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 a neurologist turned down an interesting hospital case

Doctor Grumpy, MD

Physician

August 8, 2011

Dr. Grumpy has lost his neurology mojo over time. Actually, I shouldn’t say I’ve lost it, as much as it’s been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else. The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28-year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). …

There is no billing code for compassion

Paul Levy

Patient

August 7, 2011

Back in 2009, Dr. Amy Ship gave a moving acceptance speech when she received the annual Compassionate Caregiver Award from the Schwartz Center.

The most memorable tag line from the speech was, “There is no billing code for compassion.” This resonated with so many of us — patients and providers — in part because it set forth the proposition that compassionate care should be an inherent aspect …

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There is no billing code for compassion

During the holidays, our goal should be to provide a holiday for our patients

Scrub, MD

Medical Education

August 6, 2011

During Christmas holidays, many medical students, interns, and residents will not be celebrating the holidays with their families. Instead, they will be on call, or night shifts, or just long schedules, taking care of patients.

For life and death, sickness and health, do not take holidays, and nor should our compassion for taking care of those who are in trying times. I recall working last year on Christmas Eve at …

Being a patient is an unforgettable form of medical education

Carolyn Thomas

Patient

August 6, 2011

In his online essay, This Won’t Hurt A Bit, cardiologist Dr. Eric Van De Graaff tells his own story of being a hospital patient after surviving a motorcycle accident while he was in med school. His experiences as a patient will sound very familiar to heart patients, and the lessons he learned while on the other end of the stethoscope may very well have made him a far better doctor.

A …

Ingredients of a good team meeting in a medical setting

Donald Tex Bryant

Physician

August 5, 2011

At Camden Community Hospital (a fictional hospital), Shana, a senior RN, is leading a team meeting to discuss standardizing the handoff of patients between shifts. She quickly looks over the team members, who are chatting among themselves, some not very quietly. “May I have your attention, please,” she says. Some stop talking and others keep on. She raps her hand on the table and now she has everyone’s attention. …

Hospitalist care is more expensive but don’t blame hospitalists

Kevin Pho, MD

KevinMD

August 3, 2011

Hospitalists save money. Until the patient leaves the hospital, at least.

A recent study from the Annals of Internal Medicine ignited debate over the cost effectiveness of hospitalists. Looking at Medicare patients from 2001 to 2006, researchers found that “those who were followed by a primary care physician spent about half a day more at the hospital, costing Medicare …

Why the debt ceiling deal is a horrific outcome for physicians

Kevin Pho, MD

KevinMD

August 2, 2011

If you’re a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that’s scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal “a terrible deal for health care providers.”

Under the contentious debt ceiling agreement, significant cuts in Medicare dollars will be made. …

Embracing different cultures in the service of the dying

Niamh van Meines, ANP-BC, EMT

Patient

July 30, 2011

She was overwhelmed with grief when she walked into the room and saw her mother silently and peacefully dead in the hospital bed. Her death was expected, but as always, no-one is ever quite ready to let go. She started to wail loudly and speak directly to her deceased mother about the pain she was inflicting by dying.

She was compelled to hold her prayer beads and started to dance around …

What a hospital can do to be more comfortable for patients

Kathy Kastner

Patient

July 27, 2011

Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.

How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.

I believe it …

The secret in caring for the patient is to care for the patient

Jim deMaine, MD

Physician

July 24, 2011

Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik …

The benefits of successful patient self-management programs

Mark Novotny, MD

Physician

July 22, 2011

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can …

Advice to new interns from a nurse turned medical student

Albinoblackbear

Medical Education

July 21, 2011

If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.

Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …

Public and private cloud computing at a hospital

John Halamka, MD

Health Technology

July 15, 2011

In a meeting with senior management at Harvard Medical School, one of our leaders asked, “What is our cloud strategy?”

My answer to this is simple. The public cloud (defined as the rapid provisioning and de-provisioning of CPU cycles, software licenses, and storage) is good for many things, such as web hosting or non-critical applications that do not contain patient or confidential information.

At Harvard Medical …

Attending physicians who work too many hours need restrictions too

Felicity Billings, MD

Physician

July 8, 2011

Dr. Lewis didn’t sleep last night.

All day he stood, heavy in full surgical scrub with a human heart in his hands, replacing damaged valves and calcified arteries until the heart beat on its own again. After he finished, there were a few hours before the transplant to get some dinner, to call home.

The heart came on a helicopter. A young man, a bad accident, a perfect heart. Dr. Lewis pierced …

The radiation delivered by CT scanners has gone largely unregulated

Robert Wachter, MD

Physician

July 7, 2011

Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each …

Our health system defaults toward treatment rather than compassion

Kevin

Patient

July 7, 2011

by Sara Billings, RN

I believe knowledge is power. There is no more complex topic in the healthcare debate than end-of-life care. I have been a Registered Nurse for thirty years. I deal with this every day. All of us will confront this issue eventually. When it’s your turn, I hope the medical profession will guide you to the best options for you and your family.

Often I see patients who have …

Resident responsibility at a Level 1 trauma center

Colin Son, MD

Medical Education

June 23, 2011

Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor’s trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as …

Hospitalists should limit the number of patients they see

S. Irfan Ali, MD

Physician

June 21, 2011

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

Hospitals that ban physicians from social media are long term losers

Kevin Pho, MD

KevinMD

June 20, 2011

I’ve heard that a few academic medical centers, the identities which I will keep anonymous, are advising incoming medical residents to stay off social media. Meaning, they have to close their blogs, and shutter their Twitter or Facebook accounts.

As hospitals and doctors try to best use social media, and prevent damage from its improper use, taking the extreme measure of forbidding doctors in training from utilizing social is …

The difference between an ambulatory and hospital EHR

Robert Rowley, MD

Health Technology

June 19, 2011

What difference is there between an inpatient EHR and an ambulatory EHR?

The difference is quite significant, actually. Let’s start by looking a little deeper into hospital IT issues, and the evolution of tools that try to address them.

The hospital EHR environment

Traditionally, from an IT perspective, a hospital is not really a single system – it is a collection of systems in various departments.

Over the past few decades, each …