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.

Physicians love a CIO who lets them focus on patients, not technology

Health Technology
February 8, 2011

by Donald Burt, MD

Many hospital CIOs face an uphill battle winning the hearts, minds and fingers of physicians. It’s not because doctors are technology phobic. Quite the opposite: physicians are some of the most ravenous consumers of new information technology.  Smartphones and tablets are becoming as ubiquitous as stethoscopes at many hospitals.

The truth is doctors are happy to make screen touches, mouse clicks and keyboard strokes if the application is …

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Physicians love a CIO who lets them focus on patients, not technology

Combat compassion fatigue in caregivers to improve patient care

Physician
February 7, 2011

Six months down. Six to go. I am officially halfway through what people have told me will be one of the most challenging years of my life.  I’ve rotated through Cardiology, Primary Care, Gastroenterology, General Medicine, Psychiatry, Palliative Medicine, the Medical Intensive Care Unit (MICU), and Rheumatology. Finally I have reached every resident’s favorite rotation – vacation.

Intern year has been hard work, but I’ve enjoyed it and am extremely pleased …

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Combat compassion fatigue in caregivers to improve patient care

A stent anecdote from a former FDA Associate Commissioner

Physician
February 4, 2011

by Peter J. Pitts

As the saying goes, the plural of anecdote isn’t data.  That is unless the anecdote supports your theory.  Here’s a personal anecdote — a story of how the system works.

Being adopted, I have no family history, so when I suffered through some late night chest pains I figured I’d better act on the warning signals. I called my GP and got a same-day consultation, resulting in a next-day referral …

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A stent anecdote from a former FDA Associate Commissioner

Bioethics and bedside communication in daily patient interaction

Patient
February 4, 2011

by Zakari Tata, MD

Biomedical ethics and bedside communication is currently taught to medical students in a classroom mainly in the first two years. In residency it is not usually given a lot of attention. This is leading to a situation where a very basic part of daily patient interaction is not addressed. This leads to many complex problems in the hospital that lead to moral dilemmas and conflicts.

The idea needs …

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Bioethics and bedside communication in daily patient interaction

Can posting ER wait times be dangerous to patients?

Physician
February 3, 2011

You’ve probably experienced that age-old ritual of cooling your heels in an ER waiting room hoping that it won’t be too many hours before a nurse lets you inside the sliding doors.

Simon Bradley tweeted this to my Twitter Account @WCBADoctorBrian: “My buddy had a deep laceration between the thumb and the index finger – a full layer of skin.  Took 10 hours at (name of hospital withheld), fastest in town.”

A …

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Can posting ER wait times be dangerous to patients?

Praise nurses without comparing them to physicians

Physician
February 1, 2011

Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)?  Snarkniess is not appreciated by this reader, at least.

The New York Times recently ran a column by one of its editors, “Read more…

Praise nurses without comparing them to physicians

Focus advance care planning on outcomes

Conditions and Diseases
January 31, 2011

by Drew Rosielle, MD

The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes.  Good one for the teaching file.

That is, instead of thinking of ACP as patients pre-specifying “if X …

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Focus advance care planning on outcomes

Patient safety lapses in the hospital

Physician
January 31, 2011

Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.

Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.

As the medically …

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Patient safety lapses in the hospital

Where an extremely premature baby immediately receives care matters

Conditions and Diseases
January 28, 2011

When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.

A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …

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Where an extremely premature baby immediately receives care matters

The void between physicians and administrators in hospitals

Physician
January 28, 2011

In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.

Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their …

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The void between physicians and administrators in hospitals

EHR implementation in the ambulatory or hospital setting

Health Technology
January 27, 2011

Adoption of electronic health records (EHR) systems remains a challenge, both for hospitals as well as for physicians in ambulatory practice. The process of adoption, implementation, and meaningful use of EHRs (let us keep in mind) is actually quite different between those two setting.

Much has been written concerning EHR adoption within hospitals. Much of the experience in computerized physician order entry (CPOE) comes from hospital EHR adoption, and many of …

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EHR implementation in the ambulatory or hospital setting

Your worth as a physician can be judged by how people invoke God

Physician
January 26, 2011

As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.

“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.

When she turned around, the look she gave me signaled that it was no …

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Your worth as a physician can be judged by how people invoke God

Kind and thoughtful words from a fellow physician colleague

Physician
January 13, 2011

I was sitting on one of the hospital’s nursing units having a difficult telephone conversation.  Anyone working nearby could have easily discerned the situation from my end of the call.

Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.

Having never had to make such a decision in my own life, I am left to imagine how …

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Kind and thoughtful words from a fellow physician colleague

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Do satisfaction scores really measure quality care?

Physician
January 13, 2011

Does patient satisfaction matter? The answer is a resounding “yes.”

In fact, as the director of an emergency department, feedback from dissatisfied patients has provided both me and our group with an early warning about several physicians who were not performing up to our standards. Studies show a clear correlation between decreased patient satisfaction and increased medical malpractice risk, so meeting our patients’ needs is not only in their best interests, …

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Do satisfaction scores really measure quality care?

Intubating the combative patient

Conditions and Diseases
January 11, 2011

How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.

Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …

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Intubating the combative patient

Doctors play a role in helping people through transitions with rituals

Physician
January 11, 2011

When I was an intern in internal medicine, I admitted a patient to my service with pancreatic cancer.

Pancreatic cancer is a bad one; back then, only ten percent of patients with it would be alive within five years after being diagnosed.  My patient was a farmer in the full bloom of late middle-age health when he began rapidly losing weight. An abdominal CT scan ordered by his primary care physician …

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Doctors play a role in helping people through transitions with rituals

Measuring health outcomes is important but needs caution

Physician
January 5, 2011

I sat at home with a sense of relief. I had just finished my first month of residency – a grueling inpatient hospital month where I was pushed to new limits.

I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to …

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Measuring health outcomes is important but needs caution

Hospital meals make it difficult to control blood sugars

Physician
December 30, 2010

My mom doesn’t take any diabetes medicine.  She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.”  The procedure went fine, but not the food.  The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …

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Hospital meals make it difficult to control blood sugars

Posts of the year on KevinMD.com, 2010 edition

Potpourri
December 25, 2010

Merry Christmas!

I’d like to thank everyone for your continued readership.

Doctors, patients and other health care professionals need to be heard, and there’s no better place to do so than here, on social media’s leading physician voice.

This year, KevinMD.com had a regular rotation of 175 guest contributors, and surpassed 1.75 million visits, 2.95 million pageviews, 33,000 followers on Facebook and Twitter, and 40,000 RSS subscribers.

I am truly …

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Posts of the year on KevinMD.com, 2010 edition

The art of medicine and mastering relationships

Physician
December 17, 2010

by Kelly, MD

There is a reason why people often say “the art of medicine.”

It’s not just the fact that so much of what we do is based on culture and habit rather than science, but also the fact that there is a lot of finesse when it comes to relationships as a doctor.  Oh sure, we know all about patient-doctor relationships and its importance.  There are …

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The art of medicine and mastering relationships

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