Hospital medicine

5,188 articles · Since 2004

Articles, page 109

Why quality doesn’t affect hospital CEO pay

November 18, 2013Nov 18, 201315

In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership. So, it is in this context, that we recently…

We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than others. This …

Physician voices

Use awareness intervention to improve physician behavior

Paul Levy

November 11, 2013Nov 11, 20138

Here’s a familiar story in America’s hospitals. An “old fashioned” surgeon decides that the protocols and procedures put in place by the medical executive committee or other governing body don’t apply to him. “I’ve done it this way for 30…

People in the risk management field will advise …

Physician voices

The primary care opposition to transition care

Michael Cetta, MD

November 7, 2013Nov 7, 20135

The lack of access to primary care physicians is a well known problem impacting our healthcare system. The problem sends all sorts of negative ripples through the system, not the least of which is increasingly crowded emergency rooms packed with…

What is less talked about is the mixed reaction of primary care physicians to the kinds …

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On hospital discharges: Who needs the most reassurance?

Perri Klass, MD

November 7, 2013Nov 7, 2013

I will do anything not to be in a hospital bed. I checked myself out as quickly as I could each time I was admitted (three obstetrical admissions) and once, after a day-surgery procedure, got in trouble with the recovery room nurse because she found me out of bed, getting dressed, before I was supposed to be on my feet.

Still, as a doctor, I am capable of taking great comfort …

Physician voices

How can we reduce friction in the hospital?

Leslie Kernisan, MD, MPH

November 7, 2013Nov 7, 20137

Why aren’t people in hospitals more attentive to the needs of patients? In a 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…

Why aren’t people in hospitals more attentive to the needs of patients?

In a 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 …

Health policy

How do hospitals build a culture of quality?

Ashish Jha, MD, MPH

November 7, 2013Nov 7, 2013

I was recently chastised by a colleague for being too negative in one of my pieces on hospital care. His is a remarkable story of what happens when things go well, and it has made me think a lot about…

He told me how a few months ago, soon after returning to Boston from a trip to China, he …

Physician voices

Who’s in control? Why both doctors and patients are frustrated

Shirie Leng, MD

November 6, 2013Nov 6, 20132

I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.” This is a problem since, as…

I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”

This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …

Physician voices

Solving the weekend effect for patients in the hospital

Robert Pearl, MD

November 6, 2013Nov 6, 20135

If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick? It sounds like a silly question. You don’t get to pick the day…

If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?

It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …

Health policy

It’s hard to get a handle on the true costs of defensive medicine

Peter Ubel, MD

November 4, 2013Nov 4, 201312

Ask physicians if our messed up malpractice system causes them to practice “defensive medicine,” and most will probably say yes -- hard not to be paranoid with so many lawsuits affecting so many physicians. Some experts even contend that major…

Ask physicians if our messed up malpractice system causes them to practice “defensive medicine,” and most will probably say yes — hard not to be paranoid with so many lawsuits affecting so many physicians. Some experts even contend that major reforms of our malpractice system could go a long way towards controlling spiraling healthcare costs. On the other hand, if you ask physicians whether they ever order unnecessary tests …

Physician voices

Hospital administrators are scared of JCAHO

John F. Hunt, MD

November 3, 2013Nov 3, 201380

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…

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 Sheep’s Pen was trying to make a point to JCAHO that they really followed the rules.

I didn’t. …

Physician voices

3 simple ways to improve our patient relationships

Christopher Nyte, DO

November 3, 2013Nov 3, 20134

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 …

Health technology

How video can reduce medical errors and improve patient care

Robert Wachter, MD

October 28, 2013Oct 28, 201315

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…

My sensei, a crusty ex-touring pro named Artie McNickle, watched me hit several dozen balls on the driving range, video recorder running. “So, …

Physician voices

Bringing emotions back into medicine

Elizabeth Dzeng, MD, MPH

October 28, 2013Oct 28, 20134

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 …

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Bringing emotions back into medicine

Physician voices

Navigating the health care system is as important as the care itself

David Lee Scher, MD

October 27, 2013Oct 27, 20133

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…

Navigating the healthcare landscape as a patient and caregiver has never been more difficult, even for an “insider” …

Medical education

How do I stay human in a system comprised of superhuman demands?

Jenna Cottral

October 27, 2013Oct 27, 20135

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, …

Physician voices

David and Goliath lessons for doctors and our health system

Davis Liu, MD

October 24, 2013Oct 24, 20132

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…

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

Physician voices

How do hospitals feel about locum tenens?

Val Jones, MD

October 23, 2013Oct 23, 201329

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…

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 …

Health policy

The idea of RVUs disgusts me

Robert Centor, MD

October 23, 2013Oct 23, 20134

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…

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 …

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The idea of RVUs disgusts me

Physician voices

Forms do not keep patients out of hospitals

Kathy Nieder, MD

October 21, 2013Oct 21, 201312

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…

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:

discharge Medications: (list)
present Medications: (list)
diagnostic

…

Health technology

Advice to the next national coordinator for health IT

John Halamka, MD

October 18, 2013Oct 18, 20136

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…

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 …

Hospital medicine

Articles, page 109

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