An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.
I bled.
With great pride, I skipped the obligatory required mandatory training session on “diversity awareness.” I skipped both the primary session and the make up session. The session, and its mandatory nature, had been carefully announced every day for weeks. The …
Hospital administrators are scared of JCAHO
Norman Rockwell never imagined a world where visiting a doctor could be compared to a trip through a Starbucks drive-thru. The days of shooting the breeze with patients and family members have been relegated to the “Good ole’ days” museum right next to Rockwell’s paintings portraying the doctor as more than just a healer, but a trusted friend. What happened to those days? With challenges like increased patient volumes and …
3 simple ways to improve our patient relationships
About eight years ago I was desperate to improve my golf game. I just couldn’t straighten out my drives or hit my irons crisply. (Yes, I’m fully aware that this is a first world problem). I decided to try golf camp in Palm Springs for a few days.
My sensei, a crusty ex-touring pro named Artie McNickle, watched me hit several dozen balls on the driving range, video recorder running. “So, …
How video can reduce medical errors and improve patient care
I had always thought I could never be a great doctor because I felt too emotionally bound to my patients. It was impossible for me to hold back tears when feeling that gut wrenching empathy for families mourning the passing of their loved ones. Because it always seemed as if I were the only resident moved by these scenes, I reasoned that this was an unprofessional impulse that prevented me …
Bringing emotions back into medicine
The fundamentals of healthcare itself are similar in most developed countries. Evidence based guidelines are shared by international professional societies. Digital technologies have transcended cultural and geographical divides. Once someone is brought to the attention of a healthcare provider, it is the start of a rocky road, not all downhill by any means.
Navigating the healthcare landscape as a patient and caregiver has never been more difficult, even for an “insider” …
Navigating the health care system is as important as the care itself
When we die, we die alone. Regardless the number of those who surround our deathbed, we experience our last breath alone. Our last feeling of pain. Our last moment of hope. Our last words, our parting gift to the sentient world as we depart the duress of consciousness. The ethereal message leaves our lips to pierce the very tangible aroma of Clorox and human excrement. The hearts of the healthy, …
How do I stay human in a system comprised of superhuman demands?
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.
Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …
David and Goliath lessons for doctors and our health system
I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client (in this case, hospital) side of the equation. I’ve had the chance to speak with several executives (some were physicians themselves) about the overall process of hiring and managing temporary physicians. What I heard wasn’t pretty. I thought I’d summarize their opinions in the form of a mock composite …
How do hospitals feel about locum tenens?
Blaming the American Medical Association’s Relative Value Scale Update Committee (RUC) for everything has become the latest fashion. The RUC is causing climate change. The entire health care cost problem comes from RUC decisions. Alex Rodriguez took performance enhancing drugs because of the RUC.
But the RUC did not create the system. They try hard to balance a system that is designed to achieve the wrong outcomes. The RUC has become …
Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.
Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”
I pick up two sheets of paper with multiple questions including:
Forms do not keep patients out of hospitals
Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC) while the search continues for Farzad Mostashari’s permanent replacement.
What advice would I give to the next national coordinator?
David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.”
Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were …
Advice to the next national coordinator for health IT
In 2008, I gave the keynote address at the first “Diagnostic Errors in Medicine” conference, sponsored by the Agency for Healthcare Research and Quality (AHRQ). The meeting was filled with people from a wide variety of disciplines, including clinical medicine, education, risk management, cognitive science, and informatics, all passionate about making diagnosis safer. The atmosphere was electric. My lecture was entitled, “Why diagnostic errors don’t get any respect” (I wrote up the …
We need better measures of diagnostic accuracy
Over the last month I have received several comments from readers who have or who are trying to make the choice between nursing and medicine. And may I just say what a great problem we have now, to be able to choose. I’ve been thinking about this and I submit there are three considerations: philosophical, practical, and logistical.
1. Philosophical. Many of you have heard of the “medical model,” the idea …
Making the choice between nursing and medicine
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Medical errors are a real problem. I won’t deny that.
It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …
Not all adverse events are preventable
Had I met her anywhere but the hospital, I would have gone to her side. I would have asked her what was wrong. I would have offered to help.
She was 99-years-old and about to undergo surgery. Pre-operative holding is generally a busy place. Patients lie in gurneys, spending some last moments with loved ones and fielding questions from various players of the surgical team as they come to the bedside. No, …
Had I met her anywhere but the hospital, I would have helped her
“Did you sell the business yet?”
I marvel at my patient Jack: despite his breathlessness, he’s somehow managed to greet his wife Sara with a complete sentence. Given his condition, it’s truly amazing.
Most of his lung function has been devastated by his forty-year, pack-a-day smoking habit; the rest has been demolished by cancer. The easy, automatic breathing he once took for granted is just a memory. He can’t even lie down …
Some people choose the time of their death
“Will you charge me?” he asked quietly, between labored breaths. He sat in the hospital bed with his legs over the side in what is known as a “tripod” position — his elbows resting on a nearby stool to prop his chest up as much as possible. His head was hunched over, with his eyes pointed down; clearly he was in agony.
He had been admitted to the hospital two weeks …
Is it worth it? A question providers need to be asking
An excerpt from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.
At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the …
Life and death in a hospital ravaged by Hurricane Katrina
A US District judge in South Carolina has ordered Tuomey Healthcare System (THS) to pay $238 million for violations of the Stark Law and False Claims Act (FCA). The judge originally ordered Tuomey to pay $277 million, but one of the government attorneys pointed out the judge had awarded $39 million more than the government had asked for, and the penalties were immediately reduced.
This case began in 2005 when Dr. Michael Drakeford filed …
Health care fraud: A hospital rolls the dice and loses
Hospitals struggle to get doctors and nurses to wash their hands. That’s a serious problem, since hand washing is one of the keys to reducing healthcare acquired infections that afflict more than a million patients a year and kill over 100,000. And it’s one of the reasons you should try your best to stay out of the hospital.
For the past few years …
Should patients be responsible for physician handwashing?
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