Hospital-Based Medicine

What hospitals can learn from the RaDonda Vaught case

Policy

October 10, 2022

In response to a medication administration error that led to the death of a 75-year-old patient, RaDonda Vaught, a registered nurse working in Tennessee, was recently found guilty of criminally negligent homicide and gross negligence of an impaired adult.

As a result, she was sentenced to three years of probation with the promise that her criminal record would be expunged if she successfully completes the sentence.

Months after this …

Your anesthesiologist cares for you [PODCAST]

The Podcast by KevinMD

Podcast

October 2, 2022

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

“It’s one of the hard things about anesthesiology. A window opens, you work like all get out, doing all sorts of things while the breeze blows in, then it’s shut again. Sometimes, you see your patient once …

The consequences of unmasking and ending quarantines

Stephanie Marcovici

Conditions

September 18, 2022

The CDC has updated its COVID masking and quarantine guidelines as children return to school and more adults return to work at the end of summer.

Unfortunately, the new, less restrictive guidelines are premature.

As most people know, the current COVID variant is extremely contagious. Many argue that since a majority of the public has already been exposed to COVID either by vaccination or infection, we can relax into less vigilance.

However, it …

A friendly battle with a patient’s potassium

Ton La, Jr., MD, JD

Conditions

September 14, 2022

“By God’s grace, Dr. Sal!”

“Yes, T.J.! What’s the good news?”

“Guess what Mr. Thompson’s potassium is now?”

“3.1 …”

“Wrong! 4.1!”

We high-fived each other immediately and breathed a huge sigh of relief. For six days straight, we’ve been giving Mr. T potassium through an IV and by mouth with little to no change in his potassium level.

He came to the hospital after being found passed out in his home. Very low initial blood …

My patient left against medical advice

Ton La, Jr., MD, JD

Physician

September 3, 2022

“Mr. Stenson left AMA …”

“Why?” I said out loud to my attending.

“He left with his IVs in …” said his nurse in disbelief.

An hour earlier, before rounds, I sat down with Mr. S to talk about his anxiety attack.

Ten years ago, he was shot ten times in the chest, which left him with PTSD and depression. Not long after, he started having unprovoked panic attacks. What started as once or …

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My patient left against medical advice

Talk about death in plain, simple, easy-to-understand terms

Cali Clark, DO, MBA

Conditions

September 3, 2022

“You’re dying.”

I can often visualize the impact of my words as soon as they leave my mouth, the heavy weight sinking into the mind and body of my patient as they sit in the stark white hospital bed.

It usually isn’t the first time they’ve heard the sentiment. After all, we tell them countless times in different phrases we use as physicians, expecting them to understand, but none quite as precise …

A room once full of vitality lies empty

Menachem Gurevitz, DO

Physician

September 2, 2022

More than two months after he died, his name still adorned the whiteboard of the hospital room he inhabited. As I stood there and gazed, recalling the memories he left me with, the nurse who tended to him entered the room and started to cry. Her love for Eric, she told me, did not enable her to erase his name.

He was disheveled, non-compliant, and plagued with multiple morbidities when first …

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A room once full of vitality lies empty

The art of medicine is born in the unforeseen

Nicholas Bellacicco, DO

Physician

August 30, 2022

It was 2:21 a.m., and the pager exploded in my ear like I had forgotten to turn the volume down before plugging in my headphones. The nurses told me your heart rate was getting faster, and your oxygen was dipping lower. When I made it to your room, you were laying in urine because you were too weak to stand. Your breathing was rapid and shallow, like you were caught …

No wonder doctors feel like hamsters running on an exercise wheel to nowhere

Banu Symington, MD

Physician

August 28, 2022

Burnout. We define, measure, and talk about it endlessly but do little to fix it. Unchecked, it can lead to medical mistakes, career dissatisfaction, early retirement, provider suicide, and excess costs. With the recent pandemic, the public has become more aware of it, but action to fix it is still lagging.

Feeling underappreciated, feeling one’s work is meaningless, feeling powerless to make changes, and feelings of moral injury are but a …

Keep us safe: Stop the violence against health care workers

Sara Mirza, MD

Physician

August 22, 2022

Violence against health care workers has escalated to unprecedented levels in the last decade. The pandemic seems to have accelerated outbursts against health care providers online, in print, and in person.

A man from Tulsa, Oklahoma, recently angry over back pain, killed his surgeon and other health care workers before ending his own life.

