Hospital medicine

Why doctors should take sabbaticals

Janice Boughton, MD

July 5, 2013Jul 5, 20139

In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …

Why doctors should take sabbaticals

Does alarm fatigue really kill?

John Mandrola, MD

July 5, 2013Jul 5, 20136

Patient safety and hospital quality is a scary topic. I’ll go easy. I’m just a doctor. I don’t know much. Entire departments, filled with cubicles, computers and well-meaning people, now exist to keep hospitals tightly regulated and running perfectly. There…

Patient safety and hospital quality is a scary topic. I’ll go easy. I’m just a doctor. I don’t know much.

Entire departments, filled with cubicles, computers and well-meaning people, now exist to keep hospitals tightly regulated and running perfectly. There is data to analyze, regulations to read, and oh so many meetings to attend. This place of healing will be safe—and perfect.

The …

Does alarm fatigue really kill?

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4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

June 30, 2013Jun 30, 20134

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees. Let me lay out these employed physicians gripes…

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

Medical education

How should we be training the next generation of doctors?

Janice Boughton, MD

June 28, 2013Jun 28, 20137

I have been spending time at an academic medical center lately and I'm noticing some obvious flaws in our method of shaping the doctors of the future. When I went to medical school I was trained by physicians who were…

I have been spending time at an academic medical center lately and I’m noticing some obvious flaws in our method of shaping the doctors of the future.

When I went to medical school I was trained by physicians who were eminent in their areas of specialty and also did some research. They taught in classrooms and as attending physicians when we were working on the wards as doctors in training. I …

Nelson Mandela: His doctors and nurses also need our thoughts

Dr. Martin Young

June 28, 2013Jun 28, 20132

If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that…

If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that trajectory when he was rushed to hospital in the middle of the night more than two weeks ago. It would not have …

Medical students: Embrace the joy now before it’s too late

Jordan Grumet, MD

June 25, 2013Jun 25, 201310

It's not exactly Dr. Jekyll and Mr. Hyde, but everybody knows my level of patience varies from time to time. So I was surprised to find myself happily telling the emergency room that I would assess the patient shortly. The…

It’s not exactly Dr. Jekyll and Mr. Hyde, but everybody knows my level of patience varies from time to time. So I was surprised to find myself happily telling the emergency room that I would assess the patient shortly. The kids were horsing around on the playground, and I knew I would have to call my wife and ask her to come home. It would be my second 45 minute trip to the hospital on …

Will health care price transparency help reduce costs?

Peter Ubel, MD

June 22, 2013Jun 22, 201312

Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent,…

As a response to the hidden variability in health care prices, an increasing number of states have …

A cautionary tale of employing doctors

David Mokotoff, MD

June 21, 2013Jun 21, 201320

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale. Many years ago, as I was growing my cardiology practice, it became evident that…

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale.

Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the …

A cautionary tale of employing doctors

Patient voices

There’s not much to do but wait

Linda E. Clarke

June 21, 2013Jun 21, 20138

From your perch in the coffee shop you watch a woman exit the big grey church across the street from the hospital. She’s young, probably not even 40, but she’s dressed like an elderly woman. She’s wearing a shapeless blue raincoat, heavy stockings and wide, steady shoes. Her rosary is looped around her fingers. Across from the church door there is a statue of the Virgin Mary against the fence. …

There’s not much to do but wait

A hospital transfer may not always be a good thing

Colin Son, MD

June 20, 2013Jun 20, 20136

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.

They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …

What I’ve learned from calling out my orthopedic colleagues

John Schumann, MD

June 19, 2013Jun 19, 201313

Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall. Her son wanted…

Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within …

Are hospitals really soaking the poor with high prices?

Chris Rangel, MD

June 16, 2013Jun 16, 20137

The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.

For example, Twin Cities Community Hospital in …

Sreedhar Potarazu, MD, MBA

A more realistic approach to achieving accountable care

June 15, 2013Jun 15, 20136

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within…

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are …

Quality, cost, and value in health care: How to solve the puzzle

Robert Wachter, MD

June 14, 2013Jun 14, 201318

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate. “The world is going to push us, relentlessly and without mercy, to deliver the highest…

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

The spiritual bond between two souls

Eva S. Vertelney, MD

June 12, 2013Jun 12, 20139

Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …

The spiritual bond between two souls

American Society of Anesthesiologists & Anita Gupta, DO, PharmD

Have a safer hospital stay: Use a checklist

June 12, 2013Jun 12, 2013

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Thousands of patients undergo surgery every day, but many are unaware how to better ensure a safe and comfortable experience. Too often patients feel like they’re in the…

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Thousands of patients undergo surgery every day, but many are unaware how to better ensure a safe and comfortable experience. Too often patients feel like they’re in the passenger’s seat when entering the hospital, even under the best circumstances. When planning to undergo a surgical procedure, with or without subsequent hospitalization, I always encourage patients to use a …

An important step toward cost transparency

Ishani Ganguli, MD

June 7, 2013Jun 7, 2013

How much to treat this pneumonia? The Centers for Medicare and Medicaid took a step towards answering such questions by publicly releasing how much each of 3000+ U.S. hospitals charged Medicare for 100 common medical issues in 2011 and how…

The charges were remarkably variable, even among hospitals that share a zip code. Massachusetts hospitals tended to charge below the national average (eg. …

To improve patient safety, lawyers need to embrace transparency too

Kevin Pho, MD

June 6, 2013Jun 6, 201314

How do we reduce medical errors? It’s a question at the forefront of the minds medical and policy leaders today. Entire books have been devoted to the subject, and there is no shortage of suggestions to improve patient safety. Internist…

How do we reduce medical errors?

It’s a question at the forefront of the minds medical and policy leaders today. Entire books have been devoted to the subject, and there is no shortage of suggestions to improve patient safety.

Internist Danielle Ofri recently wrote a New York Times op-ed on the issue, where she reflected on a “near miss” she had during …