Hospital-Based Medicine

Does leaving against medical advice stick patients with a bill?

Physician

March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

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Why are labor and deliveries closing?

Vivian E. von Gruenigen, MD

Policy

February 18, 2012

Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to …

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Insider tips to surviving your hospital stay

Happy Hospitalist, MD

Physician

January 24, 2012

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.

10. Bring your own pillow. Trust me.

9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.

8. Bring an accurate and updated medication list …

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Why the family meeting is important

Jeffrey Alderman, MD

Physician

January 24, 2012

“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.

“I’m afraid so.” I replied.

“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.

We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown …

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How patients can remember their doctor’s name

Anthony Breu, MD

Physician

January 8, 2012

“Do you remember my name?”

Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.

My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”

In a busy teaching hospital, it is not uncommon …

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Requiring doctors to give orders on patients they have not seen

Steven Reznick, MD

Physician

January 4, 2012

To meet Federal patient satisfaction goals, our hospital administration is requiring community based physicians to give patient admission orders before we have a chance to see the patient. Patients who self-refer themselves to the emergency department, are evaluated by the emergency room staff, and who are determined to require admission must be admitted by their community physician within 20 minutes of receiving a call from the ER staff advising the …

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What kind of shoes should you wear in the hospital?

Mary L. Brandt, MD

Physician

January 1, 2012

I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.

What kind of shoes should you wear in the hospital?

There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide …

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Conflict between physician and nurse

Sarah Beth Cowherd, RN

Physician

December 19, 2011

When it comes to doctor- nurse interactions, when is enough, enough?

Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to …

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Young doctors don’t see value in primary care careers

John Schumann, MD

Physician

December 5, 2011

In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.

At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.

For those that don’t choose a subspecialty, one choice remains: traditional …

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Why do non-profit hospitals compete with each other?

Joe Ketcherside, MD

Policy

November 13, 2011

While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.

But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …

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Doctors are reluctant to have end of life conversations

Manoj Jain, MD, MPH

Physician

November 2, 2011

My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”

Another one of my patients, an …

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The problem with round the clock hospitalist coverage

Bradley Flansbaum, DO

Physician

October 21, 2011

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …

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Why radiology is the cornerstone of any hospital

Paul Dorio, MD

Physician

October 19, 2011

Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …

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Navigating the path of contradictory medical opinions

Ralph Gordon, MD

Conditions

August 24, 2011

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory …

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The secret in caring for the patient is to care for the patient

Jim deMaine, MD

Physician

July 24, 2011

Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik …

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The benefits of successful patient self-management programs

Mark Novotny, MD

Physician

July 22, 2011

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can …

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Advice to new interns from a nurse turned medical student

Albinoblackbear

Education

July 21, 2011

If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.

Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …

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Hospitalists should limit the number of patients they see

S. Irfan Ali, MD

Physician

June 21, 2011

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

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Doctors don’t take snow days

Anesthesioboist T., MD

Physician

June 12, 2011

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t …

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