Hospital medicine

5,188 articles · Since 2004

Articles, page 106

The wisdom of Dr. Bernard Lown and sick patients with chronic diseases

February 14, 2014Feb 14, 2014

I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick! The thing…

The thing about the very sick patients I see is that they are generally what might be called medical “train wrecks.” They are very sick because they have had interventions over the years …

Physician voices

Why monetary carrots and sticks are detrimental to health care

angienadia, MD

February 13, 2014Feb 13, 20142

In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote: For many of us, Cooper wasn't even the cheapest way to go to school...So…

In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn’t even the cheapest way to go to school…So the question is: why did we go? We went not because of the financial value of free–that is, zero tuition–but rather, because of the academic value of free. At Cooper Union

…

Physician voices

Don’t take patients’ patience for granted

Maria Yang, MD

February 11, 2014Feb 11, 20145

When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.” Patients in hospitals do a lot of waiting. They wait for physicians. They…

When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”

Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Health policy

Many will not survive the millions of new Medicaid recipients

Joe Flower

February 10, 2014Feb 10, 20149

Hospitals need to overhaul their processes so they can help the un- and under-insured stay healthy. Many people running health care institutions tell me that they have been fighting the fight, learning to be nimble, transforming their cultures, making big…

Hospitals need to overhaul their processes so they can help the un- and under-insured stay healthy.

Many people running health care institutions tell me that they have been fighting the fight, learning to be nimble, transforming their cultures, making big changes as the landscape rearranges itself like a really bad day along the San Andreas Fault.

But in comparison with the actual scale of the problems, most of the business models and …

Physician voices

Infection control versus psychology: To white coat or not

Michael Edmond, MD, MPH

February 10, 2014Feb 10, 2014

There’s a piece in the Atlantic entitled "The Psychology of Lululemon." I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be…

There’s a piece in the Atlantic entitled “The Psychology of Lululemon.” I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out — that in some way, clothes have power over the wearer.

Of course, I …

Physician voices

Inside the first scandal in patient safety

Robert Wachter, MD

February 10, 2014Feb 10, 20147

In retrospect -- always in retrospect -- it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right. In a remarkable number of cases of medical errors, it’s clear -- again, in retrospect…

In retrospect — always in retrospect — it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right.

In a remarkable number of cases of medical errors, it’s clear — again, in retrospect — that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want …

Physician voices

Observation status: When you’re not a hospital inpatient

Gene Uzawa Dorio, MD

February 8, 2014Feb 8, 20142

Two decades ago, a decision was made by Medicare policymakers that carotid endarterectomies would not be allowed. Their claim was too many were being done costing Medicare money. The following year, data revealed a sharp rise in debilitating strokes, so…

For years, there have been other misjudgments against Medicare patients that are only now becoming apparent. Let me clarify …

Physician voices

Why doctors and hospitals shouldn’t advertise

Skeptical Scalpel, MD

February 6, 2014Feb 6, 201425

The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise. Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US…

The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise.

Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US Supreme Court ruled that states could not prohibit advertising by lawyers.

This opened the floodgates for all professionals. Soon advertising by doctors and hospitals became common.

I don’t know what it’s like where …

Physician voices

Are white coats obsolete? Not yet, if you look at the evidence

Skeptical Scalpel, MD

February 4, 2014Feb 4, 20146

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published. Science Daily led with the headline "New Infection Control Recommendations Could Make White Coats Obsolete," which is rather misleading since the guidelines say…

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published.

Science Daily led with the headline “New Infection Control Recommendations Could Make White Coats Obsolete,” which is rather misleading since the guidelines say no such thing.

I won’t reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments.

The guidelines say that facilities may consider adopting a …

Physician voices

4 reasons why hospitals can be very dangerous places to be

Robert Pearl, MD

February 3, 2014Feb 3, 201411

Hospitals are commonly thought of as the safest place to be for sick people. Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them. While it…

Hospitals are commonly thought of as the safest place to be for sick people.

Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.

