Hospital medicine

5,188 articles · Since 2004

Articles, page 122

The only thing I had to do was to help Jerry and I failed

September 10, 2012Sep 10, 2012

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…

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 …

Physician voices

When our health system works, it’s unbeatable

Stewart Segal, MD

September 9, 2012Sep 9, 20126

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…

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 …

Health policy

The secret sauce of great health care organizations

Robert Allan Bear, MD

September 9, 2012Sep 9, 2012

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…

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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Medical education

The first 24 hours of being a medical resident

Brian J. Secemsky, MD

September 8, 2012Sep 8, 20122

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 …

Physician voices

Which hospital should I choose? How to use hospital rankings

Ashish Jha, MD, MPH

September 8, 2012Sep 8, 2012

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 …

Physician voices

Any doctor can make the decision for mental capacity

Tamer Mahrous, MD

September 5, 2012Sep 5, 20122

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 …

Physician voices

How we die should never be taken lightly

angienadia, MD

September 3, 2012Sep 3, 20127

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 …

Patient voices

How to plan for a long hospital stay

Andrew Griffith

September 1, 2012Sep 1, 20122

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…

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

Physician voices

Work hour reform is a moral imperative

Vinay Prasad, MD

August 22, 2012Aug 22, 20122

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…

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 …

Read more…

Work hour reform is a moral imperative

Physician voices

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

August 17, 2012Aug 17, 20123

Here’s a little story from the early days of my first job as a chairman of surgery. Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having…

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

Patient voices

Hospital discharge planning: Involve the patients

Jessie Gruman, PhD

August 15, 2012Aug 15, 20124

“Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to …

Drugs and prescribing

Doctors who prescribe too many antibiotics: It’s not that simple

Anonymous

August 15, 2012Aug 15, 20123

Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless thousands of lives every year by refusing to bend to misguided…

As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide a rationale for every antibiotic dose prescribed. The Centers for Medicare and Medicaid (CMS) …

Drugs and prescribing

Why the drug shortage is leading to desperate measures in hospitals

Al Patterson, PharmD

August 15, 2012Aug 15, 20122

More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin…

But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs …

Physician voices

Doctors leaving the clinical practice: The fear of being irrelevant

Ashley Wendel, MA

August 10, 2012Aug 10, 2012

I'm always surprised at the number of physicians I work with who worry about, discount, or do not see their relevance outside of clinical practice. I do, of course, recognize their relevance - the trick is to get the docs…

I’m always surprised at the number of physicians I work with who worry about, discount, or do not see their relevance outside of clinical practice. I do, of course, recognize their relevance – the trick is to get the docs to.

For many physicians, venturing into positions of leadership, becoming a Department Chair, VP Medical Affairs or even Chief Medical Officer) is a logical step for those looking to expand their skills …

Medical education

Teaching the cost of tests in medical education

Vineet Arora, MD

August 8, 2012Aug 8, 20126

Last week, I tried something new with our residents. We tried to talk about why physicians overuse tests. This is the topic of the moment, as the American College of Physicians (ACP) just dropped their long-awaited new High Value Cost…

In addition to the ACP curriculum, which I served as one of the reviewers for, I also …

Physician voices

Beating the 30 day readmission: Why there’s little to celebrate

Shabbir Hossain, MD

August 6, 2012Aug 6, 20124

30 day hospital re-admission rates. It's a statistic that keeps hospital administrators up at night. Whether you agree or disagree with the use of this statistic as a quality and reimbursement metric, if it creates change, reduces hospital re-admissions and…

30 day hospital re-admission rates.

It’s a statistic that keeps hospital administrators up at night. Whether you agree or disagree with the use of this statistic as a quality and reimbursement metric, if it creates change, reduces hospital re-admissions and improves patient care, then in theory I support it.

I’m reminded of Mrs G. She is emblematic of today’s chronic disease patient. She was admitted to our hospital for a congestive heart …

Physician voices

Well meaning improvements can hurt critical healing relationships

James C. Salwitz, MD

August 3, 2012Aug 3, 2012

Steve is lying almost flat in the hospital room, an IV attached to his arm. I am happy to see he is more comfortable, last night’s crisis has passed. He smiles as I enter and walk to his side. I…

Steve is lying almost flat in the hospital room, an IV attached to his arm. I am happy to see he is more comfortable, last night’s crisis has passed. He smiles as I enter and walk to his side. I touch his hand as I sit down on the pressed clean blanket. And then … a shrill loud wail breaks the silence … lights flash above his bed … fear …

Physician voices

The questions in medicine never change, but sometimes the answers do

Jim deMaine, MD

August 2, 2012Aug 2, 2012

As doctors in training, we learn to think in patterns of symptoms and can often use "clinical judgement" to fit a patient's presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For…

As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam …

Physician voices

Being a ward attending: A job I am so lucky to have

Katherine Chretien, MD

August 1, 2012Aug 1, 2012

I love being a medicine attending in the summer. It's often more intense work since everyone's in a new role. Bright, fresh interns. Excited new residents. And the medical students - the new third-year students who have toiled in the…

I love being a medicine attending in the summer. It’s often more intense work since everyone’s in a new role. Bright, fresh interns. Excited new residents. And the medical students – the new third-year students who have toiled in the classroom finally get to focus on patient care.

Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it’s a …

Physician voices

The upside of hospital rankings far outweighs the downside

Robert Wachter, MD

August 1, 2012Aug 1, 20122

I knew it would happen sooner or later, and earlier this week it finally did. In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its…

I knew it would happen sooner or later, and earlier this week it finally did.

In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed …

Hospital medicine

Articles, page 122

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