Hospital medicine

5,188 articles · Since 2004

Articles, page 124

When teamwork takes more than the usual share of effort

June 7, 2012Jun 7, 20126

I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because…

I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other …

Health policy

The influence of fatigue on claim quality

Adam C. Powell, PhD

June 6, 2012Jun 6, 2012

While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider …

Conditions and diseases

Is the daily blood draw in the hospital truly necessary?

Ioana Baiu, MD

June 5, 2012Jun 5, 2012

One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds. As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day…

One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds.

As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day would be agreed upon. These morning rounds were particularly intense: in addition to the 30 patients that an intern had to manage solo over night, the brutal hours that the surgical …

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Health policy

ACP: Reducing expenses at the ground level of health care

American College of Physicians & Fred Ralston Jr., MD

June 2, 2012Jun 2, 2012

A guest column by the American College of Physicians, exclusive to KevinMD.com. I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many…

A guest column by the American College of Physicians, exclusive to KevinMD.com.

I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many of us about health care in the U.S., there is often an answer that points quickly to a particular villain or a simple fix that would change everything. Unfortunately things …

Medical education

As I progress through my medical career, I must make time to listen

Gregory Shumer, MD

June 2, 2012Jun 2, 20129

I am four months into my third year of medical school. The third year is the first clinical year, when students spend most of their time in the hospital, interacting with patients and working as part of the medical team.…

Our deans told us at the beginning of the year that we would be talking with patients more than anyone else on the medical team; we would serve as advocates for our …

Health technology

We must get past the complaints doctors have about EMRs

Deepak Ramesh

June 1, 2012Jun 1, 201212

Any new technology necessarily has a phase in which unnoticed bugs as well as unforeseen challenges crop up. In its early stages, the snail’s pace of a dial-up connection often made using the Internet onerous: before completing an email, one was often interrupted by pop-ups, viruses, cryptic 404 error messages, and a cacophony of sounds from the modem as the line repeatedly disconnected. Yet, as technology matures, the ability to …

Physician voices

How we need to take risk to reduce risk in hospitals

Richard Corder

May 31, 2012May 31, 20129

The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!” A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up.…

The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!”

A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking …

Physician voices

What medicine can learn from the Titanic

Rushil Patel

May 26, 2012May 26, 2012

April 15th marked the 100th anniversary of the sinking of the Titanic, yet the mystique surrounding its demise has not faded. When the colossal vessel first collided with the iceberg, eyewitness accounts described an eerie sense of serenity that pervaded the ship. Passenger J.J. Astor even remarked, “We are safer here than in that little boat,” before later drowning.

To prefer drowning over safety strike us as irrational, but this behavior …

Physician voices

Failure of communication led to an excessive hospital stay

Kelly Donovan

May 24, 2012May 24, 201210

On a late afternoon in mid-July I was finishing up my first Sunday on call as a third year medical student. I glanced over the patient list for 4 East, the internal medicine floor I had been assigned to cover. Familiar with patients in their eighties and nineties, I was surprised to see a 22-year-old patient admitted with acute kidney injury.

He was a nice-looking young man in good spirits. Spanish …

Health policy

The scope of the standard of care in medicine has changed

Paul Levy

May 24, 2012May 24, 20126

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 …

Health technology

When patient care becomes secondary to filling out the medical record

Jordan Grumet, MD

May 22, 2012May 22, 201221

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…

A sports car motored around a curve and flew past us unaware. The cop switched on his lights and tried …

Physician voices

Why physicians are susceptible to hardball tactics

Bradley Evans, MD

May 21, 2012May 21, 201213

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…

The course director made it crystal clear that there will be no place in the future for …

Physician voices

How we deliver bad news is critical to how families deal with grief

Kevin R. Campbell, MD

May 20, 2012May 20, 20125

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…

Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …

Physician voices

His father’s suffering had already been too great

Monica Williams-Murphy, MD

May 20, 2012May 20, 20129

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 …

Health policy

Hospitals around the world aim to remain relevant to patients

Tim Richardson, PT

May 17, 2012May 17, 20122

"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…

“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 …

Physician voices

Tips to improve your patient satisfaction scores

Donald Tex Bryant

May 14, 2012May 14, 20124

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 …

Physician voices

Poor transitions in care result in unsafe patient care

Maria Maldonado, MD

May 5, 2012May 5, 20129

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 …

Patient voices

Patient advocates need to manage expectations

Trisha Torrey

April 29, 2012Apr 29, 20129

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…

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 …

Physician voices

Why academic medical centers need a stress test

Michael Weitekamp, MD

April 27, 2012Apr 27, 2012

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 …

Hospital medicine

Articles, page 124

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