 2014Feb 19, 201422

Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and …

Health technology

Why hospitals should be scared of cyberattacks

Joe Flower

February 18, 2014Feb 18, 2014

If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them. If they haven’t been trying to get your…

If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them.

If they haven’t been trying to get your attention, it’s time to have an more serious sit-down with them, complete with charts and graphs and arrows on fip charts.

Here’s why.

Remember in November it was revealed that the Target retail …

Hospital medicine

Articles, page 105

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