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.
Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …
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5 improvements needed to modernize the American hospital landscape
Consider a medical trainee, in the second year of her medical training, who has made it a point to always show up early to work no matter the situation. She often times stays beyond the end of her shift to help out either her co-residents or juniors. She is having a bad week and uncharacteristically shows up late for rounds in the ICU. As expected, she is castigated in front …
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We need to bring back the feel-good factor to medicine
Prior authorization — a utilization management (UM) process used by health insurance companies to determine coverage for a prescribed procedure, service, or medication — is now becoming a mandatory requirement by the vast majority of large insurance companies.
While prior authorizations are pursued at the front-end for almost all planned medical services, there has also been a steep increase in denial of payment for services at the inpatient level for both …
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The burden of prior authorizations and denials in health care
On the first day of 2019, the reality show Tidying Up debuted. The show features tidying expert Marie Kondo and is based on her international best-seller, The Life-Changing Magic of Tidying Up. The 200-page manifesto details her approach to decluttering homes: discard belongings that don’t “spark joy,” then organize what remains into carefully designated spaces. The philosophy took the self-improvement world by storm, prompting an influx of …
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How to KonMari your academic life
There’s a pivotal scene in the 2007 Pixar movie Ratatouille, in which the restaurant critic Anton Ego takes a first bite of the movie’s titular food. He is then whisked back to a moment in his childhood, during which his mom provides love and comfort through a helping of her homemade ratatouille. This scene is a homage to Marcel Proust’s seminal “Madeleine Episode,” as described In Search of Lost Time, published almost …
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The scents in the hospital are from diseases you’ll never forget
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Regardless of specialty, medical practice is challenging in today’s health care landscape.
Increasing demands related to workload and job inefficiencies, an ever-increasing administrative burden, the consuming nature of health information technology, and personal and professional values that often conflict with the expectations of the …
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Seeking mastery in medicine
One of the least motivating requests I received routinely as a new intern was something like, “… and can we make sure this is a discharge before noon?” I recall a particularly eager nursing manager surveying the resident teams on her unit to gauge our interest in arriving even earlier each morning (5 a.m., perhaps?) in order to prepare potential discharges before pre-rounding. We shared a nice laugh.
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The tension between hospital administrators and medical residents
It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had “slipped” out of his nose.
Subsequently, his morning labs were just as bad as they had been on …
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Is there a link between readmission and a hospital’s non-profit status?
“The hospital room was as cold as dead skin, the hallway crowded with lost souls and reeking of illness.”
― Raquel Cepeda, “Bird of Paradise: How I Became Latina”
Once upon a time, I met a young lady who wanted to be a doctor. I could see the naked determination and resolve in her eyes. Her older sister, who was a friend, asked her to talk to me about her dream.
I asked …
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Sometimes, medicine isn’t elegant
It’s that time of year when the weather outside is growing colder, the evenings seem to kick off way too early in the day, and the decorations around town remind all of us all of the fast-approaching holiday season.
But for many of us obstetricians, this can often translate into anxiety over how often we’ll be pulled away from long-scheduled holiday activities to rush to the hospital …
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There’s no place like labor and delivery for the holidays
There are many disparities in health care. Black mothers have a much higher rate of maternal death than do white women. All women are less likely to get guideline-advised cardiac care than do men. Among the many such examples, perhaps the hardest disparity to solve is that of the poorer access to health care faced by rural communities. People living in rural counties have higher death rates from cancer and …
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Can rural health care be saved?
Harvard Medical School student Chloe Li typically dressed in scrubs or an efficient, professional outfit as she went about learning to care for patients in the intense, year-long clerkship program where I teach.
For her capstone presentation on graduation day, though, she wore a cream-colored wrap-around dress of luscious silk, tasteful jewelry, and an up-do hairstyle. She had clearly put a lot of care into these preparations. She …
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The unintended consequences of #MeToo in medical education
I’ll admit it. I’m a medical-TV junkie, addicted to 21st-century doctor and hospital dramas (most of which are now streaming on Netflix and other services).
Although some physicians are bothered by sensationalized depictions of their profession, I appreciate these shows for what they deliver: equal parts entertainment and insight. On the one hand, medical dramas are made for our amusement. They’re theatrical escapes from reality, meant to be enjoyed from comforts …
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Doctors on TV: today vs. 20 years ago
I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”
I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …
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The first lesson in medical school: Say you’re sorry
Recently, at medical schools across the country, first-year students officially donned the physician’s traditional white coat for the first time.
The white coat ceremony is a powerful symbolic moment. It signifies that the students are moving beyond their identity as ordinary citizens and into their new identity as healers. The ceremony celebrates their idealism and their commitment to a life of caring for others. And, although they may not realize this, …
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Can humanism save medicine?
A quintessential art of communication is a well-written note. A decent note is one that is self-explanatory as you read. However, to read, you need to understand what is written, and decent handwriting is vital. Unfortunately, neat handwriting is something tough to find, especially when the writer is a doctor.
While doctors may be the smartest students in their class with gold medals around their necks, immaculate in appearance, polite in …
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Doctors: Don’t care about your handwriting? You should.
“It should be in my chart.”
I’m sure we have all heard this statement uttered with a subtle (or not so subtle) edge of frustration from our patients after asking a question such as “what medications do you take?” I find clinicians despise this comment because it is interpreted as (a) the patient is not making an attempt to recall his or her medical history, or (b) that the patient doesn’t …
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A case for computers at the bedside
In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …
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3 things every hospital should invest in
It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
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Don’t judge patients for researching their health issues
Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
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Don’t forget to manage your patients’ dignity
