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.

Leading a hospital team of foreign trained doctors

Physician
September 1, 2010

Recently, I had the opportunity to decamp from the friendly confines of GlassHospital and trek a few miles to the north.

GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.

Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.

Something you should know about medicine in America …

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Leading a hospital team of foreign trained doctors

The TPA time limit for acute stroke causes mass chaos in the ER

Conditions and Diseases
September 1, 2010

I hate acute strokes. There are several reasons for it. Most of them are logistical. First, everyone gets into a tizzy because of the 3 (or 4.5) hour time limit after the onset of symptoms that which TPA can be given and hopefully improve the patient’s outcome. Unfortunately, this time limit (and the data for TPA’s efficacy is only OK at best) causes mass chaos and annoyance.

First, one has to …

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The TPA time limit for acute stroke causes mass chaos in the ER

Empiric antibiotics in the ICU

Medications
August 31, 2010

Last year, I commented on the ironic sameness of ICU infectious diseases — that incredibly sick, complex patients entered the ICU with vastly different problems, then over time, seemed to converge, presenting similar kinds of clinical issues and management challenges for the ID doc.

Or, as a visiting medical student said to me, “My ICU attending said that every patient in the ICU should be on vancomycin and Zosyn.”

Which brings up …

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Empiric antibiotics in the ICU

Fix the July Effect for incoming interns and residents

Medical Education
August 25, 2010

According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.

First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …

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Fix the July Effect for incoming interns and residents

Applying the minimally invasive concept to patient management

Patient
August 24, 2010

Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.

With the recent progress …

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Applying the minimally invasive concept to patient management

Before ordering a test, know what to do with the result

Conditions and Diseases
August 19, 2010

Insanity: Doing the same thing over and over and expecting different results.
– Albert Einstein

As medical students rotating through the wards, we spent a significant portion of each day ordering laboratory tests and then chasing down the results. We wanted to investigate our patients’ illnesses and, just as importantly, we wanted to be prepared for any question with which our professors might surprise us during Attending Rounds.

One day, as I was …

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Before ordering a test, know what to do with the result

The July Effect and causes of the spike in medication errors

Physician
August 18, 2010

“An apple a day keeps the doctor away,” or so goes the old adage.

People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they hear about the results of a study from UC-San Diego which showed that every July, there’s a 10% spike in fatal medication errors in hospitals.

The scientists behind the study suggested that …

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The July Effect and causes of the spike in medication errors

Consider the family’s perspective in the treatment plan

Physician
August 17, 2010

by John Trahanas

She was not my patient.

Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had been severely demented for many years; however, it was only in the past few months that he required such intensive inpatient care.

He was not conscious or communicative, but he …

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Consider the family’s perspective in the treatment plan

Doctors need to become whistleblowers after medical error

Physician
August 17, 2010

Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm.  Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results.

Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these …

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Doctors need to become whistleblowers after medical error

Stop calling doctors fleas and teaching professionalism

Physician
August 15, 2010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety.  As one speaker highlighted, how can we really start to address this …

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Stop calling doctors fleas and teaching professionalism

Practicing medicine as a single parent requires finding balance

Physician
August 14, 2010

A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.

His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news — a loved one going into a war zone. But, to me, 8-months …

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Practicing medicine as a single parent requires finding balance

Apple’s iPad on medical rounds, a hands on physician review

Health Technology
August 13, 2010

by Felasfa Wodajo, MD

Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians.

The summary of the …

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Apple’s iPad on medical rounds, a hands on physician review

Will the new resident duty hour rules improve patient safety?

Medical Education
August 13, 2010

One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?

Recently, in the New England Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the Joint Commission (TJC) and the Accreditation Council for Graduate Medical Education (ACGME) – announced bold new policies. To their credit, both organizations …

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Will the new resident duty hour rules improve patient safety?

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The 80 hour resident work week balances fatigue and independence

Medical Education
August 12, 2010

How many hours can a doctor work?

The residency regulators are back. About ten years ago, the national organization that accredits residency programs (ACGME) set out its first guidelines about how many hours a doctor-in-training can work. Interns and residents finally achieved the vaunted 80-hour workweek. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby Zion case.

Every patient wants …

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The 80 hour resident work week balances fatigue and independence

Being admitted to the ICU over the weekend increases risk of dying

Physician
August 12, 2010

by Nancy Walsh

Patients admitted to an intensive care unit (ICU) over the weekend face a greater likelihood of dying compared with those admitted on a weekday, a meta-analysis suggested.

The meta-analysis, encompassing more than 180,000 weekend and weekday ICU admissions, found that even after adjusting for disease severity, the odds ratio for death among those admitted to an ICU over a weekend was 1.08 (95% CI 1.04 to 1.13, P<0.001), according …

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Being admitted to the ICU over the weekend increases risk of dying

Meaningful use letter for the hospital board and senior leaders

Health Technology
August 10, 2010

In January, I wrote a Do it Yourself presentation on meaningful use for folks to use with their Board and Senior leaders.

Now that its August, there is a different kind of Do it Yourself document – a letter to your Board and Senior leaders outlining your plan and timeframe for certification, measurement of meaningful use, and collection of your stimulus funds. We cannot be completely certain about every detail, …

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Meaningful use letter for the hospital board and senior leaders

Doctors need to confront end of life care

Patient
August 10, 2010

“Avoiding those twin traps of overtreatment and therapeutic nihilism”

Recognize this phrase? It’s from our Hippocratic Oath, the one I took, standing beside my newly assigned cadaver, in my second year of medical school.

“What Broke My Father’s Heart“, recently in the New York Times Magazine, is an exquisitely painful story of medicine and our Oath gone awry in the United States. I urge you to read it.

End-of-life care is …

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Doctors need to confront end of life care

Today’s new physicians are unable to improve patient safety

Medical Education
August 10, 2010

It has been 10 years since the landmark Institute of Medicine report “To Err is Human” uncovered disturbing deficiencies in the quality of our nation’s medical care.

Progress in correcting these deficiencies remains frustratingly slow, and it has become clear that achieving the quality and safety improvements we seek will require us to examine our approach to medical education.

Although today’s newly minted physicians are well prepared in the science of medicine …

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Today’s new physicians are unable to improve patient safety

Laugh, Sing, and Eat Like a Pig: Facing death, with hope

Patient
August 9, 2010

An excerpt from Laugh, Sing, and Eat Like a Pig.

laughsingLast month Dave deBronkart, known on the internet as “e-Patient Dave,” released his first book, Laugh, Sing, and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer (and what healthcare can learn from it) (www.LaughSingBook.com).

It’s his personal cancer story – excerpts from the journal he kept …

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Laugh, Sing, and Eat Like a Pig: Facing death, with hope

Sharing medical records with patients can save lives

Patient
August 9, 2010

Regina Holliday’s husband, Fred, age 39, died of cancer in June 2009 leaving his wife, and his two young, beautiful children behind.  During their journey through the healthcare system to try to get Fred the help he needed, too many hurdles were put in their way.  Their story makes you want to scream.

Among the horrors of their journey was the fact that Fred was transferred …

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Sharing medical records with patients can save lives

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