Hospital medicine

5,188 articles · Since 2004

Articles, page 138

Surviving a potentially fatal injury and the fragility of life

October 18, 2010Oct 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…

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 …

Patient voices

A sweet and tender moment between a mother and daughter

StorytellERdoc, MD

October 17, 2010Oct 17, 20102

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 …

Patient voices

Searching for solace while balancing the care of patient

Brian McMichael, MD

October 16, 2010Oct 16, 2010

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…

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 collapsed. A physician …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Health policy

How observation admissions affect Medicare patients

WhiteCoat, MD

October 10, 2010Oct 10, 201019

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.…

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 …

Physician voices

Why specialists don’t do more curbside consults

Paul Sax, MD

October 6, 2010Oct 6, 20106

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…

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

…

Physician voices

Should CRNAs practice anesthesiology without physician supervision?

Jeffrey Parks, MD

October 5, 2010Oct 5, 201032

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…

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

…

Patient voices

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

Jeffrey Hall Dobken, MD, MPH

October 4, 2010Oct 4, 201013

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…

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 …

Patient voices

The day that medicine broke her and destroyed her innocence

Jordan Grumet, MD

October 4, 2010Oct 4, 201010

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…

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 …

Drugs and prescribing

Why drug companies lavish doctors and how they price their drugs

Daniel J. Carlat, MD

October 3, 2010Oct 3, 201015

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc. My own education in pharmaceutical marketing…

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

My own education in pharmaceutical marketing began during my second year of residency at Massachusetts General Hospital.

Suddenly, I noticed that Paxil bagels began appearing everywhere. I first saw them in the break room of …

Physician voices

People live and die by their chronic illnesses by what they do at home

Shantanu Nundy, MD

September 29, 2010Sep 29, 20102

"You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …" … "But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him…

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him …” [the ICU team laughs] … “But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without …

Physician voices

Boston Medical Center gets screwed by the Massachusetts government

Kevin Pho, MD

September 29, 2010Sep 29, 201020

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what's happening to the venerable institution is gut-wrenching to read. I trained at Boston Medical Center (BMC), completing my internal medicine…

Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.

I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:

Boston Medical Center is almost broke, perilously close to what

…

Patient voices

Nurses expect to be called by their first names, should doctors follow?

Christopher Johnson, MD

September 29, 2010Sep 29, 201017

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician. When…

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …

Patient voices

Keeping the terminal patient comfortable is the purpose of comfort care

Ralph Gordon, MD

September 28, 2010Sep 28, 20106

Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient…

Occasionally, I hear requests from the family members of the dying patient – “Can you give …

Medical education

How a medical student can exacerbate the high cost of health care

Suchita Shah

September 28, 2010Sep 28, 201020

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care. It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with…

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.

It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with my resident. The patient had liver disease and perhaps some ascites.

He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have …

Patient voices

Health and well-being hypocrisy in the health care industry

Edward Stevenson

September 27, 2010Sep 27, 20107

One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being. I would expect that if I inquired of my colleagues that a similar statements of values would…

One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.

I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the physician …

Physician voices

Why unnecessary cesareans is a misnomer

Nicholas Fogelson, MD

September 26, 2010Sep 26, 201026

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.

A popular term bandied about is “Unnecesarean”, a catchy …

Read more…

Why unnecessary cesareans is a misnomer

Conditions and diseases

Marginal treatments at a high emotional cost from families

Marya Zilberberg, MD, MPH

September 22, 2010Sep 22, 20108

My father passed away about two weeks ago after battling a brain tumor for some time. Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one…

My father passed away about two weeks ago after battling a brain tumor for some time.

Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of …

Conditions and diseases

When does a headache need to be seen at the hospital?

Chaim Colen, MD

September 20, 2010Sep 20, 2010

As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache?…

A headache is considered to be pain located anywhere in the region of the upper …

Health technology

Powerful examples of using the iPad on the wards

Vineet Arora, MD

September 16, 2010Sep 16, 20106

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students. Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but…

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students.

Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but also one of the most rewarding clinical experiences as a faculty member. The interns and residents are eager to learn and your teaching may have a more lasting impact as the residents …

Health technology

How CPOE violated medical ethics

Anonymous

September 14, 2010Sep 14, 201027

As a result of my mother's health IT-related cerebral hemorrhage and resultant multi-month hospitalization, with transfers to nursing homes then back to acute care due to setbacks, I recently had the chance to observe her care in a small community…

As a result of my mother’s health IT-related cerebral hemorrhage and resultant multi-month hospitalization, with transfers to nursing homes then back to acute care due to setbacks, I recently had the chance to observe her care in a small community hospital.

This was a hospital that, in her last several days there before going back to a nursing home for …

Read more…

How CPOE violated medical ethics

Hospital medicine

Articles, page 138

Real physician voices, twice a week

The Podcast

Latest episodes

Most popular

The Podcast

Latest episodes

Most popular