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.

Treating people with humility, and every patient like a V.I.P.

Anesthesioboist T., MD

Patient

August 8, 2010

People often seem to think that members of the medical world are excessively preoccupied with, defined according to, and ruled by a status-oriented system.

That may have been an accurate perception a generation ago, but I’ve seen enough surgeons sweeping O.R. floors, attending physicians socializing with interns, and doctors having deep conversations with custodians to believe that “medical people” have matured a little past the old caste systems that governed the …

Does surgery prevent knee osteoarthritis?

MedPage Today

Physician

August 7, 2010

by John Gever

Surgery for torn knee ligaments and meniscal cartilage may have improved patients’ short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said.

A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have …

Attribution error in a patient with colon cancer

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

August 5, 2010

Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital.

The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the …

Metastatic cancer and the matching walkers

StorytellERdoc, MD

Patient

August 5, 2010

They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.

They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were …

How developing countries use foreign health aid matters

Yann Meunier, MD

Physician

August 5, 2010

Year: 1994

Setting: Port Moresby General Hospital, Papua New Guinea
Position: Chief medical officer for Chevron Oil Co.

The wife of an expatriate employee has injured her arm and, suspecting that she has fractured her left elbow, I accompany her to the Port Moresby hospital for further evaluation. The building looks good and new. In fact, it was recently donated to Papua New Guinea by the Japanese government.

While waiting for the X-rays, I …

How to say goodbye to patients

Christian Sinclair, MD

Patient

August 3, 2010

OncRN is a wonderful blog written by an anonymous author sharing stories and insights in her line of work that many times speak to palliative themes. S/he says it best in her blog description,

my life gets intermittantly (sic) rocked by the wonders/horrors of being an oncology nurse. i just need to talk it all through sometimes.

A recent post is about how to say good-bye to our patients, particularly …

Read more…

How to say goodbye to patients

Unread echocardiogram fallout at Harlem Hospital Center

Larry Husten, PhD

Conditions and Diseases

August 3, 2010

Recently, the New York Times reported that Harlem Hospital Center had finally completed its investigation into thousands of echocardiograms that after receiving an initial reading by a technician had never been read by a physician.

It turns out that out of 7,000 tests that went unread, only 14 patients “might have been misdiagnosed because their tests had not been handled properly,” according to the hospital spokeswoman quoted in the story. …

Every patient deserves a death with dignity and without pain

George Lundberg, MD

Physician

August 3, 2010

Death is not the enemy. We all die.

The enemies of patients and physicians are premature death, disease, disability, pain, human suffering.

I believe that all people deserve a death with dignity and without pain. Palliative care is the right mode for as many as 80% of all Americans who will die of chronic progressive incurable diseases. Eighty percent of those state that they do not want to die in a hospital …

Caring for dying patients needs better physician communication

MedPage Today

Patient

August 2, 2010

by Michael Smith

Clinicians treating dying patients did well in managing pain but fell short on communicating with patients and their loved ones, researchers said.

The findings, from a single-institution study, suggest that those who care for terminal patients also often failed to assess shortness of breath in a dying patient whose mechanical ventilation was withdrawn, according to Anne Walling, MD, of the University of California Los Angeles, and colleagues.

But overall those …

Greed is not good when it comes to doctors, patients and medicine

Chris Rangel, MD

Health Policy

July 31, 2010

Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.

The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.

These rewards (increasing salary, bonuses, …

Decision support can help doctors order scans

Kevin

Patient

July 30, 2010

by Scott Cowsill

A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.

As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic …

How industry money continues to influence orthopedics

Ford Vox, MD

Physician

July 30, 2010

Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.

The …

Certified stroke centers and ischemic stroke treatment realities

Kevin

Conditions and Diseases

July 28, 2010

by John Fauber

Time is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center — a center that could administer clot-busting therapy quickly, and safely — was considered the surest way to “save brain.”

That was the concept behind the certified …

Preventing postop infections need to be implemented as a package

Kristina Fiore

Physician

July 27, 2010

by Kristina Fiore

Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.

When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.

But the three core infection prevention measures taken …

How seniors will accept cuts in Medicare from health reform

Richard Reece, MD

Health Policy

July 26, 2010

Everybody knows politics is a balancing act. One must balance promises against reality.

For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?

And how one do it without losing the vote of seniors, who hold the key to the balance of power?

The Obama administration and the Democrats hope to keep power by winning the …

Defensive medicine forces residents to use test oriented care

a medical resident, MD

Conditions and Diseases

July 26, 2010

A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.

Is it true? Absolutely.

It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …

Chronic illness needs to be managed at home, not at the hospital

Shantanu Nundy, MD

Conditions and Diseases

July 25, 2010

“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 that somebody …

Good medicine sometimes makes patients unhappy

Ralph Gordon, MD

Physician

July 24, 2010

As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?

In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is …

How can doctors minimize unnecessary testing?

Robert Centor, MD

Physician

July 21, 2010

A recent comment raised a minor controversy about the strategy of minimizing tests. I actually do not think that the disagreement is that great, but I feel like exploring the issue.

This is the sentence that triggered the comment, courtesy of primary care physician Rob Lamberts:

Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always …

Read more…

How can doctors minimize unnecessary testing?

How Massachusetts can set hospital payment rates

Paul Levy

Health Policy

July 19, 2010

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …