Hospital Medicine

Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

You can’t judge a hospital by its press releases

Trudy Lieberman

Patient

May 2, 2013

We in the press are accustomed to PR folks “advising” us of all the good things that hospitals do. They open new pavilions named for wealthy benefactors of new cancer and heart centers and children’s care, with media coverage of the ribbon-cutting ceremonies attended by famous faces. They buy big new machines that smash and diagnose illness and want the world to know about that, too.

But a press release that …

The problem of basing physician pay on quality indicators

Skeptical Scalpel, MD

Physician

May 1, 2013

New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators.

The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients …

Copy and paste medicine is not new

David Mokotoff, MD

Physician

April 28, 2013

As a second year medical student in 1971, I still remember an article in the prestigious New England Journal of Medicine, describing a new phenomenon, The Emperor’s New Clothes Syndrome. It was based upon the famous Danish author, Hans Christian Anderson’s fairly tale from the 1800’s.

A vain emperor, who cares for nothing except wearing and displaying clothes hires two swindlers who promise him the finest, best suit of clothes from …

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Copy and paste medicine is not new

Patients are the most important piece of the medical team

Danea Horn

Patient

April 27, 2013

After reading Dr. Mona Kotech’s article titled “Is the era of patient centered care decidedly anti-physician?” I immediately thought of several instances when knowing my health history and current lab readings were vital for providing me with safe care.

I was born with VACTERL Association, a birth disorder that impacts a variety of systems in the body. I have had more than twelve surgeries and a variety of medical …

There is minimal oversight of hospital marketing

Joanne Conroy, MD

Physician

April 26, 2013

I am old enough to remember when physicians did not advertise. It was considered a professional ethical issue. Hospital advertising consisted of institutional “We’re here” ads. Anything aggressive by docs or hospitals was considered bad taste… but that was before health care became as competitive as any other type of business.

I have been barraged, as have many of you, by a wave of hospital advertisements as our health care marketplaces …

Access to care isn’t enough: It’s about access to high quality care

Ashish Jha, MD, MPH

Health Policy

April 26, 2013

Ensuring that Americans who live in rural areas have access to healthcare has always been a policy priority. In healthcare, where nearly every policy decision seems contentious and partisan, there has been widespread, bipartisan support for helping providers who work in rural areas. The hallmark of the policy effort has been the Critical Access Hospital (CAH) program– and new evidence from our latest paper in the Journal of the …

12 tips to stay safe in hospitals

Leana Wen, MD

Physician

April 25, 2013

Hospitals can save you, but they can also harm you. So how can you stay safe in hospitals? Follow these 12 life-saving tips:

1. Never go alone. Always bring someone else—a trusted family member or friend—with you. That person will be your primary advocate, and can serve as an extra set of eyes and ears to help make sure you are safe. (This tip applies to routine doctors’ appointments too; always …

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12 tips to stay safe in hospitals

My hope for the upcoming generation of physicians

Karen S. Sibert, MD

Physician

April 24, 2013

My son has been accepted into medical school, we learned last week, and I must say I’m about as happy a mother and a physician as you could find anywhere. For everything that’s wrong with the American healthcare system today, medicine is a wonderful profession and it’s still the greatest honor in the world for a patient to have faith in your skills and care.

It will be interesting to see …

Can physicians really stop the actions of reckless caregivers?

Sherry Gorman, MD

Physician

April 23, 2013

In 2010, a surgical scrub technician named Kristen Parker was sentenced to thirty years in federal prison after allegedly diverting fentanyl from operating rooms, injecting herself with the powerful intravenous narcotic, refilling the contaminated syringes with saline, and replacing them to be used on patients. She was infected with hepatitis C, and her drug diversions infected over two dozen patients in the Denver area.

In 2012, David Kwiatkowski, also positive for …

Health reformers should learn from doctor-owned hospitals

Kevin Pho, MD

KevinMD

April 18, 2013

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As part of the health reform movement, hospitals that meet various quality measures, like reduced readmission rates or improved patient satisfaction measures, get financially rewarded. Those that don’t will be penalized.

How’s it going so far?

Well, it appears that safety net hospitals that can least afford a financial hit are getting dinged, while doctor-owned hospitals are getting rewarded.

Oops.

According to Kaiser Health …

Hospitals are still awful: The movement toward patient centered care

Janice Boughton, MD

Physician

April 15, 2013

First a disclaimer: People often receive compassionate, considerate and effective care at hospitals. They have countless interactions which impart the miracle of human caring and enrich their lives. It is also institutionally prevalent to have haphazard care with poor communication, near misses and avoidable misery.

I have been working at a university hospital emergency room as part of a mini-fellowship in bedside ultrasound. It is the first time I have spent …

The power of words in guiding patients toward recovery

Joyce Hyam, RN

Patient

April 12, 2013

Just three words, a short phrase, heard from an ICU nurse that changed my friend’s well-being as she lay in an ICU bed. In fact, it is the only phrase my friend remembers from her entire hospital stay after having brain surgery to remove a tumor.

She was experiencing nausea, a sick feeling, and needing and wanting care, direction, and guidance from hospital staff. And three powerful words spoken from a …

Change the warfare metaphors when it comes to illness

Rob A. Ruff

Patient

April 12, 2013

The metaphor we use, almost universally, to describe the experience of illness is that of warfare. Someone diagnosed with cancer is said to be “battling” cancer (as if the diagnosis itself implies a fight). Family members often say that their hospitalized loved one is a “fighter” who “will never give up” or surrender. Doctors refer to the most potent antibiotics as “big guns” that are prescribed to “kill the bugs” …

The patient experience can be dehumanizing

Joyce Ho, MD

Physician

April 12, 2013

Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning …

Increasing the role of nurse practitioners in the inpatient setting

Gene Uzawa Dorio, MD

Physician

April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

Quality healthcare isn’t just about clicks and lists

John Mandrola, MD

Physician

April 10, 2013

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart …

Reviewing my cataract surgery: A casual disregard for patients

Trudy Lieberman

Patient

April 9, 2013

At last it was time for my cataract surgery. Having had one eye surgery done by a different physician in another New York eye and ear specialty hospital a few months earlier, I knew what to look for and could make comparisons from a patient perspective. As I noted months ago on this blog, I really had no choice of hospitals. If I wanted my trusted doctor to …

How can doctors avoid killing or hurting people in their care?

Janice Boughton, MD

Physician

April 8, 2013

Hospitals are very focused on avoiding harming patients lately. They have been moving in that direction for a long time, but with health care reform legislation, payments are on the line, which makes something that was a very good idea into an imperative.

In the year 2000, the Institute of Medicine, a non-profit organization that monitors various aspects of medical care, reported that 44,000-98,000 people died each year due to medical …

Our medical education system does not tolerate emotional cracks

Shara Yurkiewicz

Medical Education

April 5, 2013

When we told the patient and his family that the mass in his lung was highly concerning for cancer, he didn’t say anything. His daughter asked about his symptoms. His son-in-law asked when and how he could get a definitive diagnosis. His wife asked when he could go home. Finally, he spoke.

“I’m sorry for being so much trouble.” The tone was casually apologetic, …

Let patients be their own people inside the system of care

Zackary Berger, MD, PhD

Physician

April 5, 2013

The more I try to help people in this field of mine, the more I realize that it doesn’t take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn’t figure and of dubious relevance, who came to our clinic seeking advice about …

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