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.

Texting and cell phone use are becoming more common in hospitals

Edwin Leap, MD

Physician

February 18, 2010

The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s …

Treating atrial fibrillation with catheter ablation on TV may not be ethical

Larry Husten, PhD

Conditions and Diseases

February 17, 2010

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy …

Doctors have an ethical obligation to treat complications from a transplant operation performed abroad

Kevin

Conditions and Diseases

February 11, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Patients who travel to foreign countries for organ transplants may return with more problems than they left with — and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.

“Medical tourism” has been on the rise as demand for organs outpaces supply and U.S. …

When doctors can’t figure out what’s wrong with a patient

Alex Lickerman, MD

Conditions and Diseases

February 10, 2010

Part one of a series.

The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …

How will the earthquake affect the future of the Haitian American community?

Erin Marcus, MD

Physician

February 10, 2010

Marleine Bastien is the founder and executive director of Fanm Ayisyen Nan Miyami–Haitian Women of Miami–www.fanm.org, which advocates for the rights of Haitian women. She is also a congressional candidate for U.S. House District 17, representing Little Haiti and other neighborhoods in Miami. Erin N. Marcus spoke with Bastien on Jan. 22 about the Haiti earthquake.

What has FANM been doing since the earthquake?

As soon as we heard about it, …

What is the biggest risk for soldiers fighting overseas?

Kevin

Conditions and Diseases

February 6, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

More than 85% of American military medical evacuations from the Middle East were not the direct result of enemy action, but the result of non-battle injuries and disease, researchers said.

Of some 34,000 military personnel in Iraq and Afghanistan who shipped out for medical reasons from 2004 to 2007, only …

Should society consider purchasing and selling tissues and organs?

Michael Kirsch, MD

Conditions and Diseases

January 31, 2010

by Michael Kirsch, MD

Choose the best answer.

To stimulate organ donation, we should provide organ donors with:

* Cold, hard cash
* Upgrades to business class on any flight within the continental United States for 1 year
* College tuition discounts for up to 3 children
* Income tax relief
* First row Bruce Springsteen concert tickets
* A certificate of appreciation

There is a reason that we don’t ask families of kidnapped victims what our policy should …

How should patients decide which hospitals are best for them?

Zackary Berger, MD, PhD

Physician

January 26, 2010

Johns Hopkins Hospital is consistently named one of the best in the country. I can’t disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other …

Why the Mayo Clinic is refusing to see Medicare patients

Toni Brayer, MD

Health Policy

January 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …

When are stroke patients more likely to receive clot busting drugs?

Kevin

Medications

January 23, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Patients suffering an acute ischemic stroke are about 20% more likely to receive clot-busting therapy with tissue plasminogen activator (tPA) if they arrive at the hospital on the weekend, a retrospective study showed.

However, there was no difference in rates of inhospital mortality based on the time of admission, Abby …

A doctor writes about his first day in Haiti

Kevin

Physician

January 19, 2010

by Jonathan Crocker, MD

From Cange, Central Plateau
Haiti
01-18-10

We arrived at Cange, in the Central Plateau, the heart of operations for Partners In Health/Zamni Lasante, yesterday. As we expected, things are incredibly busy. People are still arriving from Port au Prince. Those who have been fortunate enough to survive their injuries this long are now running into complications of wound infections, some of which have turned septic, and venous blood clots (from …

How root cause analysis can improve patient safety

Robert Wachter, MD

Physician

January 19, 2010

Hospitals face so many urgent tasks in safety – computerize, promote teamwork, implement evidence-based safety practices, discover unsafe conditions – that it’s hard to know where to start. If you’re struggling, I recommend that you put your Root Cause Analysis enterprise on steroids. This is what we did at UCSF Medical Center, and it was the most important change we’ve made in our safety journey. Here’s the story, …

Scenes from Haiti before the earthquake, and what the future holds

Kevin

Physician

January 18, 2010

Originally published in MedPage Today

by Michael Smith

I remember walking through the squalid downtown of Port-au-Prince and coming across a woman sitting by the roadside selling carefully washed tin cans. That was how she made her meager living.

There were scenes that were more appalling — a man on a street corner with his head split open by a machete, a corpse …

How bad patient outcomes affect physicians

Shantanu Nundy, MD

Physician

January 16, 2010

Ms. FR didn’t look so great even when I first met her. She had been admitted to the hospital three times in past 6 weeks for nausea/vomiting and generalized malaise. While the cause of her acute illness was not entirely clear, we suspected that her widely metastatic breast cancer had something to do with it.

By the time I met her she had already been in the hospital for 1 week. …

What diseases can arise from the lack of clean water in Haiti?

Kevin

Conditions and Diseases

January 15, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The lack of clean water in the stricken Haitian capital fosters conditions that may spawn an epidemic of enteric disease.

“Having large numbers of people in close proximity and not using appropriate sanitation can potentially spark those epidemics, particularly if people are forced to drink surface water,” said Rebecca Dillingham, …

Tips for Haiti earthquake relief: How to find the right charity for donations

Erin Marcus, MD

Physician

January 15, 2010

It’s impossible to watch coverage of the immense suffering in Haiti and not want to help. But many charitable groups seem to have sprung up since the disaster, and it’s tough to know which ones will be most effective at getting your donation to those most in need.

To try to sort out the difference between the major aid groups, I asked Haitian-American community organizers, as well as physicians I know …

Haiti relief effort may be too late to help the earthquake victims

Kevin

Physician

January 14, 2010

Originally posted in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Two days after a powerful earthquake shattered Haiti’s capital city, relief workers are finding it tough to provide needed medical care, coordination for the efforts is lacking, and time is running out for those trapped in the rubble.

“The window they talk about is 48 to 72 hours,” said Irwin …

Why the Haiti health crisis will be worse than Hurricane Katrina’s aftermath

Kevin

Physician

January 13, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The powerful earthquake that hammered Haiti Tuesday afternoon has created a medical nightmare, those familiar with the country say.

“I can’t even imagine the kind of horror we’re going to see in the next two to three weeks,” said Steven Williams, MD, an internist at Allegheny General Hospital in Pittsburgh …

The Haiti earthquake damage to hospitals and health care infrastructure

Kevin

Physician

January 13, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The powerful earthquake that hammered Haiti Tuesday afternoon has left healthcare in the impoverished Caribbean nation in even worse shape than before.

Several hospitals have been seriously damaged and others are swamped by casualties from the magnitude 7.0 quake.

“We are seeing wave after wave of vehicles coming from the Port-au-Prince …