While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …

Physician voices

Death of the physician progress note

David Mokotoff, MD

February 2, 2014Feb 2, 201423

I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician's progress note. To be sure, these notes, even…

I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician’s progress note. To be sure, these notes, even the now “ancient” written ones, were far from perfect. And they were often illegible. Shortcuts such as “as above” or AVSS (all vital signs stable) littered the pages of the …

Read more…

Death of the physician progress note

Health policy

The high cost of health care: Blame the financial model

Robert Pearl, MD

January 28, 2014Jan 28, 201419

The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care. For decades, the way we’ve paid doctors and hospitals has driven up health…

The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care.

For decades, the way we’ve paid doctors and hospitals has driven up health care costs. And while the pace of health care spending has slowed the last four years, it continues to rise faster and more noticeably than improvements in U.S. health care outcomes.

The reason is not …

Medical education

The transition from chief resident to attending

Akhil Narang, MD

January 28, 2014Jan 28, 2014

During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.

Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …

Health technology

Should hospitals regulate medical apps?

Tom Lewis

January 22, 2014Jan 22, 20143

The medical and health app market is growing rapidly, there’s no question about it. One as yet unanswered question though is how to regulate this emerging industry. This is something we’ve talked about before in a viewpoint published in JAMA Dermatology as well as on iMedicalApps. While it is still early on and we will in many ways have to see which approach is most suitable, its clear that some way …

Read more…

Should hospitals regulate medical apps?

Physician voices

Who is keeping Marlise Munoz on life support against her wishes?

Jennifer Gunter, MD

January 21, 2014Jan 21, 201411

Brain death is death. This is one of the definitions of death. Even in Texas. Because brain death is death, a do not resuscitate (DNR) order or invalidating a DNR are both meaningless, because you don’t do procedures on dead…

Brain death is death. This is one of the definitions of death. Even in Texas.

Because brain death is death, a do not resuscitate (DNR) order or invalidating a DNR are both meaningless, because you don’t do procedures on dead bodies. This is why taking someone off a ventilator who is brain dead is not homicide, assisted suicide, or even following a DNR, it is simply the cessation of forcing air into a …

Health policy

What if the uninsured don’t buy Obamacare?

Robert Laszewski

January 21, 2014Jan 21, 201424

Now that consumers can generally make an efficient health insurance purchase at Healthcare.gov and most of the state-run exchanges, we can finally get to the real question. Are the healthy uninsured going to buy it? The big health insurance changes…

Now that consumers can generally make an efficient health insurance purchase at Healthcare.gov and most of the state-run exchanges, we can finally get to the real question.

Are the healthy uninsured going to buy it?

The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.

To be clear, no one I know …

Health technology

Patient portals for hospitalized patients: Do they make sense?

Suneel Dhand, MD

January 20, 2014Jan 20, 2014

Patient portals are very much the future of health care. Having easy access to ones’ medical history, diagnoses, and test results, seems like such a natural thing that it’s hard to imagine that only a couple of decades ago medical…

Of course, the Internet and technology revolution has taken this concept to a whole new level. Health care organizations across the …

Health policy

What can we learn from health policy in China?

Ashish Jha, MD, MPH

January 16, 2014Jan 16, 20148

I was just recently in Guiyang, the capital of the Guizhou province in China and had a chance to visit the Huaxi District People’s Hospital (HDPH), one of the largest “secondary” hospitals in the province. Like the rest of China, it has been gripped by the construction boom, recently opening a new surgery center and revamped medical facilities. They had a terrific EHR from a local vendor — probably …

Physician voices

Developing a culture of cost effective care

Jessica Jou

January 15, 2014Jan 15, 20143

During the four weeks of my ICU rotation, I came to know Mr. S well. I was the medical student on the intensive care team, managing patients alongside the primary surgeon. Mr. S was on the road to recovery when…

Every morning we rounded, one more of the numerous tubes attached to his body were removed. He grew stronger, gradually able to speak clearly …

Physician voices

A patient trapped in his own body

Edward Thompson, MD

January 14, 2014Jan 14, 201419

Donald is large. Very large. At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks. "My stomach hurts," he says, his voice surprisingly high and childlike. It is…

Donald is large. Very large.

At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks.

“My stomach hurts,” he says, his voice surprisingly high and childlike.

It is 10:00pm in the emergency room, and I am already swamped with patients I’m trying to move through the ER before my shift is over.

Asked if he’s ever felt this kind of pain before, …

Read more…

A patient trapped in his own body

Hospital medicine

Articles, page 106

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular