Hospital medicine

5,188 articles · Since 2004

Articles, page 143

Treating a child with fever and leukemia

June 10, 2010Jun 10, 20105

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren't for her complacent eyes…

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Conditions and diseases

Causes of stroke in young adults

MedPage Today

June 9, 2010Jun 9, 20102

by Todd Neale The recent stroke suffered by Delaware's attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health. A statement from Timothy Gardner, MD, medical director of…

by Todd Neale

The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.

A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether …

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Causes of stroke in young adults

Physician voices

Interruptions in the emergency department can lead to errors

MedPage Today

June 8, 2010Jun 8, 20102

by Nancy Walsh Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found. Overall, clinicians were interrupted 6.6 times per hour, and 11%…

by Nancy Walsh

Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.

Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.

The mean “time on task” for uninterrupted tasks was 1 minute and 26 …

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Patient voices

Listening to nurses is key to being a good doctor

Doctor Grumpy, MD

June 3, 2010Jun 3, 201021

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it. I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how…

I’m a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80’s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, …

Conditions and diseases

Patients who attempt suicide and withdrawal of medical care

Ralph Gordon, MD

June 2, 2010Jun 2, 20105

If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life? Not from a legal standpoint, and not if…

If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?

Not from a legal standpoint, and not if you are living in the United States.

A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …

Patient voices

Medical compliance from a patient perspective

Dave deBronkart

May 31, 2010May 31, 20102

The new definition of participatory medicine at the Society’s website notes that patients “shift from being mere passengers to responsible drivers of their health, and … providers encourage and value them as full partners.” As with any collaboration, this must…

I recently returned from an extraordinary week in Minnesota, with visits to several thought-provoking care facilities. The week was all about …

Physician voices

How the oil shortage will affect hospitals and healthcare

Marya Zilberberg, MD, MPH

May 31, 2010May 31, 201011

I believe in the peak oil theory. Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced,…

I believe in the peak oil theory.

Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …

Physician voices

Waiting is a part of surgery, and how a surgeon perceives time

Bruce Campbell, MD

May 30, 2010May 30, 20104

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion. - Albert Einstein The surgical case is delayed for ten minutes and I am getting restless. I anticipate…

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …

Physician voices

Hospitalists are killing primary care, and other myths debunked

Vineet Arora, MD

May 26, 2010May 26, 201011

Those who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.

Of course this hatred is not new. As a …

Physician voices

Joint Commission hospital inspections have improved

Robert Wachter, MD

May 22, 2010May 22, 20105

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the…

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.

Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the …

Physician voices

Ethics of futile care

Jeffrey Hall Dobken, MD, MPH

May 21, 2010May 21, 20106

The bioethics community has been working on defining the concept of medically futile care for more than a quarter of a century, yet the debate continues. The way in which the current notion of medical futility becomes folded into the…

Sophisticated medical technology that is at once life-saving, life-prolonging as well as death-prolonging has created populations which, in the past, would have …

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Ethics of futile care

Conditions and diseases

Father of a patient with a sudden brain hemorrhage

StorytellERdoc, MD

May 20, 2010May 20, 20105

She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history. She was at home, preparing…

She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.

She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn’t drive, her elderly father had planned on swinging by to pick her up. He had just called …

Physician voices

Defensive medicine starts early in residency training

WhiteCoat, MD

May 19, 2010May 19, 20107

Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going…

I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some …

Physician voices

Blood tests in hospitals may be unnecessary

John Schumann, MD

May 17, 2010May 17, 20107

I’ve just finished a month “on-service” as a teaching attending for a general medicine team here at GlassHospital. This means I served as the physician of record for every patient admitted to the team. You might find it interesting to…

You might find it interesting to know that patients admitted to the hospital’s general medicine service get assigned to their teams by random assortment. Since there are five teams, one team takes call every fifth day. In …

Physician voices

Patient wants an apology, not money, after medical malpractice

Tricia Pil, MD

May 16, 2010May 16, 201049

This is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and…

FRIDAY

Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of Doctor A and …

Conditions and diseases

Declining autopsy rate, and how that impacts doctors

Ralph Gordon, MD

May 12, 2010May 12, 20106

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy. Participation in an autopsy was one of the most valuable lessons from…

The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.

Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death …

Conditions and diseases

C-section rates as a marker for obstetric care quality

MedPage Today

May 12, 2010May 12, 20107

by Michael Smith When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said. But the converse isn't true -- higher-than-expected C-section rates aren't associated with a protective effect, according to Sindhu Srinivas, MD,…

by Michael Smith

When cesarean section rates are lower than expected, adverse maternal or neonatal outcomes are higher, researchers said.

But the converse isn’t true — higher-than-expected C-section rates aren’t associated with a protective effect, according to Sindhu Srinivas, MD, of the University of Pennsylvania, and colleagues.

The finding comes from an attempt to see if the risk-adjusted C-section rate can be used as a marker for the quality of obstetric care, Srinivas …

Conditions and diseases

Causes of Beau Biden’s stroke

Kevin Pho, MD

May 11, 2010May 11, 20102

Beau Biden, son of Vice President Joe Biden, suffered a stroke today. He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care…

Beau Biden, son of Vice President Joe Biden, suffered a stroke today.

He is 41-years old, and is expected to make a full recovery according to the medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System:

Biden has what the doctors “believe to be a mild stroke,” according to Gardner. “[He is] “fully alert,

…

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Causes of Beau Biden’s stroke

Health policy

Transparent medical pricing lowers health costs

Michael Kirsch, MD

May 10, 2010May 10, 20106

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents. I have a different view on the subject. This issue generates spirited debate in…

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.

I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.

Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught …

Physician voices

Children with fever may not receive antibiotics in the ER

MedPage Today

May 10, 2010May 10, 2010

by John Gever Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said. A computer algorithm based on standard…

by John Gever

Up to one-third of children with febrile bacterial infections failed to receive antibiotics in a large emergency department, while 20% of youngsters without such infections received antibiotics unnecessarily, Australian researchers said.

A computer algorithm based on standard test results could do a better job of assigning feverish children to the correct treatment sooner, Jonathan C. Craig, MBChB, PhD, of the University of Sydney, and colleagues reported online in BMJ.

Although …

Hospital medicine

Articles, page 143

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