Hospital-Based Medicine

Here’s what’s wrong with time-based billing in the hospital

Physician

April 17, 2018

Consider this hypothetical addendum to a hospital discharge summary:

”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact …

Push back on toxic behaviors from other doctors

Todd Rice, MD, MBA

Physician

April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

How physicians dress matters. Here’s why.

Suneel Dhand, MD

Physician

April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

Why your physician wellness programs aren’t working

Larry DeLuca, MD, EdD, Kristi Grall, MD, and Matthew Freeman, MPH, DNP

Physician

April 9, 2018

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

Physicians must learn to say no

Varun Verma, MD

Physician

April 4, 2018

As a physician, is it acceptable to say no? After working as a hospital medicine physician across five different states and internationally, I’ve realized that saying no is actually imperative. Physicians are stretched thin, abused, demonized and expected to be superhuman when it comes to patient care. We secretly complain in online forums, we commiserate with other physicians in on-call rooms, sometimes we even seek mental health help, but rarely …

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Physicians must learn to say no

5 things pathologists want other doctors to know

Collin O'Hara, MD

Physician

April 1, 2018

1. Clinical history is important. What did you see when you took the biopsy? Was there a mass there? Does the patient have a history of malignancy? These are all important questions, and they help pathologists arrive at the most accurate diagnosis possible. Rarely, the best we can give you is a differential, but the more clinical information given to us, the more likely we can narrow things down and pinpoint …

3 ways to better deal with negative interactions

Suneel Dhand, MD

Physician

April 1, 2018

Following a recent article about 3 things we need to be teaching more to our students, I received some good and thoughtful correspondence.

The part which seemed most interesting (for me as well to write) was about being more resilient. I wanted to expand a bit more on this, since I know people may have questions about what I do myself, to be a more resilient person. …

The first time this doctor hated a patient. And what he did next.

Joshua Goldman, MD

Physician

March 31, 2018

“Dr. WHAT?!” she spat.

“Gold … man. Gold, like the precious metal, and, y’know — a man.” This carefully crafted response was curated and vetted by countless returned pages, and it rarely failed to produce a chuckle. The patient was not amused, and she referred to me, instead, with a disdainful, “Rosenberg.” Every day I re-introduced myself, and every day — “Rosenberg.”

This 36-year-old female admitted for road rash and multiple rib …

What should physicians look like? Should it matter?

Maria Yang, MD

Physician

March 28, 2018

I don’t remember her name, but I do remember her light brown hair, the simple nose ring that looped out of her left nostril, and the calm and centered presence she had with patients. She came across as unassuming, professional, and caring. We were both in medical school, though she was two years behind me. I admired how she treated people.

I don’t remember his name, but I do remember that …

Clinical plagiarism: the problem of copy and pasting in EMRs

Eric R. Gottlieb, MD

Tech

March 26, 2018

It is all too common for a section in a progress note to look something like this:

# Aspiration pneumonia:

Continue vancomycin 1 g bid

Continue Zosyn 3.325 g q6h

Follow-up blood cultures

Follow-up sputum cultures

MRSA nares screen negative

Blood cultures negative

Discontinue vancomycin

Yesterday, a version of this note (lines 1 to 5 to be precise) had my name on it. Today, it is signed by someone else. Read it …

5 ways to build a relationship with hospital administrators

Amy Baruch, MD

Physician

March 23, 2018

My desire to write this piece stems from my recent realization that I wasted a good part of my early career in medicine. While I was happily working in my pathology “bubble,” I was completely oblivious to the great untapped potential I had to affect change not just within, but also outside of, my department. In an effort to encourage other physicians to find ways to make an impact, I …

The difficult conversations physicians have with patients

Uzma Khan, MD

Physician

March 21, 2018

A 60-year-old lady came for follow-up after a recent stay in the hospital. She was diabetic — horribly uncontrolled — the result of which was that she had already been on dialysis for four years. She ended up in the emergency room with chest pain. Diabetic patients are at higher risk than the general population of having heart attacks.

She underwent studies to evaluate for blockages in her heart. The cardiologist …

What do you do when your loved one becomes suddenly ill?

Natalie Santiago, MD

Physician

March 21, 2018

When someone you love who has always been healthy and a go-getter suddenly takes ill, it can be very scary and confusing for both of you. It can be particularly scary and confusing for your loved one. Your loved one, while healing, is also experiencing grief/loss, and not just over the loss of health. Even as adults, we can sometimes feel like bad things won’t ever happen to us. Feeling …

The public’s unrealistic expectations about CPR

Skeptical Scalpel, MD

Physician

March 19, 2018

A survey of 1,000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered: a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an …

Communication skills: a tale of 2 doctors

Suneel Dhand, MD

Physician

March 18, 2018

There are two doctors working at the local hospital. They are both around the same age, been in practice for several years, and in the same specialty.

Dr. Cooper grew up in Ohio and went to medical school in California, before moving to New York after his residency training. Dr. Steele grew up in Michigan, where he also went to medical school, before completing his residency in Florida, and then ending …

Intern year is still universally hard. Intern year is also universally great.

Grace Faith Chao, MD

Physician

March 17, 2018

4:00 p.m. Right on time.

I am walking down the street with my brother on his first visit to me in residency; I’m only two weeks in.

I turn to him: “Wait a second.”

I place my hand on the cement wall next to us, and I start to heave.

“Um … are you OK?”

“Yeah. No worries. My body’s just adjusting.”

I go on to describe how every day at 4 p.m. after a 24-hour …

The implicit biases of gender stereotypes in medicine

Jenny Hartsock, MD

Physician

March 15, 2018

I was lucky to be raised in a place and time where I have not had any significant barrier in my way because I am a woman. I have been allowed to make my own choices and pursue my own path in life. My gender never deterred me from achieving what I set out to do. Can you imagine being a woman a hundred or two hundred years ago or …

10 tips for surviving and thriving throughout your partner’s residency

Nashira Pearl

Education

March 13, 2018

Your partner’s residency is hard for you both, but it is possible to both survive and thrive throughout it! Finding happiness and success while your partner is in residency comes down to a handful of simple lessons, at least in theory if not in practice.

1. It’s your residency, too. It’s a simple but powerful departure point: residency is both your partner’s job and a significant period in your life together. Your …

A physician’s faith in God

Marissa Lombardo, MD

Physician

March 8, 2018

My testimony is quite an odd one, similar to my professional journey.

I came to believe in God on a medical mission trip in Honduras when I was about twenty-one years old. A staunch atheist at the time, I was interested in beefing up my medical school application. A local church donated thousands of dollars for my college group’s mission trip; I was stunned. I had never even attended church! Finally, …

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A physician’s faith in God

Do doctors see patients as machines?

Rajeev Kurapati, MD

Physician

March 7, 2018

An excerpt from Physician: How Science Transformed the Art of Medicine.

While working at a community hospital in the Midwest in the early 2000s, I came to know Walter Stephenson (name changed), who was under my medical care during a lengthy …

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Do doctors see patients as machines?