Hospital medicine

5,188 articles · Since 2004

Articles, page 110

We need better measures of diagnostic accuracy

October 18, 2013Oct 18, 2013

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 …

Physician voices

Making the choice between nursing and medicine

Shirie Leng, MD

October 18, 2013Oct 18, 20136

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 …

Physician voices

Not all adverse events are preventable

Skeptical Scalpel, MD

October 16, 2013Oct 16, 201357

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…

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 …

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Not all adverse events are preventable

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Medical education

Had I met her anywhere but the hospital, I would have helped her

Ilana Yurkiewicz

October 16, 2013Oct 16, 2013

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…

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, …

Patient voices

Some people choose the time of their death

Judith Reishtein, RN

October 15, 2013Oct 15, 20133

"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…

“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 …

Physician voices

Is it worth it? A question providers need to be asking

John Ly, MD

October 14, 2013Oct 14, 201313

“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…

“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 …

Patient voices

Life and death in a hospital ravaged by Hurricane Katrina

Sheri Fink, MD, PhD

October 13, 2013Oct 13, 2013

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…

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 hospital, where they had now spent four days. Doctors and nurses milled in the foul-smelling second-floor lobby. …

Health policy

Health care fraud: A hospital rolls the dice and loses

The Pathology Blawg, MD

October 13, 2013Oct 13, 2013

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 …

Patient voices

Should patients be responsible for physician handwashing?

David Williams

October 12, 2013Oct 12, 20138

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…

For the past few years …

Conditions and diseases

The gaps in our current care of critically ill patients

Albert Fuchs, MD

October 10, 2013Oct 10, 20135

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…

To the family, the first day or two is a blur of life-saving treatments, painfully waiting for the next …

Physician voices

What do we do with the extreme elderly?

Janice Boughton, MD

October 10, 2013Oct 10, 201312

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. …

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What do we do with the extreme elderly?

Medical education

Sub-internship: The small stones are under my guardianship

Shara Yurkiewicz

October 8, 2013Oct 8, 2013

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…

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 …

Health policy

A day at the VA during the shutdown

Megan S. Lemay, MD

October 7, 2013Oct 7, 20133

“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…

“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, …

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A day at the VA during the shutdown

Health policy

To cut hospital costs, look at the supply chain

David B. Nash, MD, MBA

October 6, 2013Oct 6, 2013

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…

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, …

Social media in medicine

The OR is not a good place for a prank

Skeptical Scalpel, MD

October 2, 2013Oct 2, 20136

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…

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.

The patient, who said she had to quit her job …

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The OR is not a good place for a prank

Physician voices

Doctors can learn from how nurses provide care

Kevin R. Campbell, MD

October 1, 2013Oct 1, 2013

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…

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 …

Medical education

The price for improvement sometimes outweighs the benefits

Joyce Ho, MD

September 30, 2013Sep 30, 20134

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…

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 …

Health policy

How nurses can help contain health care costs

September Wallingford, RN

September 30, 2013Sep 30, 201310

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, …

Health policy

Nurses are too afraid to speak up in their organizations and be vocal

Alene Nitzky, RN, PhD

September 29, 2013Sep 29, 201345

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…

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.

They …

Physician voices

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

Leslie Kernisan, MD, MPH

September 24, 2013Sep 24, 201336

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,…

On the bike path where Jha took his initial tumble, people went out of their way to …

Hospital medicine

Articles, page 110

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