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.
Malpractice lawsuits are a necessary evil in our society. At times, they are frivolous, often resulting from a patient’s or family’s anger at a result that was not what they had hoped. Some are actually designed just to try to get a financial settlement. When doctors are sued for malpractice, it is a searing process, isolating and painful. I have known several excellent doctors who have given up established practices …
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The scope of the standard of care in medicine has changed
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above the limit. I lamented the forced, measured pace as the road lazily formed a long straight path. The clock refused to slow for my new found law abiding citizenry.
A sports car motored around a curve and flew past us unaware. The cop switched on his lights and tried …
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When patient care becomes secondary to filling out the medical record
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the meeting. The topic was healthcare reform and its effect on hospitals and physicians. Included were discussions on patient-centered medical homes, accountable care organizations, bundled payments and physician integration and alignment with hospitals.
The course director made it crystal clear that there will be no place in the future for …
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Why physicians are susceptible to hardball tactics
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career. How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.
Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …
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How we deliver bad news is critical to how families deal with grief
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I thought the patient was dead. He was nearly the same color as the pale sheet covering his thin frame. His cheeks were sunken in and his eyes were gazing upward, in what I sometimes call the “death stare.” Then, surprisingly, he moved his arm upward to push his …
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His father’s suffering had already been too great
“It was the best of times, it was the worst of times …”
So begins a story called A Tale of Two Cities by Charles Dickens. Its about the differing responses of two different nations to the revolutionary events and social upheaval of 1775. I’m going to tell a tale of three hospitals. You’ll see why soon.
Today, in 2012, health care systems around the world, including the United States, are launching …
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Hospitals around the world aim to remain relevant to patients
Recently I was asked, “How can I improve my Press Ganey scores?” Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals. Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS …
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Tips to improve your patient satisfaction scores
I have participated in two transitions in care with my mother. The first was when she was released from the hospital after undergoing neurosurgery for a malignant brain tumor. Immediately after surgery of her brain tumor, she went through two weeks of intensive physical, occupational, and speech therapy. At the end of this period, the recommendation was clear. She required around the clock supervision. The plan was to send her …
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Poor transitions in care result in unsafe patient care
Consider this scenario.
Joan, age 75, living in Ft. Lauderdale, was diagnosed with Stage IV Ovarian Cancer. Joan’s daughter, Beth, who lives in Kansas, contacts Maxine, a private patient advocate and RN who works in Ft. Lauderdale, to help her mother. Joan, Beth and Maxine have extensive conversations about the care Joan will need. The decision is made that Joan will need surgery and chemo. Maxine is hired to oversee the …
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Patient advocates need to manage expectations
A group of nine medical specialty societies recently announced the “Choose Wisely” campaign, targeting 45 commonly performed medical procedures and tests that offer little or no value in improving health. These interventions waste precious health care resources, lead to erroneous conclusions and/or false security, spur unwarranted additional interventions, and cause patient harm. Among the appropriately indicted procedures was cardiac stress testing of asymptomatic, low-risk patients. There is an old …
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Why academic medical centers need a stress test
I was working in the Intensive Care Unit (ICU) the other day and as I counted, I found that more than half of the patients there, for lack of a better term, brought the condition upon themselves.
I sound harsh, but there was no better way to put it. I was taking care of Mrs. B, a 60-year-old lady with COPD who called EMS for shortness of breath. As EMS readied …
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Heroic measures cannot cure how people want to live their lives
An excerpt from Potent Medicine The Collaborative Cure for Healthcare.
It was mid-summer 2010 when the full scope of everything that Nancy D’Agostino did not know hit home. Still raw from surgery and missing parts of her body, she thought that all the hard choices were behind her. Then here was a new face, a radiation oncologist, outlining side effects of treatment and asking her to choose. And then a medical …
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Lack of health care coordination benefits physicians
Hospitals commonly espouse a commitment to patient-centered care (PCC). Most fail to achieve it. Causative factors are legion. PCC is often considered a strategy or a tactic, for example, when it really should be integral to an organization’s culture, and enabled by a supportive vision. Some organizations appreciate this, yet still struggle. This is understandable. Today’s health care providers were not trained to provide PCC. They lack the requisite skills, …
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Is patient-centered care an outmoded concept?
The fundamental challenge in any high-risk industry is balancing “productivity” versus “safety.” The term “protection” is frequently used within the scientific literature to express the role of safety departments within an organization. Described this way, it might sound as if the safety experts are framing the debate to suggest “the evil factory bosses are continually speeding up the assembly line, while the righteous safety-folks are yelling ‘slow down!’” This essential …
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The problem of mixing productivity with patient safety
For various reasons our nation’s public health programs have been decimated. This comes at a time when the number of unemployed and health uninsured are at a record high number. Additionally, we are seeing individuals live longer and experience more chronic debilitating illnesses and conditions that stretch the resources of an already under manned and under funded health system. Emphasizing prevention and healthy living should be a lifetime necessity for …
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Why we need a National Health Service Corp
When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, …
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A simple innovation to improve hospital quality and safety
It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must do everyday.
It’s no surprise, then, that reports of problematic doctor interactions with social media are …
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How can doctors curb digital distractions?
As I enter the hospital in which I work, I am struck by a number of signs that denote that my place of employment is a Christian hospital, with Christian values, and a Christian “vision” of health care. I don’t have the vaguest clue as to what that means. And I don’t really mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem …
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A Hindu physician in a Christian hospital
My patient ran away from the hospital.
This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.
Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him …
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Why my patient ran away from the hospital
When it comes to medicine and social media, much of the attention is negative.
