Hospital medicine

5,188 articles · Since 2004

Articles, page 112

When donated blood is wasted

August 19, 2013Aug 19, 201322

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 …

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When donated blood is wasted

Health policy

Many hospitals approach safety improvement the wrong way

Paul Levy

August 19, 2013Aug 19, 20137

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…

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 …

Physician voices

When sparrows fall: A tribute to a baby girl

Brenda Izen, MD

August 17, 2013Aug 17, 201324

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 …

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Medical education

Many physicians view retirement as a kind of failure

Robert Marion, MD

August 15, 2013Aug 15, 201311

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 …

Patient voices

With my son hospitalized, an opportunity to apply my teachings

Karen Libertoff Harrington

August 14, 2013Aug 14, 201323

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…

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 …

Physician voices

After a medical mistake, an apology is both simple and difficult

Jim deMaine, MD

August 13, 2013Aug 13, 201333

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…

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, …

Health technology

How an iPhone improved patient care in the ICU

Iltifat Husain, MD

August 12, 2013Aug 12, 20132

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…

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 …

Health technology

Boston hospitals go Epic: Hear from a holdout

John Halamka, MD

August 11, 2013Aug 11, 20136

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, …

Health policy

Observation status: How Medicare’s solution could make things worse

Robert Wachter, MD

August 11, 2013Aug 11, 201335

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…

“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, …

Physician voices

Why I pray for my patients

Rajeev Kurapati, MD

August 7, 2013Aug 7, 20135

We have come a long way in medicine, treating serious illnesses and preventing life-threatening diseases. As a hospital-based physician, I treat various severe diseases every day throughout the ICU, medical, and surgical floors. On a normal day, I roll at a fast pace — admitting, treating and, discharging patients has become fairly routine for me. On any given day, we have an …

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Why I pray for my patients

Medical education

You may not remember me, but you changed me

Ilana Yurkiewicz

August 7, 2013Aug 7, 201313

You may not remember me, but when I asked how you were, you said, “alive.” A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that…

You may not remember me, but when I asked how you were, you said, “alive.”

A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.

You may not remember …

Patient voices

The gratitude of a terrified parent when kindness is shown

Pat Mastors

August 5, 2013Aug 5, 201312

Hospital transport arrives to take my daughter just after 9am. We’d been told her ultrasound and x-ray were scheduled for 10am, an hour away. Jess and I exchange a look. She’s just about to take another swig of the laxative…

“I’ll go with you,” I say.

“We’ll make sure there’s a bathroom nearby.”

Strike one for the Golden Cocoon.

We get to the ultrasound department, and are left …

Medical education

Each patient is still human and deserves to be treated as such

Joyce Ho, MD

August 4, 2013Aug 4, 201310

“I don’t want a tube down my nose. I’ve been through it before and I don’t want it again.” Charlie turned his head away from the team and crossed his arms in defiance. “I’d rather be sick.” I looked at…

I looked at the intern, who looked at the resident, who just said, “Well, think about it. We’ll be back in the afternoon.”

“I’m also hungry and haven’t eaten in days,” Charlie added.

“Maybe some food …

Conditions and diseases

Hospital care practically guarantees that we won’t get good sleep

Peter Ubel, MD

July 31, 2013Jul 31, 20138

The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won’t get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.

Recently I was all-too-miserably reminded of …

Physician voices

Reflecting on DNR/DNI after being a code team leader

Robert Glass, MD

July 28, 2013Jul 28, 20134

“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.” It’s like music to…

It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit …

Health policy

Turning health care into a giant used car lot

Naomi Freundlich

July 28, 2013Jul 28, 201313

I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing…

And so it has come as somewhat of a shock to me that medical care has become …

Health policy

Is the hospital readmission rate a measure of quality?

Brad Wright, PhD

July 20, 2013Jul 20, 201312

Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …

Health policy

Is your hospital leader committed to patient-centered care?

Robbin Dick, MD

July 11, 2013Jul 11, 20133

Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to…

They usually go like this: first priority is high margin surgical cases; second priority is …

Physician voices

How should the workplace accommodate women physicians?

Linda Brodsky, MD

July 10, 2013Jul 10, 20138

A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …

Physician voices

Choosing a hospital: What is most important to you?

Leana Wen, MD

July 9, 2013Jul 9, 20136

Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but…

At the moment, there is very little information for you to make such a decision. Many people will choose …

Hospital medicine

Articles, page 112

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