Hospital-Based Medicine

The medical illiteracy epidemic

Physician

October 14, 2019

This past August, I attended the American College of Obstetricians and Gynecologists (ACOG) District VI meeting in Wisconsin. The theme of this year’s meeting was “Bringing it Back Home,” with a keynote presentation focused on developing the emotional habits to influence others and “embody the inner attitude of a leader.”

After a day of much self-reflection, I decided to stop by the poster presentations during a break between the major talks. …

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The medical illiteracy epidemic

How pneumatic tubes symbolizes our health system

Fred N. Pelzman, MD

Physician

September 24, 2019

About once or twice a day, everyone on our hospital’s computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning.

They include things like a notification that a particular data system is down and that a backup on paper will have to be used for documentation, or the hospital …

Never let your patients know you’re in a hurry

Suneel Dhand, MD

Physician

September 11, 2019

I was recently working in clinic on a Friday afternoon. I was on my last patient of the day, and it had been a particularly long clinic. I had big plans for the weekend and should have already finished. The gentleman entered the room, sat down, and we began the consultation. Because I was so behind, I went through everything a little quicker than I usually would, but still covering …

Does the House of God stand the test of time?

David B. Nash, MD, MBA

Physician

September 9, 2019

As media coverage of the 50th anniversary of Woodstock shifted into high gear earlier this month, two articles in the “Arts and Medicine” section of JAMA called attention to another anniversary that transported me back in time.

It has been 40 years since the publication of The House of God — an unabashedly irreverent (some would say “borderline pathological”) fictionalized account of author Stephen Bergman’s …

Do physicians feel guilt and embarrassment more often than they admit?

Bobak Akhavan, MD

Physician

August 31, 2019

I was an intern, doing a rotation in the coronary care unit (CCU) of a large urban hospital. It was very challenging: The patients had complex medical issues, and my fellow residents and I were given lots of responsibility for their care. Still, I felt I was finally getting the hang of residency.

One of the first patients I saw was Mrs. Smith, a middle-aged woman who had come to the …

The story of a hospital collapse and how small towns were devastated

Barbara Feder Ostrov and Lauren Weber

Policy

August 28, 2019

The money was so good in the beginning, and it seemed it might gush forever, right through tiny country hospitals in Missouri, Oklahoma, Tennessee and into the coffers of companies controlled by Jorge A. Perez, his family, and business partners.

It was his “secret sauce,” the rotund Miami entrepreneur would smilingly tell people in their no-stoplight towns. The money-making ventures he proposed sounded complicated, sure, but he said they would bring …

Don’t make me choose between motherhood and my career

Anonymous

Physician

August 22, 2019

A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.

The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.

For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …

4 actionable tips for new medical interns

Liang Chen, MD

Physician

August 17, 2019

People often compare internship to drinking from a fire hose. Overwhelmed by new information and workflow, interns (especially international) usually do not have a clear direction about how to optimize their working/learning experience. Here are some tips for interns to smooth their transition from a newbie into a high-functioning intern in the setting of medicine inpatient wards.

Success leaves clues

Don’t explore yourself, specifically ask your upper-level resident about the most productive …

Becoming a doctor in India can be life-threatening

Dr. Saurabh Jha

Education

August 12, 2019

Recently, my niece gingerly confided that she was going to study engineering rather than medicine. I was certain she’d become a doctor – so deep was her love for biology and her deference to our family tradition. But she calculated, as would anyone with common sense, that with an engineering degree and an MBA, she’d be working for a multinational company making a comfortable income by twenty-eight. If she stuck …

White coats should no longer be worn by physicians

Frederick Gandolfo, MD

Physician

August 6, 2019

Did you know that the traditional doctor’s white coat that you probably associate with your physician actually was a look that doctors “borrowed” from another profession? Back in the early days of doctoring, to add some perceived legitimacy to the title physician, the white coat look was adopted from our colleagues in the hard sciences who did actual experiments in the lab. If you recall, what we doctors call a “white …

Who are the best educators for medical students?

Kunal Shetty

Education

August 6, 2019

I shared my assessment and plan with the preceptor as she walked into the room. She cut me off, “You think this patient needs surgery?” she smirked. “He has no idea what he is talking about, don’t mind him,” she whispered loudly to the patient. I kept quiet until the patient left, and my preceptor began writing her note. I pulled up a recent research article I had found prior …

A critical discussion is needed about planned death

Tom Schaaf, MD and Hope Wechkin, MD

Conditions

August 4, 2019

“Planned death.”

When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.

When necessary, we prognosticate. But …

What The Big Sick says about our profession

Lindsay Ripley, MD

Physician

August 3, 2019

“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but …

Roundsmanship: the skill you didn’t know you needed

Shannon Casey, PA-C

Physician

August 3, 2019

“What’s the most common missed fracture?” my supervising PA asked during my clinical rotation in the emergency department. “The second one,” I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions.

Unfortunately, I didn’t always know …

When should physicians read the House of God?

Paul Sax, MD

Physician

August 2, 2019

Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results.

The survival strategies of the interns in …

How physicians become medical narcissists

Shannon Casey, PA-C

Physician

July 30, 2019

It is no secret that health care providers shoulder a lot of responsibility. As a whole, they take this on with both competence and kindness. Sacrificially, they go above and beyond in order to provide patients with the highest of quality care. They juggle a multitude of professional and personal responsibilities in creative and admirable ways. Meanwhile, each health care provider learns to adopt a unique combination of coping mechanisms …

Are pediatric hospitals ready to embrace value-based payment models?

Johanna Vidal Phelan, MD, MBA

Policy

July 30, 2019

Although pediatric (children’s) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery.

The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children’s hospitals “are the backbone …

5 powerful words you can say to patients

Suneel Dhand, MD

Physician

July 28, 2019

Our job as health care professionals is not just to diagnose our patients by applying our scientific knowledge and clinical skills, but also to be the “communicator-in-chief,” “listener-in-chief,” and “reassurer-in-chief.”

Any doctor who doesn’t fully grasp this, is not doing the best job they can or being the best doctor they can be. I truly believe that over 90 percent of our everyday job as a physician involves being a good …

The disaster at Hahnemann University Hospital

Karen S. Sibert, MD

Physician

July 26, 2019

Though the news at first stayed local in Philadelphia and the northeast, it’s gaining traction nationwide. ZDoggMD is on it. Bernie Sanders held a rally.

What happened? The venerable Hahnemann University Hospital, the main teaching hospital for Drexel University College of Medicine in Philadelphia, is bankrupt and will soon close its doors after more than 170 years as a safety-net hospital serving inner-city patients.

Why should we care? After all, there …

5 things I learned from being a “high-maintenance” patient

Dhaval Desai, MD

Physician

July 25, 2019

Physicians and health care providers across the world are trained to treat disease processes and disease states. Often, this approach becomes technical. And while directed towards the patient, it paradoxically distances itself from the patient. The distance created between the patient and the physician through diagnostic and therapeutic approaches is related to the patient’s dissatisfaction with their medical journey.

Being sick and ill, whether it is a major or minor illness, …