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.

Patient transparency cannot be mandated by a federal agency

Manoj Jain, MD, MPH

Physician

September 26, 2011

Not long ago, when my father was about to undergo a heart procedure, I hinted to the cardiologist, a colleague, that I wanted to be there, too, not just to offer comfort but also to be present for the play-by-play that would lead to a critical decision: whether to open his blocked arteries with a stent or to perform bypass surgery. Draped in an X-ray-shielding body suit over his blue …

Why I left a top children’s hospital for a private office

Anonymous

Physician

September 25, 2011

All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble …

Achieving a 90 minute door-to-balloon time in STEMI patients

John E. Brush, MD

Conditions and Diseases

September 23, 2011

At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention.

One target that caught my interest was for achieving a door-to-balloon time of less than 90 minutes in STEMI patients. As an interventional cardiologist who …

How our resuscitation efforts would be interpreted by fate

StorytellERdoc, MD

Patient

September 17, 2011

I walked up to the closed door and paused, exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful …

The inability to locate price anywhere in the hospital

Eric Lespin

Patient

September 16, 2011

A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A.’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the …

Patients should care about physician stress and burnout

Kevin Pho, MD

KevinMD

September 15, 2011

Physicians are human, like everyone else.

And when things go wrong, like making a medical error or having a patient die, they suffer like most people would.

Pauline Chen writes about Schwartz Rounds in the New York Times, where, in a confidential environment, doctors and other health professionals can discuss challenging cases.

As Dr. Chen writes, “the discussions that ensue are …

How hospitals can avoid readmissions

Stephen Jencks, MD, MPH

Physician

September 13, 2011

An interview by Curaspan Health Group with Stephen Jencks, MD, MPH.

Stephen Jencks is lead author of the 2009 landmark study of the multibillion-dollar cost of readmissions, says there’s “been a great deal of movement” on readmissions since his work was published in The New England Journal of Medicine, but there’s more that hospitals and communities can do.

Dr. Jencks, an independent consultant in health-care safety and quality, and …

Read more…

How hospitals can avoid readmissions

The problem of inadequate discussions of end of life wishes

Janice Boughton, MD

Physician

September 13, 2011

The Annals of Internal Medicine occasionally reviews the articles and studies of note in a particular field of internal medicine for those of us who don’t read all of the specialty journals. Recently, there was an update in pulmonary and critical care medicine, the internal medicine specialty that is most intimately involved with caring for the very ill and those people who are at the ends of their lives. …

Physicians need to be more proactive asking about code status

S. Irfan Ali, MD

Physician

September 13, 2011

When I saw my first patient die, I was in shock. You will never forget your first one, that always stays with you.

My first patient died during medical school, a young guy around 40. He died of complications from endocarditis. He was fine in the afternoon, talking about his family and what he does, but when I came back in the morning he was gone. I was shocked beyond …

A reminder of why doctors do what they do

Gregory Bratton, MD

Physician

September 8, 2011

Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.

During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, …

Private rooms in the ICU can reduce length of stay

Marya Zilberberg, MD, MPH

Physician

September 6, 2011

We have known for quite some time now that the patient’s environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room’s window on a bunch trees is associated with better and less eventful post-operative recovery than staring at a brick wall, …

Your consumer powers when choosing a hospital

Steven Kussin, MD

Patient

August 26, 2011

An excerpt from Doctor, Your Patient Will See You Now: Gaining the Upper Hand in Your Medical Care (Rowman & Littlefield).

The casual attitude people demonstrate when choosing doctors incurs a steep price. Let’s direct our attention to your consumer powers when choosing a hospital.

The imperative ‘caveat emptor’ (let the buyer beware) carries the most consequence when you purchase health care. When it comes to hiring a hospital’s services, it’s more …

Top 10 musts for your hospital visit

Mitchell Brooks, MD

Patient

August 25, 2011

Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met.

You must become informed about the terms and limits of your health insurance policy. See if the fees you are being …
Read more…

Top 10 musts for your hospital visit

An ER specifically built for older patients

Brian Goldman, MD

Patient

August 24, 2011

Seniors spend a lot of time at hospital ER’s. Now, a small but growing number of hospitals in the US have built ER’s especially for the aging patient – with wider hallways, motion detectors, hearing and visual aids. To me, this is long overdue.

Older patients are avid consumers of emergency medical services. Older people make up a significant percentage of the total population of ER patients. A 2008 Read more…

An ER specifically built for older patients

Navigating the path of contradictory medical opinions

Ralph Gordon, MD

Conditions and Diseases

August 24, 2011

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory …

An opportunity for hospitalists to improve patient care

Robert Centor, MD

Physician

August 18, 2011

Some hospitalists are in denial. Some hospitalists have become methodologic critics. But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously. We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.

This article provides an opportunity, not a scolding:

In an accompanying editorial, two other researchers from the VA Medical Center in …

Read more…

An opportunity for hospitalists to improve patient care

Why is the iPad be revolutionary for doctors and nurses?

Jared Sinclair, RN

Health Technology

August 13, 2011

As a nurse, I spend a lot of time with other nurses. When they ask me to explain why I think the iPad is great, I respond with the following metaphor: imagine that you are a nurse who has been asked to design a new hospital from scratch. You are free to question every prior assumption, to throw out old ideas that no longer fit, to redesign everything according …

Why work hour restrictions won’t improve patient safety

Kevin Pho, MD

KevinMD

August 11, 2011

Darshak Sanghavi recently wrote an excellent piece in the New York Times summarizing the controversy over resident work hours.

The topic has been discussed here frequently, with ramifications ranging from the fact that errors arising from patient handoffs negate any benefit gained from restricting work hours, to surgeons not accumulating enough experience during their work hour-restricted training.

I’ve often …

What the death penalty has to do with medical errors

angienadia, MD

Patient

August 10, 2011

A fascinating, beautifully-written article on a death penalty granted to a most likely innocent man, with interesting details on fire dynamics and the history of the judicial system pertaining to the death penalty.

Reading about the system in place that should prevent an innocent man from being wrongfully executed reminds me of the supposed system that prevents medical errors from occurring – both are imperfect, with innocent victims falling through …

Why you would want a younger doctor in the hospital

Maxwell S. Kennerly

Physician

August 10, 2011

Recently, the American Journal of Medicine published a study with the unexpected conclusion that hospitalized patients were more likely to die or stay long in the care of an experienced physician than in the care of a recent graduate from residency: “When doctors weren’t very busy, they kept patients in the hospital for roughly the same average time no matter how many years of experience they had. But when they did have a …

Hospital Medicine

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