There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.
So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more. Doctors lives are spent staring at these damn screens now. I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central …
The new standard of an exceptional physician
I told you so.
Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be reimbursed. I pointed out that several were in fact not 100% preventable despite any institution’s best efforts, and the rates of many of these occurrences would not fall to zero.
Now …
Penalizing hospitals for never event infections is ineffective
It is nearly impossible to ignore the need for clear thinking, confident and “in control” leaders. And whether in Congress or in a physician’s office, medical school department or hospital administrative suite, women leaders are notably absent. And while recent research tells us that women aspire to be leaders, the barriers to achieving this nebulous goal are enormous.
So whose fault is it anyway? I say both the women and the …
Can women physicians truly be senior leaders in medicine?
I visited Safdarjung Hospital in New Delhi recently – an institution with 1,531 beds and 145% occupancy rate. Yes, 145%. You do the math. A lot of bed sharing and asking families to bring in cots. It’s right across the street from the All India Institute of Medical Sciences (AIIMS), the premier public healthcare institution in India. While both AIIMS and Safdarjung are run by the federal government, …
A high volume, efficiency-driven institution that delivers great care
During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don’t have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much …
An end of life discussion is one of the most important to do right
I recently took call on the pediatric ward. Our team was caring for a young patient facing a new diagnosis of a chronic illness. In addition to stabilizing her symptoms, coordinating care with her new specialist, and managing her medications, I also see it as our job to make sure she and her family start to understand what is going on and what this diagnosis means for her.
How does this …
Patient education is often an afterthought
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.
The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …
MKSAP: 78-year-old man with poor glycemic control
Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.
I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.
In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain …
Doctors can play a major role to reduce waste
As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%.
Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. …
Is it really fair to penalize hospitals for readmissions?
If you want to know if restaurant food is safe, there’s help. Just look at the signs in the window showing that the eatery got an A, B or worse on its latest government inspection report. There are government inspection reports for hospitals too, but you won’t see them on the front door or any place else in the hospital, for that matter.
Hospital inspections conducted by state departments of health …
My search for helpful quality information on hospitals
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
A guest post by the American College of Chest Physicians, exclusive to KevinMD.com.
In light of Hurricane Sandy’s impact upon the east coast, and subsequent effect on the area’s healthcare delivery systems, many physicians and healthcare professionals are likely considering how they would respond if disaster were to strike their community. From the decision making process and preparation for evacuation to evacuation …
What if Hurricane Sandy came to your city?
I learned a lot of medicine during residency, but perhaps I actually learned even more about how to just get things done in a hospital. If you wanted a right-upper-quadrant ultrasound done for our patient, I was your man. I had a complicated series of unwritten algorithmic flow diagrams in my head that included handwriting an order, making sure that it was faxed to the right number, calling the appropriate …
Waste in medicine is disrespectful to both patients and doctors
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Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National Nurses Week. Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.
Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based healthcare providers, we are in …
Every week should be National Nurses Week
When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I discovered, I wondered if perhaps a few measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients …
Having patient satisfaction data isn’t enough to choose a hospital
She was in her late thirties when her medical oncologist asked me to see her. Five years before, one of our community surgeons had removed part of her colon for cancer. She also had a recognized, single metastatic tumor in her liver at the time of that original surgery.
The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance …
From surgeon to management: Was my decision selfish?
I’ve written about trying to communicate acuity to families. Maybe that needs to be expanded to encompass the same to other physicians.
To be fair I’m sure some of this, perhaps much of it, rests solely on my shoulders. Recognizing that I’m still going to make an accusation that talking life and death with families and patients is a skill not fostered in many providers. More accurately for this anecdote, and …
A physician removed from the reality of acute care
It was some doctor show on cable: Nurse McCarthy bustles into the hospital room, says “Good morning!” brightly, and crosses the brilliantly polished linoleum floor to the window. Humming to herself, she sweeps open the curtains to the view of the brick wall across the airshaft, then goes to the patient on the right and checks his dressing, clucking and offering encouragement. After a few moments she does the same …
Hospitals need evidence based design
Two articles recently addressed medical errors.
In the Wall Street Journal, surgeon Dr. Marty Makary discusses the alarming costs of medical errors and offers suggestions to improve the system. In medicine, particularly during the training years of residency and fellowship, young doctors are not given the opportunity or security to report shortcomings of their superiors.
As discussed in the article, all of us have a memory of a particular surgeon …
National reporting isn’t the answer to reduce medical errors
Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …
Having our own doctor treat us in the hospital is a thing of the past
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