Hospital medicine

5,188 articles · Since 2004

Articles, page 125

Heroic measures cannot cure how people want to live their lives

April 26, 2012Apr 26, 2012104

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,…

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 …

Health policy

Lack of health care coordination benefits physicians

John Toussaint, MD

April 25, 2012Apr 25, 20129

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…

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 …

Physician voices

Is patient-centered care an outmoded concept?

Robert Allan Bear, MD

April 21, 2012Apr 21, 201211

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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Health policy

The problem of mixing productivity with patient safety

Michael Appel, MD

April 20, 2012Apr 20, 20127

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 …

Physician voices

Why we need a National Health Service Corp

Steven Reznick, MD

April 20, 2012Apr 20, 201220

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 …

Health policy

A simple innovation to improve hospital quality and safety

John Self

April 19, 2012Apr 19, 20127

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, …

Health technology

How can doctors curb digital distractions?

Robert Wachter, MD

April 18, 2012Apr 18, 2012

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,…

It’s no surprise, then, that reports of problematic doctor interactions with social media are …

Physician voices

A Hindu physician in a Christian hospital

Deep Ramachandran, MD

April 17, 2012Apr 17, 201215

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…

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 …

Physician voices

Why my patient ran away from the hospital

Kiran Raj Pandey, MD

April 10, 2012Apr 10, 2012

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…

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 …

Health policy

Why your local hospital may not be relevant in the future

Howard Luks, MD

April 8, 2012Apr 8, 20127

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…

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 …

Health policy

My philanthropic advice to America’s healthcare supporters

Kristine Christlieb Canavan

April 5, 2012Apr 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 …

Physician voices

Greening the operating room

American Society of Anesthesiologists & Susan M. Ryan, MD, PhD & T. Kate Huncke, MD

April 5, 2012Apr 5, 20125

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…

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 health of the community, which is dependent on a healthy environment. Unfortunately, the …

Read more…

Greening the operating room

Patient voices

The real doctors will see you in the morning

Samuel Wasswa-Kintu

April 4, 2012Apr 4, 20126

“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…

“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 …

Physician voices

Why full code should not be the default status for patients

Anonymous

March 30, 2012Mar 30, 201211

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…

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

Physician voices

The necessary steps healthcare must take for patient safety

Michael Appel, MD

March 24, 2012Mar 24, 20126

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…

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

Health policy

Healthcare consolidation may bend the cost curve the wrong way

Mitchell Brooks, MD

March 16, 2012Mar 16, 201213

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…

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 …

Physician voices

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

Janice Boughton, MD

March 16, 2012Mar 16, 201214

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…

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 …

Patient voices

Improving patient safety requires a commitment to transparency

Paul Levy

March 15, 2012Mar 15, 20125

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…

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 …

Health policy

Why one-third of hospitals will close by 2020

David Houle & Jonathan Fleece

March 14, 2012Mar 14, 2012330

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 …

Physician voices

Does leaving against medical advice stick patients with a bill?

John Schumann, MD

March 8, 2012Mar 8, 201211

(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…

(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 …

Hospital medicine

Articles, page 125

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