A sudden life-threatening illness is every family’s nightmare. A loved-one suddenly develops an overwhelming infection or is in a terrible accident. She is rushed to the intensive care unit (ICU) and is put on a ventilator (breathing machine). Many medications are started or she is rushed to surgery for her traumatic injuries.
To the family, the first day or two is a blur of life-saving treatments, painfully waiting for the next …
A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …
On my second day of fourth year, I had to make a decision.
“Mr. K would like Miralax,” read the nurse’s page.
A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …
“Thank God you’re still here, Doc! It looks like they already laid off half the pharmacy department! The line is out the door!”
“Don’t worry, Mr. Golati! It’s just a regular day at the VA!” I replied.
October 1st at the VA Hospital was like every other day in most ways. It was still hard to find a parking space in the far-too-small lot. The hallways still bustled with white coats, smiling vets, …
As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country — from the U.S. Congress to state governments to health systems and hospitals — it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies.
Supplies run the gamut — from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, …
An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.
According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”
And if that wasn’t bad enough, a “nursing attendant” took a photograph.
In today’s health care environment, we are all driven to see more patients in less time and do more with less support. Obviously most of this is financially motivated — the delivery of medical care had unfortunately become more of a business than an art. As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now …
After getting off a 15 hour call day, all I want to do is write.
These past 2 weeks death has been on my mind a lot, more than it ever has been. I have always known that physicians counsel patients and families on dying, but actually being the one to do it is entirely different.
How do you tell someone that their best medical option, the best thing you can offer …
Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …
I recently saw an article about Vanderbilt University Medical Center’s nursing staff.
The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.
In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha took his initial tumble, people went out of their way to …
Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
Though I have been accused by various commenters as protecting my own specialty when I point out excesses, flaws and conflicts of interest in the medical profession, this accusation would be handily dismantled after a fair reading of prior posts. Indeed, my own specialty of gastroenterology and my own medical practice has felt the effects of the honed Whistleblower scalpel. If an individual or an institution will not willingly engage …
As I travel around the country, working in the trenches of various hospitals, I’ve been struck by the number of errors made by physicians and nurses whose administrative burden distracts them from patient care. The clinicians who make the errors are intelligent and competent — and they feel badly when an error is made.
However, the volume of tasks required of them in a day (many of which are designed to fulfill …
If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.
Another seemingly harmless bureaucratic initiative aimed at physicians sunk its taproot deep in the daily workings of medicine recently. The Physician Payment Sunshine Act promises transparency in all industry dealings with physicians by shedding light on the issue of payments to physicians from pharmaceutical companies and medical device manufacturers. In turn, it will save the system money, since all those freebies bestowed upon physicians when the corporate world came knocking …
Huge numbers of older persons transition from hospitals to the nursing home. Often, an older hospitalized patient needs skilled nursing care before they are ready to return home. In other cases, a nursing home patient who needed hospitalization is returning to the nursing home. Older patients and their families certainly hope that great communication between the hospital and nursing home would assure …
Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …
Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that …
Are the days numbered for Salem Community Hospital and other community hospitals around the country? Recently, a local story happened that made me think of this.
The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.
