Hospital Medicine

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.

Why your local hospital may not be relevant in the future

Howard Luks, MD

Health Policy

April 8, 2012

The pressures mounting on most institutions as the years trudge by are mounting. They are mired in mountains of regulations, the need to implement millions of dollars of IT “improvements,” streamline their most productive service lines, strip down their front-line staff to dangerous levels … and all this while their reimbursements are being crushed.

Consider that a profitable hospital currently operates on a 1% margin.

Consider that the hospital is considered the most costly …

My philanthropic advice to America’s healthcare supporters

Kristine Christlieb Canavan

Health Policy

April 5, 2012

If you have a brain and work in healthcare, you know chances are good that David Houle and Jonathan Fleece’s prediction that “one third of hospitals will close by 2020” is on the money. Until a recent marriage and move took me to St. Louis, my job was to sell a Texas hospital system’s plans for the future to major donors; and throughout my five-year tenure, the looming and pervasive …

Greening the operating room

T. Kate Huncke, MD and Susan M. Ryan, MD, PhD

Physician

April 5, 2012

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

In an effort to recognize April as Earth Month, the American Society of Anesthesiologists (ASA) is taking action to help hospitals across the country green their operating rooms with a white paper by the ASA Task Force on Environmental Sustainability.

Physicians such as anesthesiologists are responsible for the …

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Greening the operating room

The real doctors will see you in the morning

Samuel Wasswa-Kintu

Patient

April 4, 2012

“Wait, you said you’re a medical student?”

“Yes, I am.”

“I will be seeing a real doctor though, right?”

“Yes, of course!” I smiled, then attempted to defuse his frustration with a quip about getting two opinions for the price of one.

He didn’t laugh, understandably. He was only 25, built like a linebacker, draped in a backwards hospital gown that exposed his unfamiliarity with this environment, among other things. Yet he was here …

Why full code should not be the default status for patients

Anonymous

Physician

March 30, 2012

Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.

Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …

The necessary steps healthcare must take for patient safety

Michael Appel, MD

Physician

March 24, 2012

Unlike most other industries, safety in healthcare has a unique set of circumstances to overcome: 1) patients die from errors one-at-a-time, and 2) we rarely find out exactly why. The “sensationalism” from a front-page disaster is completely absent. And, due to a myriad of factors, the underlying hazards usually remain a secret.

As we ride the crest of a current wave of interest in “patient safety,” is the refreshing new focus blinding …

Healthcare consolidation may bend the cost curve the wrong way

Mitchell Brooks, MD

Health Policy

March 16, 2012

Last year, Ann Mathews wrote a brilliant piece in the Wall Street Journal about the future of medical care in the United States. It is an extremely informative study and provides the reader with a very fine 50,000-foot view of the current condition of its subject.

What she did not mention, or truly highlight, is the threatening trend that is taking place with ever increasing rapidity, of hospital conglomerates, both …

Complex, painful and expensive medical procedures at the end of life

Janice Boughton, MD

Physician

March 16, 2012

It isn’t that it was a bad day, because it wasn’t really. There was too much work, yes, and I ended up staying late, but it was mostly made of good interactions and I felt generally competent. So, no, it wasn’t just a bad day. Still, this evening I feel like the best possible future would be one in which there was no technological medical care, where we just worked …

Improving patient safety requires a commitment to transparency

Paul Levy

Patient

March 15, 2012

An excerpt from Goal Play!: Leadership Lessons from the Soccer Field.

I recently had lunch with one of my soccer alumnae, now aged 28. Tovah said to me, “Do you remember that play I made in the tournament we went to in Connecticut? I mean when I mistakenly headed the ball into our own goal and caused us to lose the game.”

“Well, I was devastated and was sitting on the …

Why one-third of hospitals will close by 2020

David Houle and Jonathan Fleece

Health Policy

March 14, 2012

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For centuries, hospitals have served as a cornerstone of the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to …

Does leaving against medical advice stick patients with a bill?

John Schumann, MD

Physician

March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

Overtreatment and the ethics of end of life care

Bradley Flansbaum, DO

Physician

March 1, 2012

There was an exceptionally well-written piece published in the Washington Post recently. I presume a hospitalist wrote it, which magnifies its significance. In it, he describes the difficulties in caring for terminally ill patients.

As I read it, it reminded me of a story my dad told me several years ago. His friend, I will call him Steve, was experiencing a great deal of stress because of his dad’s ailing …

Why the civil litigation system is unfair to physicians

Chris Rangel, MD

Physician

February 24, 2012

It’s unclear how many non-legal persons actually understand how different civil trials are from criminal proceedings. Most people have heard that juries in criminal trials are told that they can only find a defendant guilty if their belief that the defendant is guilty is beyond a reasonable doubt. Federal courts define this term further as, “proof of such a convincing character that a reasonable person would not hesitate to act …

Understanding what patient centered care really means

Jordan Grumet, MD

Physician

February 21, 2012

There was nothing the professor despised more then the syrup that oozed out of his partner’s lips when dealing with patients. He often cringed as he walked by the examining room and imagined the hand holding that was taking place behind closed doors.

Privately, they argued about the different approaches. One saw the world in terms of black and white, while the other was steeped in a foggy haze of gray. …

Doctors cannot be expected to be financial engineers

Andrew Schutzbank, MD, MPH

Physician

February 20, 2012

Peggy was in her early 70s and suffered from a terrible lung disease known as pulmonary hypertension. So bad in fact, that she had a pump infusing a medicine under her skin 24 hours a day to keep the blood supply to her lungs open. Once started, this medicine, treprostinil, was known to improve life in those with pulmonary hypertension. Unfortunately, like all continuous infusion medicines of this type, it …

Why patient engagement is reciprocal

Steve Wilkins, MPH

Patient

February 20, 2012

It is said that “turn around is fair play.”

So if providers (physicians, hospitals and other health care professionals) expect patients to become more engaged in their own care, isn’t it fair for patients to expect their physicians to also get more involved in their care?

If you look closely at “proxy measures” for physician engagement, you will see that this is a legitimate if not equally important line of inquiry.

Hello? Hello? …

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Why patient engagement is reciprocal

Why are labor and deliveries closing?

Vivian E. von Gruenigen, MD

Health Policy

February 18, 2012

Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to …

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Why are labor and deliveries closing?

How patient satisfaction can kill

Kevin Pho, MD

KevinMD

February 14, 2012

Patient satisfaction is all the rage.

Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country are under pressure from administrative executives to raise patient satisfaction scores.

High scores are even used by hospitals as a powerful marketing tool.

But, in the end, are patient satisfaction scores hurting patients?

I wrote about the issue previously, saying that patient …

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How patient satisfaction can kill

Good communication in health care is about listening

Rev. George Handzo

Patient

January 30, 2012

A great deal of effort in the current health care environment is being put into improving communication – between patients and families and members of the health care team, among family members, and among members of the team. The case can be made that good communication is at the heart of patient safety, cultural sensitivity, and the pillar of palliative care — aligning patient’s wishes and goals with treatment plans.

So …

Insider tips to surviving your hospital stay

Happy Hospitalist, MD

Physician

January 24, 2012

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.

10. Bring your own pillow. Trust me.

9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.

8. Bring an accurate and updated medication list …