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.
Since the earliest days of medical school, I learned fast to bring my computer wherever I went. Not only did my laptop function as my personal entertainment center through the dullest parts of lectures, but it also proved to be a source of instantaneous and infinite medical knowledge via the click of a mouse. Four years later and here I am, one hand on the shoulder of patients whilst listening …
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This generation of doctors has permanently lost their physician brains
Just as preparing for a lengthy hospital stay requires planning, so does returning to home after the hospital. While your condition and strength will shape the best approach for you, my experience following my stem cell transplants may be helpful should you find yourself in this situation.
Before you leave get the information you need. Most hospitals are pretty good in providing written information sheets on follow-up care, related instructions, and …
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Plan your return home after a long hospital stay
The call comes in at 9pm or so. The patient sounds sick as all hell. The Surgeon listens to the random assortment of numbers and vitals the nurse provides and clicks off his cell. He finishes reading a boring Berenstain Bear story to his daughter and tucks her into bed. He looks at the clock and runs some mental numbers. By the time he arrives at Hospital, close to ten. See the …
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The Surgeon places hands on belly and the diagnosis is clear
The gynecologist made several incisions and inserted the laparoscope. With the help of her surgical team of nurses, students and anesthesiologists, she removed the patient’s uterus, which had been bleeding uncontrollably for the past six months despite aggressive medical therapy. The price tag of the procedure? Around $6,000.
Meanwhile in a nearby hospital, another gynecologist removes another woman’s uterus, in a procedure no more complicated or time consuming than the first …
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Why hospital pricing practices concern me
Recently, I discovered the statewide report on quality of stroke care in Massachusetts. It’s a plain document, mostly in black and white, much of what you might expect from a state government report. Yet, this 4-page document is a reminder of how we have come to accept mediocrity as the standard in our healthcare delivery system.
The report is about 1,082 men and women in Massachusetts unfortunate enough to have a stroke …
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Stop setting hospital benchmarks at the state average
Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. …
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5 pieces of advice nobody tells you before starting residency
He had been in the hospital for 3 months. A rocky 3 months, much of it in the ICU. Now, when it looks like he will be leaving on his way to a near full recovery, his wife tells me she can’t thank me enough telling her husband “she never lost faith in you.”
I felt as if my medical practice had suddenly been realigned. All the recent years of practice …
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A reminder of medicine’s main purpose
As a longtime consumer reporter, I’ve always thought the best way to see how the marketplace works is to put yourself in the shoes of someone buying the product or service you’re investigating. After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.
To begin my quest for the best, I searched for ratings for four …
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Even when using rankings, differences among hospitals may be subtle
An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections.
On the surface, it kind of makes sense – one should be punished for making a …
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Why punishing medical mistakes won’t make patients safer
Have you ever sat on your bed after being discharged from a hospital stay and suddenly felt – along with the relief of being home – overwhelmed by what you have just been told that you and your loved ones must now do? Similarly, have you ever walked out of an appointment with your clinician and said, “HUH? Exactly what did we agree I am going to do about this …
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An OpenTable approach to hospital discharge planning
I have failed Jerry, and now I’m replaying every word I ever said in my head, over and over, the whole exercise consuming my being.
Jerry was not old. He just turned sixty, a good few decades of retirement awaiting him. Then, he was diagnosed with stage 4 esophageal cancer. It seemed that he had spent his entire life working up to that moment, only to be stolen away unjustly, by …
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The only thing I had to do was to help Jerry and I failed
Today was a great day. Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing. Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world. I know. I saw it happen today.
Today, Mr. X presented with a troublesome history and an even more threatening physical exam. I was afraid that the disease I was about to diagnose would …
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When our health system works, it’s unbeatable
Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.”
The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and …
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The secret sauce of great health care organizations
As this is the season for spanking-new physician trainees to flood hospitals around the U.S., I decided to chronicle my own very first 24 hours as a doctor so the reader can get a better insight into this annual event.
2000 hours, evening before: With my newly starched white coat, stethoscope and light pen packed neatly into my Tumi man-purse, I make believe that I am sufficiently prepared for the first …
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The first 24 hours of being a medical resident
After years of breaking down, my sedan recently died. Finding myself in the market for a new car, I did what most Americans would do – went to the web. Reading reviews and checking rankings, it quickly became clear that each website emphasized something different: Some valued fuel-efficiency and reliability, while others made safety the primary concern. Others clearly put a premium on style and performance. It was enough to …
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Which hospital should I choose? How to use hospital rankings
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …
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Any doctor can make the decision for mental capacity
It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.
“We …
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How we die should never be taken lightly
Planning a lengthy hospital stay is like planning any extended vacation or business trip, with the difference that transitioning to hospital life means transitioning to no longer being in control, where choice is limited, and where one is dependent on others.
Given my lengthy hospital stays as part of my stem cell transplants – some planned, some as a result of complications – the following may be helpful should you find …
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How to plan for a long hospital stay
While new doctors in Europe “enjoy” 50 to 60 hour work weeks, doctors in the US work up to 80 hours a week, and sometimes beyond that. But the situation is changing.
One year has passed since new limits on the number of hours doctors can work in their first job. For first year physicians, shifts are limited to 16 hours, and in other years, the limit is 28 hours.
There has …
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Work hour reform is a moral imperative
