"Disruptive physician" is one of the most misused terms in healthcare these days. In many organizations, those two words have become the c-suite's trump card to quash any physician resistance to new administrative programs. These programs are often have purely…
“Disruptive physician” is one of the most misused terms in healthcare these days. In many organizations, those two words have become the c-suite’s trump card to quash any physician resistance to new administrative programs. These programs are often have purely financial motives or are a brazen attempt to dump additional tasks on the physicians with no regard for their workload or stress levels.
The doctor’s legitimate concerns about quality of care …
In the new book, Establishing, Managing, and Protecting Your Online Reputation, physician ratings are highlighted. This is a topic that gives many physicians some pause, and for some, causes tremendous anxiety. Whether doctors know it or not, they already have…
Whether doctors know it or not, they already have online profiles. Third-party rating sites, like Vitals or Healthgrades, already have web pages of most physicians, and they …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Hospital dramas are not very short on excitement, but for some reason, anesthesiologists never seem to get the glamour treatment. Maybe that’s because our job is so difficult…
Hospital dramas are not very short on excitement, but for some reason, anesthesiologists never seem to get the glamour treatment. Maybe that’s because our job is so difficult to transition onto the silver screen. After all, it would be pretty boring to see only one person bridging communication gaps between physicians to provide comprehensive care, all while …
Another disturbed and disturbing night. It doesn't happen often three years later. Now – when it does happen – I generally know why. I am preparing to make a presentation of a sentinel event from my daughter's final illness to…
Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.
I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?
The stories have now been relegated to the back pages: “Smoldering batteries forced safety regulators to ground Boeing’s new 787 Dreamliner jets.” This is a glimpse into the challenges that this aircraft and company seem to have been besieged by.…
The stories have now been relegated to the back pages: “Smoldering batteries forced safety regulators to ground Boeing’s new 787 Dreamliner jets.” This is a glimpse into the challenges that this aircraft and company seem to have been besieged by. The recent grounding of the fleet comes on the heels of other safety related incidents that while “typical” with a new plane …
-Kahlil Gibran Dear Debbie, You cared for my mom briefly in the ICU. You might not remember me, but I remember you. My mother, a healthy 54-year-old woman came down with the flu on Christmas. Within a week, she had…
When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.
-Kahlil Gibran
Dear Debbie,
You cared for my mom briefly in the ICU. You might not remember me, but I remember you. My mother, a healthy 54-year-old woman came down with the flu on Christmas. Within a …
Our nurses will soon have "scripting" guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which…
Our nurses will soon have “scripting” guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!
Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the …
Rapid change is engulfing health care across the United States, but the strategic responses of organizations to these changes are sharply divided. In the shift that has been broadly shorthanded “from volume to value,” many organizations across the country are…
Rapid change is engulfing health care across the United States, but the strategic responses of organizations to these changes are sharply divided. In the shift that has been broadly shorthanded “from volume to value,” many organizations across the country are deeply engaged in moving toward “value” by building new partnerships, affiliations, capacities and economic structures, striving to bring better health and health care to more people for less money.
These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one focused on volume to one that rewards performance.…
These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one focused on volume to one that rewards performance. The new system (currently a work-in-progress) promises to put skin in the patient safety game as never before.
Yet I’ve never been more worried about the safety movement than I am …
When a patient dies in the hospital, we go through a checklist that has become eerily mundane. Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some…
When a patient dies in the hospital, we go through a checklist that has become eerily mundane. Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere …
The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and…
The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and doctors for having poor HCAHPS scores has reaped its own set of unforeseen complications.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the Press-Ganey …
She was 94-years old with advanced Alzheimer's. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip. She'd fallen at her assisted living facility.…
She was 94-years old with advanced Alzheimer’s. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip.
She’d fallen at her assisted living facility. It was the second time in as many months. She’d broken her collarbone on the previous occasion.
Over the past year, she’d lost 30 pounds. This is natural in the progression of …
It wasn’t until I became a nurse that I realized how long a hospital hall could be! And, whether we are walking, rolling, or running down those halls, our steps can seem endless. Oh sure. Current hospital halls may be…
It wasn’t until I became a nurse that I realized how long a hospital hall could be! And, whether we are walking, rolling, or running down those halls, our steps can seem endless.
Oh sure. Current hospital halls may be relatively short, compared to the immense and cavernous wards of days gone by. But hospital halls have an open and hollow resonance of …
If you think that medical errors are a thing of the past, you are mistaken. It has been 14 years since the Institute of Medicine's report "To Err Is Human" shattered the myth that most, if not all, physicians are…
If you think that medical errors are a thing of the past, you are mistaken.
It has been 14 years since the Institute of Medicine’s report “To Err Is Human” shattered the myth that most, if not all, physicians are all-knowing practitioners with flawless skills and infallible judgment.
The story of what happened in the report’s wake was predictable:
A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time…
A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at …
I was startled awake at 3:40 am by a loudspeaker blaring "Code Blue ... Code Blue." As the hospital's newly hired chaplain intern, I'd been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my…
I was startled awake at 3:40 am by a loudspeaker blaring “Code Blue … Code Blue.”
As the hospital’s newly hired chaplain intern, I’d been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my pajamas, I made sure to put on my hospital badge.
I made my way to the hospital’s “Z” building, where the ICU was located, and took the elevator to the fourth floor. …
Juan Gonzales, (not his real name), is a somewhat demented elderly Hispanic male, who I met last week in an intensive care unit. He spoke little English, and I spoke limited Spanish. His devoted family was at the bedside, and…
Juan Gonzales, (not his real name), is a somewhat demented elderly Hispanic male, who I met last week in an intensive care unit. He spoke little English, and I spoke limited Spanish. His devoted family was at the bedside, and fortunately his daughter was able to provide some history. He was admitted with palpitations and dizziness and atrial fibrillation with a rapid response.
By the time I met her, Ms. Jacob had been in the hospital for 202 days, 15 hours, and 38 minutes. 39 minutes. 40 minutes. Starting work on a floor that prided itself on delivering comprehensive, efficient care, I studied…
By the time I met her, Ms. Jacob had been in the hospital for 202 days, 15 hours, and 38 minutes. 39 minutes. 40 minutes.
Starting work on a floor that prided itself on delivering comprehensive, efficient care, I studied the computer monitor describing patient lengths of stay, wondering why this woman had been here 25 times longer than the average patient – …
As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It's also how I personally cope with the devastating injuries to the patient and the…
As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It’s also how I personally cope with the devastating injuries to the patient and the aftermath left for the family. Sometimes, though, I am caught off guard and my defenses aren’t strong enough.
A middle-aged man was brought in one evening after being hit while riding …
Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not. It’s a silly debate, with proponents pointing…
Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not. It’s a silly debate, with proponents pointing to the logic that “you get what you pay for” and critics arguing that the evidence is not very encouraging. Both sides …
