Hospital medicine

5,188 articles · Since 2004

Articles, page 119

Balancing honesty and optimism in critical care

January 8, 2013Jan 8, 20136

A recent little essay entitled “Do patients bond best with doctors who misinform them with optimism” got me thinking about balancing honesty and optimism in practicing any medical specialty in which patients not infrequently die. Tragic things can happen in…

Tragic things can happen in the pediatric intensive care unit. Anyone who works there — doctors, nurses, respiratory therapists, and many others — see these …

Physician voices

When physicians don’t communicate about their patients

Michael Kirsch, MD

January 7, 2013Jan 7, 201313

One of the gripes that patients have about the medical profession is that we physicians don’t communicate sufficiently about our patients. In my view, this criticism is spot on. Patients we see in the office often have several physicians participating…

One of the gripes that patients have about the medical profession is that we physicians don’t communicate sufficiently about our patients. In my view, this criticism is spot on.

Patients we see in the office often have several physicians participating in their care. The level of communication among us is variable. While electronic medical records (EMR) has the potential to facilitate communication between physicians’ offices and hospitals, the promise has not …

Physician voices

The recipe for a great hospitalist program

Janice Boughton, MD

January 7, 2013Jan 7, 20135

Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …

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Physician voices

The increasing stress that radiologists face

Matthew D. Rifkin, MD

January 5, 2013Jan 5, 20134

In the past, the radiology profession was seen as a very financially successful specialty, but as every businessperson knows, success often has peaks and valleys. Radiology residencies are some of the most competitive to obtain, which is due to the…

In the early 1990’s, when financial pressures first appeared on the …

Health policy

The critical factors driving up American health costs

Samuel Metz, MD

January 4, 2013Jan 4, 20132

The Bipartisan Policy Report titled “What is Driving US Health Care Spending? America’s Unsustainable Health Care Cost Growth” issued in September lists seven factors increasing American health care costs. The “fiscal cliff” debates include many of these arguments. While these…

While these factors do indeed play roles in American health care, almost all are at work in other industrialized countries, all of whom provide better care to more people for half what we …

Health policy

Doctors cannot escape quality improvement

Brian J. Secemsky, MD

January 3, 2013Jan 3, 2013

Prior to heading out West for my postgraduate medical training, I spent four amazing years in Chicago absorbing everything I could about becoming a doctor. Throughout this time in medical school, I was taught everything from the smallest components of atoms to the largest organs of the human body. Academic physicians spent countless hours teaching me the art of bedside patient care and the scientific evidence behind clinical decision-making.

Despite this …

Physician voices

How to deliver bad news to patients: 9 tips to do it better

Alex Lickerman, MD

January 2, 2013Jan 2, 201311

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?” “Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and…

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”

“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.

“Yes?”

“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”

There was silence. Then a breathless, “Yes?”

“Mrs. Peterson, …

Patient voices

What patients can learn from public hospital ratings

Trudy Lieberman

January 2, 2013Jan 2, 20133

Recently, I spent some time answering the questions on one of those CAHPS surveys for doctors. CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, and these days hospitals ask patients to use them to review not only their…

Many public hospital ratings use data collected from CAHPS hospital experience surveys, but patients rarely have much access to …

Physician voices

P4P: Should physicians be treated as purely economic animals?

Robert Wachter, MD

January 1, 2013Jan 1, 20136

The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical. Just in the past several months, we’ve…

Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that …

Physician voices

The age differential in medical care

Ishani Ganguli, MD

December 30, 2012Dec 30, 2012

We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders? A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors…

We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?

A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance …

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The age differential in medical care

Health policy

Most ACOs are accountable in name only

Brian Klepper, PhD

December 25, 2012Dec 25, 20122

Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect: The healthcare world has…

The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In

…

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Most ACOs are accountable in name only

Physician voices

3 clear signs that you work in a hospital

Brian J. Secemsky, MD

December 22, 2012Dec 22, 20124

You try to hide it. You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party. But regardless how…

You try to hide it.

You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party.

But regardless how much effort you put into leaving your career where it belongs, it is so obvious that you work in a hospital.

And here are …

Medical education

The transition from resident to attending physician

Dawn Baker, MD

December 19, 2012Dec 19, 20124

The patient had arrived for a urology procedure with a blood glucose in the 400's. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was…

The patient had arrived for a urology procedure with a blood glucose in the 400’s. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and …

Health policy

Reducing medical errors should take priority over readmissions

Ashish Jha, MD, MPH

December 19, 2012Dec 19, 20122

I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.” It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and…

A year ago, on a Saturday morning, I saw Mr. “Johnson,” who was in the hospital with a pneumonia. He was still breathing …

Health policy

Why cost and revenue will kill independent hospitals

Joe Flower

December 19, 2012Dec 19, 20122

Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation…

Right now this enormous sector is turning itself inside out. It has turned the “transmogrification” setting to “warp.” Why? It’s all about …

Health technology

Explaining the epic failure of EMRs

Kiran Raj Pandey, MD

December 19, 2012Dec 19, 201216

It is no news a lot of doctors like to stick up a rather snotty nose to EMR. The defenders of the EMR tend to label such doctors as archetypal Luddites, sticking to their archaic ways and unbecoming of change and the new times. But as is usually the case with any two heated but opposite arguments, the truth likely lies …

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Explaining the epic failure of EMRs

Physician voices

I work for my patient because I care for my patient

Peter Elias, MD

December 18, 2012Dec 18, 20122

As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let …

Health policy

The loopholes around penalizing hospitals for readmissions

Brad Wright, PhD

December 16, 2012Dec 16, 20127

With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they…

For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …

Physician voices

How do you know if you’re a disruptive physician?

Linda Brodsky, MD

December 12, 2012Dec 12, 201243

Physicians are being attacked in many ways and in many places. It is no longer about how able, available, and affable you are. It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs. Many of whom have sharp teeth.

Here are a few questions that might indicate you are headed for trouble:

Do …

Physician voices

NPO and be merry

Rena Xu

December 12, 2012Dec 12, 2012

It is the holiday season, and all through the hospital, patients are being made “NPO.” This is the medical term for “no eating or drinking allowed.” Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis. "We…

It is the holiday season, and all through the hospital, patients are being made “NPO.” This is the medical term for “no eating or drinking allowed.”

Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis. “We don’t want to upset your pancreas,” the team tells him when we pass through on morning rounds. It is nearly breakfast time. We hover around his bed in a half circle …

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NPO and be merry

Hospital medicine

Articles, page 119

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