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.

Can a social media manager convince doctors to get online?

Kevin Pho, MD

KevinMD

November 8, 2010

A social media manager is becoming an imperative position for hospitals.

Medical institutions are waking up to the fact that they need to engage their patients and physicians online. No where is there more fertile growth than in the various social media platforms that are prevalent today — like Facebook, Twitter, and YouTube.

American Medical News recently profiled the phenomenon, highlighting the position of social media manager, which some institutions pay between …

Induction of labor should be restricted to medical indications

Amy Tuteur, MD

Conditions and Diseases

November 2, 2010

It seems rather obvious that medical procedures should be reserved for medical indications. Why? Because almost every medical procedure, even some of the simplest, have small but real risks of complications. And risking complications can only be justified if the medical benefit outweighs the risk.

That rule applies to labor inductions, although many obstetricians have forgotten it. Induction of labor for non-medical reasons, primarily convenience, is attractive, but labor induction is …

Case reports continue to be an important part of journal publication

Vineet Arora, MD

Conditions and Diseases

November 1, 2010

I am teaching a new course entitled “Turning your Clinical Cases into Scholarly Work.”

I hope to draw on my own experiences through the years mentoring students and residents in writing up several clinical cases, but also in making diagnoses. In preparing for this course, I have also learned quite a bit about the controversy surrounding case reports and the challenges that they face in today’s healthcare system.

Unfortunately, case reports have …

10 things you need to know before surgery and during the hospital stay

Kevin

Physician

October 29, 2010

by Winston F. Mitchell

I’m a 53 year-old male with no history of hypertension, no cholesterol problems and glucose count normal.

I was overweight but still in great physical shape. But over a period of weeks, walking to work, I started experiencing a shortness of breath. Finally I went to my doctor, he informed me he was going to admit me to the hospital immediately because a …

US News hospital rankings too subjective and encourage self-promotion

Danielle Ofri, MD, PhD

Physician

October 28, 2010

Every year US News & World Report publishes its rankings of the nation’s top 50 hospitals. Hospital administrators await this top 50 report with a tension and fervor that rivals the NFL first-draft pick.

As soon as the report is released, snippets rocket their way into donor appeals, local hospital signage, and highway billboards. “Ranked X by US News & World Report” becomes a descriptor that is supposed to …

Sick doctors who work are doing more harm to their patients than good

Kevin Pho, MD

KevinMD

October 28, 2010

Doctors: if you’re sick, don’t go to work.

The stereotype of doctors is that they go to work, despite whatever symptoms ail them. Calling in sick places strain on colleagues. Especially in residency, where team members are expected to pick up the slack.

In a recent column, the New York Times’ Pauline Chen discusses the image of self-sacrifice that a sick doctor going to work portrays:

Hacking, febrile or racked with the …

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Sick doctors who work are doing more harm to their patients than good

EMTALA and why this emergency physician is against it

911Doc, MD

Physician

October 26, 2010

by 911Doc, MD

American medicine will die or be reborn in the next ten years. Correction, it will either continue an accelerated slide into banal mediocrity, or be reborn. The battle is finally joined, and it has been joined by the specialists. Thank you, doctors, for drawing the line in the sand. I hope you win. Honest.

I am cheering against my own college here because they have …

How to command respect in any medical setting

Trisha Torrey

Patient

October 25, 2010

It’s a simple question, but it has stirred some controversy. It’s the word “friendly.”

Colleague and fellow passionate advocate Bart Windrum got (as my mother would say) his blood in a bubble after reading an article about engaging a patient advocate to help you navigate your healthcare, published in a Tampa newspaper.

In a list of tips about how to advocate for someone else, one tip said, “In hospitals ask, …

Senior leaders need to periodically reflect on their role

John Halamka, MD

Physician

October 25, 2010

Leaders often think about succession plans for their direct reports, but what about themselves?

What if I had a serious health problem or accident that impaired my ability to lead my IT organizations? Here’s my brief analysis.

Beth Israel-Deaconess Medical Center

My role at BIDMC is to document the strategies prioritized by our governance groups, ensure our organizational chart structure is optimized for executing the strategies, …

Religious coping in dying patients

Richard Barager, MD

Patient

October 23, 2010

In downtown Los Angeles recently, two very different celebrations went on within walking distance of each other.

On West Temple Street, at the beautiful and contemporary Cathedral of Our Lady of the Angels—a structure with no right angles in its adobe-colored walls—Catholic Mass was offered throughout the morning, in both English and Spanish. Five blocks south, at the stunningly refurbished Millennium Biltmore Hotel on Grand Avenue, the Council for Secular Humanism, …

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Religious coping in dying patients

Reduce medical malpractice and create a culture of patient safety

Brian Goldman, MD

Physician

October 19, 2010

When I was a resident in internal medicine many years ago, I saw an elderly woman who came to the ER complaining of chest pain and shortness of breath. She had a history of heart disease. When I listened to her chest, the crackles I heard emanating from her wet lungs told me she had congestive heart failure. I treated her chest pain and gave her diuretics to help her get rid of the water that was making …

Surviving a potentially fatal injury and the fragility of life

Howard Luks, MD

Patient

October 18, 2010

You are now out of the Gray Zone, and you are now a member of an exclusive club.

But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …

A sweet and tender moment between a mother and daughter

StorytellERdoc, MD

Patient

October 17, 2010

I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.

While driving to work, I …

Searching for solace while balancing the care of patient

Kevin

Patient

October 16, 2010

by Brian McMichael, MD

The NEJM recently published an interesting case in the ongoing series: “ A Request for Retrieval of Oocytes from a 36-year old Woman with Anoxic Brain Injury.” Usually these cases are diagnostic dilemmas. This one focused on an ethical dilemma at end-of-life.

The Case

A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and …

How observation admissions affect Medicare patients

WhiteCoat, MD

Health Policy

October 10, 2010

A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.

Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s …

Why specialists don’t do more curbside consults

Paul Sax, MD

Physician

October 6, 2010

One of the simultaneously most enjoyable and exasperating aspects of being an infectious disease specialist is the large volume of “curbside” consultations we get from colleagues.

For example, here’s this week’s tally — and it’s only Tuesday — done from memory and without systematically keeping track of emails, pages, phone calls, etc.:

Duration of antibiotics after urosepsis, organism resistant to TMP/SMX and quinolones
Need for repeat immunizations in splenectomized adults (got that one …
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Why specialists don’t do more curbside consults

Should CRNAs practice anesthesiology without physician supervision?

Jeffrey Parks, MD

Physician

October 5, 2010

Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …

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Should CRNAs practice anesthesiology without physician supervision?

POLST and the next generation of the “Do Not Resuscitate” order

Jeffrey Hall Dobken, MD, MPH

Patient

October 4, 2010

POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.

The …

The day that medicine broke her and destroyed her innocence

Jordan Grumet, MD

Patient

October 4, 2010

I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.

I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified.

We’d started morning rounds …