Many health care workers report they are used to working in environments that are …

Controlling physician behavior

Charles Sharp, MD

Physician

August 21, 2022

Some years ago, I had the privilege of serving as chief of staff of my community hospital. One of my responsibilities was to review complaints directed at doctors. Ten to twenty “occurrence reports” came across my desk every week. Most were from nurses who felt doctors had unfairly reproached them.

Hospitals are required by their deeming organizations — ours is The Joint Commission (TJC) — to adjudicate each item with due …

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Controlling physician behavior

Does patient-centered care really meet human-centered care?

Dr. Vivek Podder

Physician

August 18, 2022

This episode was during my elective time in India in the late winter of 2017. It was a patient-centered learning opportunity for students around the world who has an interest in medicine. I was excited about this because of my earliest clinical exposure to patient encounters as a medical student. I was excited to meet the patients, talk to them, and help them despite the uncertainty and emptiness in my …

An experience of shame in training

Brett Linzer, MD

Physician

August 17, 2022

Early one morning in 1996, after a sleepless night on call, I stood with my team in the VA hospital, outside room 102. I was a 28-year-old intern in the general medicine service. We were making rounds on twelve patients that my intern partner, myself, and our supervising resident had admitted overnight. We would walk room to room, and the intern would present the information regarding the patient by gathering …

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An experience of shame in training

How privileged a physician’s knowledge is

Cia Bishop, MD

Physician

August 16, 2022

I was warned about it before we walked into the room.

So when I did walk in, I made sure my eyes stayed focused on his eyes, my gaze high and attentive. I smiled, possibly more than normal, to make sure he felt comfortable. Like a puppeteer holding up his doll, I knew it wasn’t time for me to drop down my eyes yet.

The resident with me began the routine visit …

Academic medicine on life support: a letter to a newly appointed CEO of a leading academic medical institution

Anonymous

Physician

August 15, 2022

Congratulations on our leading academic medical institution (LAMI) yet again making it to the top ten list of the U.S. News & World Report!

You have taken the reins in perilous times (globally and domestically), and what you do and what you stand for will determine if this great hospital will not just survive but survive with its brand and reputation intact. Getting hired as a physician who grew up in …

When a hospital unexpectedly closes

Marie Myung-Ok Lee

Conditions

August 12, 2022

An excerpt from The Evening Hero.

This was apparently not to be a Yungman-only meeting. It was in their conference room, same one where had their monthly morbidity and mortality conferences, and it was packed with doctors. In fact, there was just one chair open, and Yungmans best friend Ken the …

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When a hospital unexpectedly closes

We’re reacting to medical errors the wrong way

Vidya Raju, MD

Physician

August 7, 2022

Medical mistakes are as old as the practice of medicine itself, but it wasn’t until 1999 that the United States started paying more attention to them.

Over twenty years later, we may be reducing medical errors — a recent study published in the Journal of the American Medical Association found significant decreases in mistakes in cases of pneumonia, acute myocardial infarction, heart …

People behaving badly: 4 steps to de-escalate hostile people

Ann F. Beach, MD

Physician

August 4, 2022

Imagine that you are a brand-new attending in a hospital. You have your new starched white coat and stethoscope around your neck. Before you enter your patient’s room, the nurse says, “Whew! Good luck! The patient’s dad is really angry! He’s been yelling for the last ten minutes!”

Are you prepared? Do you know what to do?

The boundaries of unacceptable behavior have eroded in the past few years. Politicians, law enforcement, …

He was more than a housekeeper

Debbie Moore-Black, RN

Conditions

July 18, 2022

Over 30 years ago, this man began working for our hospital system.

He was assigned to our ICU/CVICU units. Though some health care employees hadn’t even been born yet, Charles was a tried and true “lifer.”

He was our housekeeper. And he was our friend — our family.

He was a man with energy and stamina. He was a hard worker. Relentless. He could spin circles around a pack of 20-year-olds put together.

His …

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He was more than a housekeeper

Top 10 things new interns should do

Vijay Rajput, MD

Education

July 16, 2022

New resident physicians who have earned their MD degrees will be heading to hospitals to start their residencies during the last two week in June and the first week in July. What can a beginning doctor do during the first month of internship to get his or her career off to a good start, and in so doing, also learn to provide the best care to patients? Here are 10 …

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Top 10 things new interns should do