Hospital medicine

5,188 articles · Since 2004

Articles, page 144

False patient contact information worsens emergency care

May 10, 2010May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave. Patients sometimes leave false contact information -- which makes it difficult for the emergency room staff should problems arise after the visit. The issue was illustrated in…

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

Conditions and diseases

Dying of old age in the era of modern medicine

John Mandrola, MD

May 8, 2010May 8, 201023

He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late. Despite…

Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke …

Health technology

How Massachusetts can lead health IT modernization

John Halamka, MD

May 6, 2010May 6, 201010

Although healthcare reform has its supporters and detractors, healthcare IT reform - the use of technology to improve the quality, safety and efficiency of healthcare throughout the country - has broad support from all stakeholders. The passage of last year’s…

Although healthcare reform has its supporters and detractors, healthcare IT reform – the use of technology to improve the quality, safety and efficiency of healthcare throughout the country – has broad support from all stakeholders.

The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use …

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Physician voices

Quality hospital care deserves to be celebrated

Brian Klepper, PhD

May 5, 2010May 5, 2010

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and …

Physician voices

Avoiding the ER and arranging a direct admit is not easy

Kevin

May 4, 2010May 4, 201016

Are emergency departments solely responsible for the bulk of unnecessary tests? Most would like to believe so, but emergency physician Edwin Leap says that's not the case. He cites an instance involving a primary care doctor and hospitalist: Local physician,…

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist.

…

Medical education

Residency team changes can improve education and patient care

Robert Wachter, MD

May 3, 2010May 3, 2010

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.

When I took over our residency in 1992, …

Physician voices

Healthcare reform and the new role of hospitalists

MedPage Today

April 30, 2010Apr 30, 20102

by John Gever With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent…

by John Gever

With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent hospitalist said.

“Some organizations with hospitalist programs need look no further than these programs to chart a course toward more effective physician-hospital integration,” wrote Robert M. Wachter, MD, of the University of …

Physician voices

Cardiac arrest resuscitation, with wife as witness

StorytellERdoc, MD

April 29, 2010Apr 29, 201012

The patient arrived in cardiac arrest. He had been brought to our emergency department in the middle of the night. Although he had a significant cardiac history, he was only in his late-forties. His transport from his house to our department had been less than ten minutes and, along the way, the pre-hospital team had done an excellent job of intubating this patient and establishing an IV.

His wife was with …

Physician voices

Hospital practice can come with pitfalls for doctors

Victoria Rentel, MD

April 28, 2010Apr 28, 201017

I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment. I worked for a hospital system in a…

I read recent New York Times and KevinMD.com items about the migration of doctors to hospital-owned practices. The benefits are obvious: guaranteed salary, regular hours, malpractice coverage, paid benefits, school loan repayment.

I worked for a hospital system in a small suburban practice in a large Midwestern city for almost four years. I did indeed enjoy the subsidized salary. Who can argue with vesting? I had a terrific group …

Conditions and diseases

Aneurysm as a cause of the Bret Michaels brain hemorrhage

Kevin Pho, MD

April 26, 2010Apr 26, 20102

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage. According to his road manager, "further testing this week will help locate the source of the bleeding." What exactly does that entail? As I…

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.

According to his road manager, “further testing this week will help locate the source of the bleeding.”

What exactly does that entail?

As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or …

Physician voices

Undocumented individuals make hospital discharge difficult

John Schumann, MD

April 26, 2010Apr 26, 20108

Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be…

Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central …

Physician voices

Quality care requires open clinical transparency

Paul Levy

April 26, 2010Apr 26, 2010

Let's face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense…

Let’s face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the “efficient market” described by economists.

In such an environment, …

Health policy

Health reform won’t help the ER

Chris Rangel, MD

April 26, 2010Apr 26, 20102

Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according…

Frequent users account for about 8% of ED patients but 28% of visits. Although frequent

…

Read more…

Health reform won’t help the ER

Physician voices

St. Vincent’s Hospital closes, but who’s to blame?

Marie Cooper

April 24, 2010Apr 24, 20104

St. Vincent’s Medical Center in Greenwich Village was founded in 1849, making it the third oldest hospital in New York City. It has been an occasional scene of notoriety but mostly it has witnessed countless episodes of anonymous compassion and care. My two sons were born there. As a major teaching hospital, it has over 1000 affiliated physicians. It is where generations of New Yorkers …

Conditions and diseases

Bret Michaels has a subarachnoid hemorrhage, and what that means

Kevin Pho, MD

April 23, 2010Apr 23, 201019

Bret Michaels is in critical condition from a subarachnoid hemorrhage. I've been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he…

Bret Michaels is in critical condition from a subarachnoid hemorrhage.

I’ve been watching Celebrity Apprentice recently, and he comes across as a genuine person who, of course, has been raising awareness for Type 1 diabetes. As most people know, he has battled various diabetic complications on the show, and recently underwent an emergency appendectomy.

What’s his prognosis like?

Not good, I’m …

Conditions and diseases

Palliative care physicians confronting their own mortality

Lyle Fettig, MD

April 23, 2010Apr 23, 20102

Dr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41. Her story provides palliative care clinicians an opportunity to reflect…

Dr. Desiree Pardi was the palliative care medical director at Weill Cornell Medical Center in New York. She died of metastatic breast cancer in 2009 at the age of 41.

Her story provides palliative care clinicians an opportunity to reflect on how our own personal mortality interacts with our professional lives.

I did not personally know Dr. Pardi. I write this post knowing that many readers did indeed know her, some …

Physician voices

Psychiatric patients detained in the ER

Edwin Leap, MD

April 22, 2010Apr 22, 201011

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things.…

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

Read more…

Psychiatric patients detained in the ER

Physician voices

Palliative care needs a simple and consistent message

Alex Smith, MD

April 20, 2010Apr 20, 20106

I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable.…

I went to see her. She had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking …

Physician voices

MRSA control takes consistent time and effort

MedPage Today

April 20, 2010Apr 20, 20102

by Michael Smith It's possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals -- all it takes is consistent effort over time, French researchers say. That's the conclusion after a 15-year, intensive program aimed at reducing the impact…

by Michael Smith

It’s possible to reduce the burden of drug-resistant pathogens in hard-hit hospitals — all it takes is consistent effort over time, French researchers say.

That’s the conclusion after a 15-year, intensive program aimed at reducing the impact of methicillin-resistant Staphylococcus aureus (MRSA) on Parisian hospitals reported in the March 22 Archives of Internal Medicine.

The program started in 1993 in the 38-hospital, 23,000-bed Assistance Publique-Hôpitaux de Paris, the largest …

Conditions and diseases

President Obama should have had colonoscopy without sedation

Michael Kirsch, MD

April 19, 2010Apr 19, 20108

by Michael Kirsch, MD Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless…

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

Hospital medicine

Articles, page 144

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