Hospital medicine

5,188 articles · Since 2004

Articles, page 131

Advice to new interns from a nurse turned medical student

July 21, 2011Jul 21, 20118

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…

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 …

Health technology

Public and private cloud computing at a hospital

John Halamka, MD

July 15, 2011Jul 15, 20113

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…

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 …

Physician voices

Attending physicians who work too many hours need restrictions too

Felicity Billings, MD

July 8, 2011Jul 8, 201115

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…

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 …

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Physician voices

The radiation delivered by CT scanners has gone largely unregulated

Robert Wachter, MD

July 7, 2011Jul 7, 20119

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 …

Patient voices

Our health system defaults toward treatment rather than compassion

Sara Billings, RN

July 7, 2011Jul 7, 201126

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 prepared living …

Medical education

Resident responsibility at a Level 1 trauma center

Colin Son, MD

June 23, 2011Jun 23, 20114

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 …

Physician voices

Hospitalists should limit the number of patients they see

S. Irfan Ali, MD

June 21, 2011Jun 21, 20112

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…

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 …

Health technology

The difference between an ambulatory and hospital EHR

Robert Rowley, MD

June 19, 2011Jun 19, 20116

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…

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 …

Physician voices

How far should hospitals go to treat obese patients?

WhiteCoat, MD

June 17, 2011Jun 17, 201179

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…

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 …

Physician voices

What big hospitals can learn from smaller ones

Dr. Martin Young

June 17, 2011Jun 17, 20113

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…

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,

…

Physician voices

How medicine can be like a scene in Jerry Maguire

Gregory Bratton, MD

June 17, 2011Jun 17, 20115

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…

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 …

Physician voices

Insurance companies cutting corners puts patients at risk

Vipan Nikore, MD

June 14, 2011Jun 14, 201114

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…

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) …

Health technology

Hospital inefficiencies observed during a surgery rotation

Anar Mikailov

June 14, 2011Jun 14, 2011

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 to inspire …

Physician voices

Hospital bullying requires everyone to share in the blame and solution

Kevin Pho, MD

June 12, 2011Jun 12, 201111

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…

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 …

Physician voices

Doctors don’t take snow days

Anesthesioboist T., MD

June 12, 2011Jun 12, 201111

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…

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 …

Read more…

Doctors don’t take snow days

Medical education

ABIM Maintenance of Certification (MOC) internal medicine exam tips

Kevin Pho, MD

June 10, 2011Jun 10, 201110

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…

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 …

Physician voices

Why families and advocacy groups accept the torture of dying patients

Aroop Mangalik, MD

June 9, 2011Jun 9, 201120

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…

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 …

Physician voices

Prices should be readily available to save hospitals money

Happy Hospitalist, MD

June 9, 2011Jun 9, 20116

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…

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

Physician voices

Budget cuts to NICU admissions will have a ripple effect

Linda Burke, MD

June 8, 2011Jun 8, 20115

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…

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 …

Hospital medicine

Articles, page 131

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