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.

Is wellness simply a hospital marketing term?

Michael Kirsch, MD

Physician

October 29, 2011

There’s a new term that has entered the medical lexicon. The word is wellness. Hospitals and medical offices are incorporating this term into their mission statements, corporate names, business cards, medical conferences and other marketing materials. The Cleveland Clinic Foundation has appointed a Chief Wellness Officer, an intriguing fluffy title that does not clearly denote this individual’s role and function. This is deliberate, as the word wellness is designed …

Why hospitals and physicians should get serious about patient-centered care

Steve Wilkins, MPH

Patient

October 28, 2011

Health care professionals are a cynical lot. We joke about the “fad or buzzword of the month,” usually some vague concept heralded by the powers on high. Our job is to promote the idea, knowing full well that the “next big thing” is probably right around the corner.

Take “patient-centered.” It sure feels like a buzz word. I suspect most hospital and physician executives, and their ad agency partners, …

Discussing end of life issues with a teenager

Jim deMaine, MD

Patient

October 26, 2011

Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with “kids” at the children’s clinic. But she wasn’t doing well.

Her pediatrician had suspected the problem shortly after birth. She wasn’t growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The …

The problem with round the clock hospitalist coverage

Bradley Flansbaum, DO

Physician

October 21, 2011

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …

Why radiology is the cornerstone of any hospital

Paul Dorio, MD

Physician

October 19, 2011

Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …

Why nursing homes need more doctors on site

Alan Cato, MD

Physician

October 19, 2011

The recent New England Journal of Medicine article, highlighting burdensome healthcare transitions in a subset of nursing home patients, is certainly of documentary value. However, for many of us with real-world experience in the nursing home medical care venue, the article certainly falls short of newsworthy. Not even mildly surprising really.

Too many of our nation’s nursing home staffs suffer from a lack of onsite MDs for evaluating acute …

Sexual harassment in the medical workplace

Gizabeth Shyder, MD

Physician

October 18, 2011

Sexual harassment in the workplace is an important topic to discuss, one that is all too often swept under the rug. I recently had an uncomfortable encounter with a clinician in the doctor’s lounge – I work at many hospitals so think I can say this pretty anonymously. He introduced himself, and asked me immediately if I was married. The way he did it – body language and demeanor, mostly …

Hospital discharge summaries are a health literacy issue

Hilary Seligman, MD

Patient

October 11, 2011

A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she would have died had she not received immediate treatment.

The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit …

Knowing the true name of a medical condition

Christopher Johnson, MD

Conditions and Diseases

October 11, 2011

There is a long tradition in folklore, one shared by shamans and occultists, that knowing the true name of something gives you power over it.

Many years ago I had a very sick patient in the PICU who one morning, totally out of the blue, broke out in a bright, red rash all over his body. The boy had many critical problems already and, although the rash didn’t seem to be causing …

Palliative care physicians can enhance patient decision making

Mark Novotny, MD

Health Policy

October 7, 2011

Data from the Dartmouth Atlas show patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, with much of that expense going toward physician and hospital fees associated with repeated hospitalizations.

Opportunities to reduce medical expenditures during the last 2 years of life are often looked upon as a way to reduce the cost of healthcare while actually improving the …

A doctor cannot be on time and take care of your needs

Stewart Segal, MD

Physician

October 6, 2011

Today’s article addresses a common complaint about physicians.

“Freewheel” responded to a previous article by writing the following, “you will not make me wait more than 10 minutes. My time is important, too.” One of the most common complaints I hear is “I waited over an hour to see you!” Waiting for an appointment, particularly when you are sick, is frustrating. Once you have that appointment, waiting for a doc who …

Healthcare professionals need to get an annual flu shot

Norman H. Edelman, MD

Conditions and Diseases

October 6, 2011

Whether you are a physician, nurse, physician assistant, pharmacist, or someone else who cares for sick or disabled people, your job as a healthcare professional is an important one. Healthcare professionals are expected to provide services to individuals in need and to do so with quality and care.

One way we can help ensure that we are doing our job the best way possible is to get our annual flu …

You may benefit from having a medical student care for you

Vineet Arora, MD

Patient

October 4, 2011

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Amid the buzz about whether medical students should be sued and the bill currently debated in Arizona (a state which finds itself in the spotlight more than usual these days), I noticed some commentary from several people who do not think they would like a medical student on their case. Sometimes patients do refuse to be cared for by medical …

Considering patient advocacy as a career

Trisha Torrey

Patient

October 3, 2011

Several questions have come my way recently about what kinds of job opportunities might exist for patient advocates. I refer people to an article I’ve written elsewhere, but the real answer is – to be a true advocate, you must analyze who is paying for your services, and what your responsibility will be to them.

Finding an employer

In 2011, most of the job possibilities for patient advocates are found either …

The only anesthesiologist in this vast hospital

Felicity Billings, MD

Physician

September 29, 2011

His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.

I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.

Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves …

A hospital board needs to understand generative thinking

Kent Bottles, MD

Physician

September 29, 2011

Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.

Generative thinking is …

Father and son, doctor and grieving family member

Jordan Grumet, MD

Physician

September 28, 2011

The edges of Cameron’s lips rise undeniably toward the clear blue sky. His legs move methodically. One motionless on the scooter and the other periodically kicking to propel himself forward. He weaves in and out dodging my shadow as I jog beside him.

I struggle to keep pace. My breathing unsteady and labored. My joints aching. And my brain foggy from lack of sleep and replaying the events of the day.

***

The …

The threats to profit in academic medical centers

Robert Wachter, MD

Health Policy

September 27, 2011

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.

We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.

Yet angst is in the air, borne …

A hundred shifts in, I have fine tuned my instincts as a physician

Anne K. Merritt, MD

Physician

September 27, 2011

I gather my belongings: stained white coat, stethoscope, pen light, black ballpoint. I stuff the last two granola bars into my canvas bag. I glance at the clock on the microwave, which is three minutes fast.

Twenty-two minutes until my shift begins. One minute before I will lock the door to my apartment.

Precision is critical: ER shifts change fast and blend together, from late nights to early mornings to mid-afternoons. Suns …

How to predict which patients will be hospitalized

Eric Schultz and Andrew Wickerham

Health Policy

September 27, 2011

What’s the most effective way to predict which patients will be hospitalized in the coming year? The Heritage Provider Network, a managed care group in California, hopes to answer this question through its sponsorship of the Heritage Health Prize, a $3 million X Prize-like competition for health care. The contest invites participants to develop a prediction algorithm to identify patients who will spend time in the hospital in …

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