During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.
Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …
As health reform sets in, hospitals are gearing up for many challenges. While some of these are new to the health industry, several are against the backdrop of old problems that have plagued us for decades. Speaking as a doctor who has worked in a number of different hospitals up and down the east coast, I would like to identify 5 of these that I believe are fairly universal.
1. Medication …
Who works at a hospital? (Again, just indulge me for now.)
Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical …
We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.
The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …
As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from …
If you had to pick a single metric to a measure a hospital, which would you choose?
Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …
Why aren’t people in hospitals more attentive to the needs of patients?
In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha …
I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”
This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …
If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?
It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.
Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …
Medical errors are a real problem. I won’t deny that.
It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …
A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …
An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.
According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”
And if that wasn’t bad enough, a “nursing attendant” took a photograph.
The patient, who said she had to quit her job …
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Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …
I recently saw an article about Vanderbilt University Medical Center’s nursing staff.
The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.
They …
In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha took his initial tumble, people went out of their way to …
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Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …
I’ve been traveling around the United States working as a locum tenens (in Latin, “place holder” – a more elegant name than “temp”) physician. We’ve all heard of traveling nurses, but more and more physicians are also “living la vida locums,” as it were. There are actually over 100 agencies who find/provide temporary physician coverage for hospitals who need to fill gaps in their full timers’ schedules. You can find out more about …
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In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?
Watching the implementations around me, …
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