Hospital medicine

5,188 articles · Since 2004

Articles, page 139

“A Pediatric Surgeon in Iraq” does not disappoint

September 12, 2010Sep 12, 2010

by 911Doc, MD I can't help but stand in awe of surgeons. I thought I was going to be one when I went to medical school, but my short attention span and my lack of true interest in the procedures…

by 911Doc, MD

I can’t help but stand in awe of surgeons. I thought I was going to be one when I went to medical school, but my short attention span and my lack of true interest in the procedures spelled doom for that. Still, when I work in the ER and I have a surgical patient, I especially want to dot my i’s and cross …

Physician voices

Doctors and family members often push for futile, aggressive care

Erin Marcus, MD

September 12, 2010Sep 12, 201013

Every once in a while, there's a magazine piece that so encapsulates the key moral issues -- and irrationality -- of 21st Century medicine that it warrants designation as mandatory reading for anyone who interacts with patients. Atul Gawande has…

Every once in a while, there’s a magazine piece that so encapsulates the key moral issues — and irrationality — of 21st Century medicine that it warrants designation as mandatory reading for anyone who interacts with patients. Atul Gawande has written some of these; so too has Slate medical columnist, Darshak Sangavi.

The latest entry on the required reading list is Katy Butler’s “My Father’s Broken Heart,” which appeared …

KevinMD.com in the New York Times and New York Post and other recent media mentions

Kevin

September 12, 2010Sep 12, 2010

I’d like to thank various media outlets for recently citing KevinMD.com. In her New York Times diagnosis column, The heat of the night, Lisa Sanders discusses the case where a patient live-blogged his hospital stay, crowd sourcing his diagnosis: Schumann…

I’d like to thank various media outlets for recently citing KevinMD.com.

In her New York Times diagnosis column, The heat of the night, Lisa Sanders discusses the case where a patient live-blogged his hospital stay, crowd sourcing his diagnosis:

[Physician blogger John] Schumann was worried, too. He lived nearly a thousand miles away — too far to come and see his friend. Besides, the patient was posting all his test

…

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Patient voices

Improve patient safety and cut costs with clinical pharmacists

Emmanuel King, MD

September 8, 2010Sep 8, 20107

by Emmanuel King, MD What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday? On October 1, 2010, that is just what we can expect when clinical pharmacists move…

by Emmanuel King, MD

What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday? On October 1, 2010, that is just what we can expect when clinical pharmacists move from the back room to the bedside in ten general medical units at the Hospital of the University of Pennsylvania.

As we all know, medications play an intensely complex and ever-growing …

Conditions and diseases

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD & Pamela Hartzband, MD

September 6, 2010Sep 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology…

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Patient voices

Moments of internal struggle in the ER

StorytellERdoc, MD

September 5, 2010Sep 5, 20105

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting. The patient sat on her cot with her pant legs rolled up above her…

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting.

The patient sat on her cot with her pant legs rolled up above her knees, refusing, according to her nurse, Gwen, to put on a treatment gown. Her left leg hung in the air, her ankle crossed over the knee of her right leg. Her …

Read more…

Moments of internal struggle in the ER

Physician voices

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

September 5, 2010Sep 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years. In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare…

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Physician voices

Hospitalist: Long hospital stays are often due to poor planning

S. Irfan Ali, MD

September 2, 2010Sep 2, 20102

Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning. Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is…

Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.

Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the …

Physician voices

An advocate for patients might save your life in the hospital

Dennis Grace

September 2, 2010Sep 2, 201034

by Dennis Grace So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay,…

by Dennis Grace

So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.

Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big …

Physician voices

Leading a hospital team of foreign trained doctors

John Schumann, MD

September 1, 2010Sep 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…

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 …

Conditions and diseases

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

ER Stories, MD

September 1, 2010Sep 1, 201014

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 …

Drugs and prescribing

Empiric antibiotics in the ICU

Paul Sax, MD

August 31, 2010Aug 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…

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 …

Read more…

Empiric antibiotics in the ICU

Medical education

Fix the July Effect for incoming interns and residents

a medical resident, MD

August 25, 2010Aug 25, 20105

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…

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. …

Patient voices

Applying the minimally invasive concept to patient management

Ralph Gordon, MD

August 24, 2010Aug 24, 20105

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 …

Conditions and diseases

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

Bruce Campbell, MD

August 19, 2010Aug 19, 20105

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…

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 …

Physician voices

The July Effect and causes of the spike in medication errors

Glenn Laffel, MD, PhD

August 18, 2010Aug 18, 20102

"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…

“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 …

Physician voices

Consider the family’s perspective in the treatment plan

John Trahanas

August 17, 2010Aug 17, 20103

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…

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 was clearly …

Physician voices

Doctors need to become whistleblowers after medical error

Dr. Martin Young

August 17, 2010Aug 17, 20107

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…

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 …

Physician voices

Stop calling doctors fleas and teaching professionalism

Vineet Arora, MD

August 15, 2010Aug 15, 201010

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…

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 …

Physician voices

Practicing medicine as a single parent requires finding balance

Katherine Chretien, MD

August 14, 2010Aug 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…

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 …

Hospital medicine

Articles, page 139

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