Hospital medicine

5,188 articles · Since 2004

Articles, page 114

How Obamacare will largely eliminate price variations

June 4, 2013Jun 4, 201375

If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to …

Health technology

User friendly recording of data often seems like an EHR afterthought

David Mokotoff, MD

June 4, 2013Jun 4, 20132

As I began logging on to my third different hospital EHR (electronic health record) recently, I contemplated how much more of this I could take. Being less than a year from planned retirement, the nuances of learning a new EHR and CPOE (computerized physician order entry) system is not fun. Furthermore, every hour I spend learning a new and unique system is …

Physician voices

Improving informed consent for resuscitation without playing God

Janice Boughton, MD

June 4, 2013Jun 4, 20139

To resuscitate or not to resuscitate, that is the question. Whether 'tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to…

To resuscitate or not to resuscitate, that is the question. Whether ’tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing.

The United States has come a long way in the last 2 decades since 1991 when the …

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Patient voices

Does shared decision making really increase health costs?

Dave deBronkart

June 4, 2013Jun 4, 201316

In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a…

In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment.

That’s a good thing.

Unfortunately, the University of Chicago …

Health policy

Why do hospitals buy primary care practices?

Doug Farrago, MD

June 3, 2013Jun 3, 201322

One reason is to apply an extra “facility fee” to patients’ bills. Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation…

One reason is to apply an extra “facility fee” to patients’ bills.

Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do.

PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a …

Health policy

How physician-owned hospitals are making teaching hospitals pay

Joanne Conroy, MD

May 31, 2013May 31, 201313

I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system …

Health policy

How the medical profession is being forced to game the system

Michael Kirsch, MD

May 29, 2013May 29, 201318

I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …

Physician voices

Please don’t call me a hospitalist

Suneel Dhand, MD

May 29, 2013May 29, 20138

I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I’ve had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their—hopefully very short—hospitalization. We take ownership …

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Please don’t call me a hospitalist

Physician voices

Why I rely on non-physician providers

Don S. Dizon, MD

May 29, 2013May 29, 2013114

I still recall my first rotation as an inpatient attending at Memorial Sloan-Kettering Cancer Center (MSKCC). Perhaps it was the anxiety that I remembered most; that I was “in charge” of a service. Fortunately, having done fellowship at MSKCC, the…

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Why I rely on non-physician providers

Conditions and diseases

Visiting my family member: A tale of two facilities

Betsy Nicoletti, MS

May 29, 2013May 29, 2013109

Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks. During that time, the unit kept him safe and provided medication for mood stabilization and thinking. After seeing my family member, my first priority was to talk with the attending physician and care team.

Evidently, the attending doesn’t like to …

Physician voices

What I’ve learned from saving physicians from suicide

Pamela Wible, MD

May 27, 2013May 27, 2013492

A psychiatrist in Seattle had picked out the bridge. At 3 a.m. he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep. A surgeon in Oregon was lying on the floor of her…

A psychiatrist in Seattle had picked out the bridge. At 3 a.m. he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.

A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.

An internal medicine resident in Atlanta heard an anesthesiologist joking about …

Health policy

As health care consolidates, physicians face a choice

Angelo Falcone, MD

May 27, 2013May 27, 20132

Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while…

The changes occurring in our care delivery systems have generated great interest, innovation, and yes, fear among many in healthcare, doctors …

Physician voices

The winds of change are blowing us out of the hospital

Jordan Grumet, MD

May 25, 2013May 25, 20135

The sweat coalesced on my forehead. I leaned forward to push the weight of my body into the wheel chair. I was terrified. Behind me strode the baffled parents with their arms full of coats and scarves. The young boy shrunk into the chair and balanced his IV’ed arm on the rest, trying not to disrupt the tubing that had been so painfully inserted.

I was lost. A week into my rotation as a volunteer …

Health technology

The impact of outdated communications technologies in healthcare

Sean Kelly, MD

May 23, 2013May 23, 2013

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care. If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and…

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.

If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …

Physician voices

Why banning curbside consults may not be the answer

Robert Wachter, MD

May 22, 2013May 22, 20139

Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare. Consultants hate being asked…

Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the underlying facts and assumptions aren’t right (the old garbage in, …

Health policy

Why pay for performance saves lives in the UK but not in the US

Jason H. Wasfy, MD & Jesse Pines, MD

May 22, 2013May 22, 20132

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common…

This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common medical conditions. Patient outcomes were compared to other National Health Service hospitals not eligible for the bonuses, and several other conditions that were not explicitly measured in the same …

Physician voices

Bringing OpenNotes to Geisinger

Jon Darer, MD

May 20, 2013May 20, 201325

Recently, over 520 of our doctors began sharing their office visit notes with patients. All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s…

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each …

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Bringing OpenNotes to Geisinger

Conditions and diseases

How to have a hospital stay without pain

Anita Gupta, DO, PharmD

May 19, 2013May 19, 20135

Too often patients feel like they’re in the passenger seat when entering the hospital. Even in the best of circumstances — such as planned admissions — patients often don’t feel in control of their own care. One of the most…

One of the most unnecessary issues facing patients when they enter the hospital is untreated (or undertreated) pain. Often the focus of the medical team is to treat a condition, and controlling a patient’s pain …

Patient voices

Measuring patient engagement: What would Ken Schwartz think?

Pat Mastors

May 17, 2013May 17, 20134

Don't get me wrong, it's huge to see patient safety evolving to be a front-burner issue. After beating the drum for years, the National Patient Safety Foundation and other groups are seeing progress, with meaningful use, electronic health records, pay…

Don’t get me wrong, it’s huge to see patient safety evolving to be a front-burner issue. After beating the drum for years, the National Patient Safety Foundation and other groups are seeing progress, with meaningful use, electronic health records, pay for performance, and the patient-centered medical home.

Medicare innovation grants and the Partnership for Patients are chipping away at medical harm and 30 day readmissions. Empowered patients are test-driving their choices …

Physician voices

Stories surround every physician

Bruce Campbell, MD

May 17, 2013May 17, 20133

Could a greater miracle take place than for us to look through each other’s eyes for an instant? -Henry David Thoreau It is almost 7:00am I carry my briefcase and lunch bag from the car to my office. I nod…

Could a greater miracle take place than for us to look through each other’s eyes for an instant?
-Henry David Thoreau

It is almost 7:00am I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun.

I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today …

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Stories surround every physician

Hospital medicine

Articles, page 114

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