To designer and architect Michael Graves, paralyzed from a rare virus and in a wheelchair since 2003, the ultimate indignity came one day while he was a patient in a top-ranked hospital: “I was in a Hoyer Lift.” (a body sling mounted to a metal structure, used to help lift and move a patient). “The nurse was moving me from the bed …
How design can empower patients
I used to be a big believer in the transformative power of digital data in medicine. In fact, I devoted the past decade of my life to assisting the “movement” towards better record keeping and shared data. It seemed intuitive that breaking down the information silos in healthcare would be the first logical step in establishing price transparency, promoting evidence-based practices, and empowering patients to become more engaged in their …
The sad state of EMRs: How they are doing more harm than good
I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don’t work, and make up cool theories. I have time to read and listen to people and have become curious about several …
Should hospitals subsidize physician salaries?
A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.
Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized …
What I learned from my mother’s hospital admission
We’ve run amok with wearing gloves in the hospital. And by “we” I mean every healthcare worker in sight. I see people putting on gloves before they’ll give a patient a clean warm blanket. This is not only ridiculous, it’s actually harmful. Here’s why.
We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the …
Hand hygiene in hospitals has gone too far
A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …
Medicare places hospitals in a discharge conundrum
Standing up from my computer terminal to go see another patient, I caught a glimpse of a small, spindly frail woman being rolled by paramedics into one of my shock and trauma rooms.
Very calmly, I remarked, “That woman is dying.”
The medical student who was rotating with me was unnerved that I would make such a pronouncement out of a mere casual observance, “Oh my goodness! How can you just say …
Failing a patient 3 times: A case of moral medical malpractice
Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …
Aviation doesn’t hold all the answers to patient safety in health care
Whether it lasted hours or months, every hospital stay is chronicled in that one final document: the proverbial baton passed from a patient’s hospital doctor to his primary care provider better known as a discharge summary.
This report has always been available to patients after they fill out a decent amount of paperwork. In mid-July, Massachusetts General Hospital began sharing discharge summaries with all patients through an online portal. The move …
Doctors are conflicted about sharing discharge summaries with patients
I recently had the opportunity to test Google Glass.
It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses. The small prism “screen” displays video at half HD resolution. The sound features use bone conduction, so only the wearer can hear audio output. It has a motion sensitive accelerometer for gestural commands. …
5 ways Google Glass can be used in a hospital
I’ve been traveling around the United States working as a locum tenens (in Latin, “place holder” – a more elegant name than “temp”) physician. We’ve all heard of traveling nurses, but more and more physicians are also “living la vida locums,” as it were. There are actually over 100 agencies who find/provide temporary physician coverage for hospitals who need to fill gaps in their full timers’ schedules. You can find out more about …
A comprehensive locum tenens guide for physicians
This week my toughest case involved futile care. We admitted a patient with very advanced cancer, dying naturally at home on hospice. Because of last minute family intervention, the patient ended up spending 48 hours on super-max support, dying quite horribly with tubes and lines in every natural and unnatural orifice. Liver failure, lung failure, kidney failure, bleeding, blood clots and …
The time has come to drive a stake through the heart of an oft-repeated assertion.
How often have you heard something like the following when those of us in healthcare who want to stimulate quality and safety improvements draw analogies to the airline industry?
“Well, in an airplane, the pilot has an extra incentive to be safe, because he will go down with the ship. In contrast, when a doctor hurts a …
Many hospitals approach safety improvement the wrong way
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It began like any other day on the OB floor. My hair was still wet under my cap from my morning shower at 4:30am. I was just returning to labor and delivery after making postpartum rounds and performing the daily circumcisions. The doctors and medical students were all congregated for board rounds. During board rounds we learned who was working and what was going on with each patient.
As I approached …
When sparrows fall: A tribute to a baby girl
In early December 2012, I experienced two life-altering events. First, on December 5, Sadie, my first grandchild, was born. Second, on December 8, I suffered a myocardial infarction. All things considered, I was extremely fortunate. Because I received outstanding care almost immediately, I survived the heart attack. But that night, as I lay in bed in the coronary care unit after undergoing an angioplasty and the placement of a drug-eluting …
Many physicians view retirement as a kind of failure
As a medical educator in a hospital setting, I often tell first-year medical students about disparities in health care and about the vastly different quality of care that hospitals deliver, depending on their resources.
I tell my students how important it is to advocate for patients, to learn to navigate the healthcare system and to work respectfully with health professionals in order to get optimal care for your patients.
When my own …
With my son hospitalized, an opportunity to apply my teachings
Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”
Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?
Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double shift, …
After a medical mistake, an apology is both simple and difficult
At iMedicalApps we have traditionally expounded on how smart phones can help us with patient care in regards to providing Physician centric tools at bedside. These range from drug reference tools to various clinical algorithm medical apps.
But there are also non-traditional methods where smartphones enable us to improve patient care at the bedside. These are subtle, but can be equally or more powerful.
When I was working in the ICU recently, there were …
How an iPhone improved patient care in the ICU
In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?
Watching the implementations around me, …
Boston hospitals go Epic: Hear from a holdout
There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians.
“Obs status” began life as Medicare’s way of characterizing those patients who needed a little more time after their ED stay to sort out whether they truly needed admission. In many hospitals, …
Observation status: How Medicare’s solution could make things worse
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