Hospital-Based Medicine

A patient that reminded me of the first man I ever witnessed dying

Conditions

April 24, 2019

He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats, to 40 beats, to that which is incompatible with life. The nurse pushed …

A nurse’s downfall was telling the truth

Debbie Moore-Black, RN

Conditions

April 21, 2019

These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.

I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into …

The powerful phrase that’s ruining medicine

Jackson B. Salvant, Jr., MD

Physician

April 20, 2019

Within the clinics, hospital corridors, and halls of medicine, a new phrase has emerged and taken hold of the practice of medicine. Whenever confronted with the challenging, inconvenient, undesirable, underinsured or maybe when just overwhelmed, health care personnel have begun to utter the phrase “I’m not comfortable with …”

Upon the utterance, all responsibility to the patient, institution or the honorable practice of medicine is immediately and completely discharged until the …

8 things to watch for if you, or a family member, is hospitalized

Suneel Dhand, MD

Physician

April 18, 2019

Hospitals are busy, hectic, and unpredictable places. Professionals who work in health care are highly trained and competent individuals, and if you are receiving acute care in America — the standard of your treatment and access to high-quality tests and an array of specialists, is unparalleled (take it from someone who has worked in different countries). Nevertheless, the hospital experience itself, despite our best efforts, often falls short. Here are …

Was she a doctor? Or was she a hack?

Dana Canfield, MD

Physician

April 14, 2019

Separating fact from fiction had once been her favorite activity. Going over research with a fine-toothed comb, she caught the inaccuracies that riddled popular culture like unruly strands of hair. It came down to this simple algorithm: there were things that could be proven and things that could not. In other words, there were things that would happen consistently given the same set of conditions, while other things were random. …

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Was she a doctor? Or was she a hack?

Appreciative and respectful of my privilege in caring for elderly patients

StorytellERdoc, MD

Physician

April 1, 2019

I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member.

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this …

A tragic Fentanyl story without redemption

Marcia Glass, MD

Physician

April 1, 2019

Matt was 40, my sister’s age. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler with a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on.

Matt’s best …

Fixing burnout among hospitalists is a leadership challenge

Rahulkumar Singh, MD

Physician

March 28, 2019

“Happiness is when what you think, what you say and what you do are in harmony.”
– Mahatma Gandhi

Burnout among physicians is at an epidemic proportion. National data suggests that more than 50 percent of our workforce is burned out, and this trend has been across the board from physicians in training to practicing physicians. Some of the specialties are more affected than others. Repercussions of provider burnout on health care …

Reminding ourselves why we practice medicine

Jasmine Toor, MD

Physician

March 25, 2019

Going to medical school was a dream come true. I was excited; I couldn’t wait. I spent my childhood dreaming about it. It was this amazing fantasy in my head where nothing was impossible, and I would be able to help thousands of people, maybe millions? Biology, physiology, chemistry, physics — they resonated with me. I could not imagine doing anything else. I loved meeting new people. I loved learning …

3 health tips to help busy physicians

Suneel Dhand, MD

Physician

March 18, 2019

Practicing medicine at the frontlines is hard. It’s damn hard. Every minute you need to be alert, ready to respond to a potential life or death situation, and be called to another important problem. The current medical practice environment — with excessive bureaucracy, suboptimal information technology, and extreme time pressure with patients — adds exponentially to the mix, and can make for a very stressful job. Make no mistake, even …

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3 health tips to help busy physicians

Health care workers and administrators aren’t rowing in the same direction

Benjamin Davison, RRT

Policy

March 11, 2019

My wife and I once canoed across a glacial lake. There were twelve people in our 30-foot canoe. To reach the shore of the Mendenhall Glacier, we had to paddle two miles across a lake. All twelve of us had to paddle together to reach the shore. But what if we had different goals? What if the right side of the canoe wanted to paddle east and the left side …

Communication in the hospital setting from a medical student perspective

Ton La, Jr., MD, JD

Conditions

March 11, 2019

When it comes to communication in the hospital setting, I have seen many iterations. My favorite version was at the VA on the inpatient medicine unit. Every morning, we all met in the medicine team room to discuss patients on the floor. The team’s social worker, nurses, residents, students, and the attending ran down the list to identify individual patient goals, what’s needed for safe and effective discharges home, and …

A medical student’s first code. Here’s what he learned.

Timothy S. Kelly

Education

March 8, 2019

Well, today it happened. I participated in my first code.

We were in the telemetry unit (the room where they monitor all the patients who have EKG strips) to ask about a different patient of mine only to find that a patient was coding (lost a life-sustaining heartbeat). With some coaxing from my attending, the other student and I wound our way through the around-20 people standing outside and inside of …

A paradigm shift in acute pain assessment and management

Myles Gart, MD

Meds

March 8, 2019

We have embarked upon a unique strategy to assess and manage pain. “Opioids Rarely Help Bodily Pain” is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first …

The most loving thing: end of life and saying goodbye

Jonathan Staloff, MD

Conditions

March 6, 2019

“Grandma fell and we’re in the emergency room. She’s very distressed and does not look good. I’m going to put the doctor on the phone.”

I could hear my mother’s voice strain on the other end of the phone line as I braced myself for my conversation with the emergency department physician.

The emergency physician told me that though the work-up was still developing, my grandmother was in respiratory distress, and that …

5 tips for interns tackling a busy schedule

Abeer Arain, MD, MPH

Physician

March 1, 2019

The rotations on adult medicine and critical care are probably the most challenging ones for the residents doing internal medicine residency. No matter how much we try, we tend to feel overwhelmed, fatigued and swamped sometimes. As we progress into residency, we not only gain knowledge and clinical skills but also learn to tackle the challenges of a busy schedule. Below are some of the tips that might be helpful.

1. …

Every physician will kill a patient

Michael Grzeskowiak, MD

Physician

February 26, 2019

How did I miss his hypokalemia? Two weeks into my intern year and my patient’s potassium returned at 2.9. Minutes later, he coded. And I felt responsible. As I explained to my partner how my patient had become pulseless after diuresis of his heart failure, she looked at me and said, “Physicians kill patients, it’s inevitable. Has no one told you it’s part of the job?”

There is truth to this …

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Every physician will kill a patient

How a medical student can help the team during clinical rotations

Ton La, Jr., MD, JD

Education

February 23, 2019

Based on my clinical experiences, there are ten pieces of advice I would give to any medical student starting their rotations that will maximize productivity and lead to a robust and thriving work environment (your interns will thank you).

1. Do as complete of a workup on your assigned patients as you can. Be thorough with your admission H&P. Think of all the tests, labs and imaging studies you want ordered. …

The hidden curriculum of medicine

Errin Weisman, DO

Education

February 13, 2019

Think all the way back to your grade school years. Did you know that your personality traits were starting to be honed for the work you do today? Let me give you some examples about myself and see if you can relate.

I remember the praise and exhilaration of being the only kid in the class to get a 100 percent on an extremely difficult second-grade spelling test. My teacher told …

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The hidden curriculum of medicine

Wonder why your hospital is full?

Steve M. Grant, MD

Physician

February 11, 2019

Why is your hospital always full? Actually, it’s more than full. You have twenty boarders in the ED. You turned your postop recovery unit into an overnight surge center. Every day administrators beg you to please, please discharge patients, if possible before 11 a.m. You’ve hired an army of case managers, dissected the discharge process, and held countless capacity management meetings, but you’re still bursting at the seams.

It wasn’t always …

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Wonder why your hospital is full?