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.

How far should hospitals go to treat obese patients?

Physician
June 17, 2011

Boston Emergency Medical Services recently debuted an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance.

My problem is this: I think we need to do our best to provide medical care to all patients. But patients need to take some basal level of responsibility for their own health. If you’re saying that you …

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How far should hospitals go to treat obese patients?

What big hospitals can learn from smaller ones

Physician
June 17, 2011

Every now and then a tonsillectomy patient bleeds after arriving back on the ward after surgery.  On this occasion, there was nothing remarkable in the event itself.  What was remarkable was the efficiency of the response.

I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital.  I checked on my patient in the ward, confirmed the bleed, …

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What big hospitals can learn from smaller ones

How medicine can be like a scene in Jerry Maguire

Physician
June 17, 2011

Although the famous clip from Jerry Maguire is about a sports agent trying to negotiate a new contract for an entitled egotistical football player, every time I see it, it reminds me of work. Put a white coat on Tom Cruise, and transplant them from a shower room to an exam room, and it becomes a pretty accurate portrait of my daily conversations with patients.

In fact, when I was on …

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How medicine can be like a scene in Jerry Maguire

Insurance companies cutting corners puts patients at risk

Physician
June 14, 2011

My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.

She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) …

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Insurance companies cutting corners puts patients at risk

Hospital inefficiencies observed during a surgery rotation

Health Technology
June 14, 2011

by Anar Mikailov

I recently finished my surgery rotation at a Level 1 Trauma Hospital in Philadelphia and amidst the ephemeral eight weeks I quickly realized the immense demands of a surgical residency. So, as an avid technology enthusiast and a team member, I took note of inefficient workflows with potential for technology driven solutions. By discussing the observed inefficiencies and potential solutions I hope …

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Hospital inefficiencies observed during a surgery rotation

Hospital bullying requires everyone to share in the blame and solution

KevinMD
June 12, 2011

The following column was published on May 28, 2011 in FoxNews.com.

Theresa Brown’s New York Times op-ed, Physician, Heel Thyself, recently introduced hospital bullying into the national health care conversation.

In it, she recounted a hospital vignette while working as an oncology nurse.  A patient asked a doctor who should he blame for a late test result.  The …

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Hospital bullying requires everyone to share in the blame and solution

Doctors don’t take snow days

Physician
June 12, 2011

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t …

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Doctors don’t take snow days

ABIM Maintenance of Certification (MOC) internal medicine exam tips

KevinMD
June 10, 2011

This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.

7 weeks later, I received my results.  Thankfully, I passed.

This was not entirely a surprise, as the pass rate for first-time test takers was 88%.  But it definitely requires some studying.  It’s not a gimmie.

Considering that I last took my board exam in …

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ABIM Maintenance of Certification (MOC) internal medicine exam tips

Why families and advocacy groups accept the torture of dying patients

Physician
June 9, 2011

by Aroop Mangalik, MD

A man has lung cancer that has spread to the brain. The cancer in the brain has been growing despite full dose radiation. His lungs have failed and he has been on a respirator for 10 days with progressive worsening of lung function.

Despite multiple discussions between the doctors and the Intensive Care Unit’s team …

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Why families and advocacy groups accept the torture of dying patients

Prices should be readily available to save hospitals money

Physician
June 9, 2011

Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.

One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins …

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Prices should be readily available to save hospitals money

Budget cuts to NICU admissions will have a ripple effect

Physician
June 8, 2011

What is wrong with the state of Texas? Have they no heart? Why is it that at the time of fiscal crisis, it’s always the “little” people whose services are eliminated first?

The “little” people in this case would be babies who are either born sick or premature. The New York Times article, In Search of Cuts, Health Officials Question NICU Overuse, was shocking. The Texas state officials have …

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Budget cuts to NICU admissions will have a ripple effect

The growing disconnect between hospitals and post-acute providers

Physician
June 7, 2011

An interview by Curaspan Health Group with Mark Lachs, MD

Mark Lachs, MD, MPH, geriatrics physician, professor, researcher and author of the new book, Treat Me, Not My Age, says one of the hottest new areas of research is care transitions. He warns that there’s a growing disconnect between hospitals and post-acute providers.

Curaspan: …

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The growing disconnect between hospitals and post-acute providers

How to minimize the costs of surgery

Health Policy
June 5, 2011

Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.

In rank order, the costs of surgery come from (highest to lowest):

How to minimize the costs of surgery

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Nurses who work in the cardiac catheterization lab

Patient
June 3, 2011

Ready to learn more about nurses who work beyond the bedside?  Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care.  Amy Sellers, RN blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.

Amy has worked in the Cath Lab for about 6 months now.  She previously worked in cardiovascular intensive …

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Nurses who work in the cardiac catheterization lab

What happened inside the hospital during the Joplin, MO tornado

Physician
May 31, 2011

joplin hospital tornado

Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.

You never know that it will be the most important day of your life until the day is over.  The day started like any other day for me: …

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What happened inside the hospital during the Joplin, MO tornado

In medicine, the greatest save is not having to make a save at all

Physician
May 31, 2011

In the real world of medicine, “great saves” are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.

I first met Mr. GR in the emergency room. As …

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In medicine, the greatest save is not having to make a save at all

The evolution of hospitals and the present state of health policy

Health Policy
May 30, 2011

My first exposure to KevinMD.com is reading Healthcare costs can be reduced with emerging business models by Joe Flower.

While I am not informed about the medical business models to which he refers, I am experienced in business. I hail from a family of doctors and hospital owners. While I did lose touch with the industry for several years, I have noted several changes which do not make sense. …

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The evolution of hospitals and the present state of health policy

How protocols are taking the decisions away from nurses

Patient
May 27, 2011

If you have been at your nursing job for a while, you’ve probably almost forgotten.

Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give …

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How protocols are taking the decisions away from nurses

How doctors should professionally behave on Twitter

KevinMD
May 26, 2011

According to one of the  the guidelines set forth by the AMA about professionalism in social media, “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.”

With that in mind, Bryan Vartabedian, who …

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How doctors should professionally behave on Twitter

Cut hospitalizations to reduce hospital related medical errors

Physician
May 25, 2011

To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative.

Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times …

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Cut hospitalizations to reduce hospital related medical errors

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