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.

When compassion meets progress in American health care

Edwin Leap, MD

Health Policy

October 24, 2009

Does anyone realize that the chaos of modern American health-care is not a tragedy, but a triumph? We’re so busy trying to fix what isn’t broken and ignoring what is, so busy casting stones and casting doubts that we are blind to what we have.

I have practiced medicine in this labyrinth for 16 years. I am an emergency physician. I practice in what may be considered the ‘epicenter’ of modern …

When patients receive too much radiation from CT scans by mistake

Kevin

Conditions and Diseases

October 21, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Reports of stroke patients who were accidentally exposed to eight times the normal radiation dose during diagnostic CT scans at Cedars-Sinai Medical Center in Los Angeles are prompting safety warnings and soul searching among radiologists nationwide.

Over an 18-month period, 206 patients at the center received 3 to 4 …

Does robotic surgery for prostate cancer help patients?

Kevin

Conditions and Diseases

October 19, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Men who opt for minimally invasive prostate surgery — often with a helping hand from a robot — are twice as likely to have genitourinary complications as men who have a traditional prostatectomy.

That finding is especially troubling because the use of robotic-assisted minimally invasive prostatectomy has increased exponentially in …

Doctors need to fix the health care system that they had a hand in breaking

Kevin

Health Policy

October 16, 2009

by Daniel A. Graubert, MD

Medicine has changed so dramatically since I graduated medical school in the 1980’s, that it is hardly recognizable.

Certainly, there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as CT scans and MRIs became available, we were able to see the inside of large numbers of patients …

Texting young liver transplant patients to take their medications

Kevin

Conditions and Diseases

October 16, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Here’s a case where texting may actually improve a teenager’s health: Text message reminders appear to be effective in getting young liver transplant patients to take their immunosuppressive medications, a small study showed.

In 41 patients with a median age of 15, there was a significant improvement in medication compliance …

One way to treat patients with severe H1N1 flu

Kevin

Conditions and Diseases

October 15, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Most patients who underwent extracorporeal membrane oxygenation (ECMO) for respiratory failure survived their struggle with pandemic H1N1 flu, according to a study by researchers from Australia and New Zealand.

Of the 68 patients treated with ECMO during the Southern Hemisphere’s winter, 54 were still alive as of Sept. 7, according to …

How H1N1 pandemic flu will affect intensive care units

Kevin

Conditions and Diseases

October 14, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The winter wave of the pandemic H1N1 flu hit intensive care units in Australia and New Zealand hard, researchers said, and may offer lessons for doctors bracing for the pandemic’s return to the Northern Hemisphere.

All told, 722 people with confirmed pandemic flu were admitted to one of the …

Do HMOs drive blacks to the emergency room?

Kevin

Physician

October 13, 2009

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Many African-Americans in California enrolled in health maintenance organizations (HMOs) appear to prefer getting medical treatment in emergency rooms, researchers said.

One-quarter of African-Americans enrolled in Kaiser Permanente or other commercial HMOs in California, who would therefore have a range of treatment options, sought treatment in emergency rooms in 2007, …

Why rapid viral testing for kids with URIs may not help in the ER

Kevin

Physician

October 12, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Rapid viral diagnostic testing did not reduce the burden of treating children with respiratory symptoms and fever in the emergency department, according to a Cochrane Review meta-analysis.

Pooling the results of four trials, researchers found a significant reduction in the use of chest radiography (RR 0.77, 95% CI 0.65 to …

Will more primary care doctors keep patients out of the ER?

Edwin Leap, MD

Physician

October 9, 2009

One of the many questions asked in the health-care reform debate is ‘how do we keep people out of emergency departments in order to reduce costs?’ Simply put, we probably can’t. And 16 years into my emergency medicine practice, I think I know why.

Having taken my own children to the emergency department, even I have been surprised at the charges generated. But we should step back and remember that emergency …

Can ventilating patients spread H1N1 flu in hospitals?

Kevin

Conditions and Diseases

October 9, 2009

Originally published in MedPage Today

by Crystal Phend, MedPage Today Senior Staff Writer

Plumes of virus-laden air shooting out from the masks of patients undergoing noninvasive ventilation could put healthcare workers at increased risk for infectious diseases such as the pandemic H1N1 (swine) flu, researchers said.

A positive-pressure ventilation mask on a simulated patient yielded a jet of exhaled air extending …

Is incident reporting effective in reducing medical errors and increasing patient safety?

Robert Wachter, MD

Health Policy

October 6, 2009

When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.

But one lesson from …

Flu and H1N1 influenza vaccine recommendations for doctors and health care workers

American College of Physicians

Conditions and Diseases

October 5, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In the Fall of 2009, we physicians should perhaps change the Biblical phrase, “Physician, heal thyself” to “Physician, immunize thyself” and then follow the phrase twice – once for seasonal influenza and once for H1N1. To date, physicians and other health care workers have too often been lax …

Did the 1918 flu pandemic increase the risk of heart disease?

Kevin

Conditions and Diseases

October 5, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Men who were in utero during the peak of the 1918-1919 flu pandemic were at increased risk of heart disease when they reached their 60s, 70s, and 80s, researchers said.

In those men, the rate of heart disease was more than 23% higher than among those whose mothers …

Analysis of the Senate Finance Committee health care reform bill

Kevin

Health Policy

October 3, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it …

Health care reform analysis from a former insurance and hospital executive

Kevin

Health Policy

October 3, 2009

by Marie Cooper

I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.

The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.

Insurer side

Insurance companies have to maximize their revenue because they answer to their boards. They …

Are hospice doctors relying too much on symptom scores to assess pain?

Eric Widera, MD

Conditions and Diseases

September 29, 2009

A recent issue in The Lancet included an article entitled “The Death of Ivan Ilyich and pain relief at the end of life.” This is a thought provoking article focused on the question of whether there is overuse of pharmaceuticals to treat various forms of suffering in hospice and palliative medicine.

The authors argue that a good death, as seen through their interpretation of The Death of Ivan Ilyich, may include …

Should letting a premature infant die be considered health care rationing?

Kevin

Conditions and Diseases

September 27, 2009

by an anonymous NICU nurse

There is a medical controversy brewing over in England that is threatening to invade the United States. Ms. Capewell, a 23-year old British mother, is claiming English doctors let her 21 5/7 week infant die, only because they were following national perinatal guidelines.

If only he was born at 22 weeks, she insists, they would have tried everything to save him and admitted him to the …

Does the bulk of excessive medical care happen in the ER?

Michael Kirsch, MD

Physician

September 25, 2009

by Michael Kirsch, MD

The concept of medical excess is very difficult for ordinary patients to grasp. The medical community has worked hard for decades teaching them that more medicine meant better medical care. The public has learned these lessons well. Physicians who sent their patients for various diagnostic tests or specialty consultations were regarded as conscientious and thorough. Patients approved of doctors who prescribed antibiotics regularly for colds and other …

Radiologists and communicating mammogram results to patients and their doctors

Kevin

Conditions and Diseases

September 24, 2009

by an anonymous radiologist

I recently read the article and comments on this link from this post, concerning radiologists, from Musings of a Dinosaur.

I was disturbed to discover the animosity with which this topic is covered. The tenor of the blog is that radiologists are greedy, self-serving and are out to erode the doctor-patient relationship. The suggestion that radiologists would schedule percutaneous breast biopsies for their financial enhancement is both …

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