Hospital medicine

5,188 articles · Since 2004

Articles, page 42

It is for these patients that the doctors at rural hospitals continue

March 19, 2019Mar 19, 20193

Rural hospitals are closing their obstetric wards and stopping all obstetric services — at least those hospitals that manage to remain open at all. The tertiary care centers don’t seem to mind. Always wary of those rural hospital disasters in the middle of the night. Accepting transfers from a place where they must not have the latest technology, clearly, your little hospital must be behind the times, only subspecialty care …

Physician voices

What’s happened to clinician empathy?

Austin Perlmutter, MD

March 19, 2019Mar 19, 20196

In 2006, the Mayo Clinic asked 192 patients an important question: What makes an ideal physician? From their responses, several characteristics emerged. Among the top criteria, they wanted doctors to be “personal,” “empathetic” and “humane.” This shouldn’t come as much…

Of course, we want doctors who relate to their patients as people instead of just another “case.” We want doctors to have sympathy for patients …

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What’s happened to clinician empathy?

Physician voices

3 health tips to help busy physicians

Suneel Dhand, MD

March 18, 2019Mar 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

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Medical education

The difference between learning medicine and doing medicine

Steven Zhang, MD

March 18, 2019Mar 18, 2019

Back when I was a third-year medical student, I would sometimes bike to the hospital campus early enough to catch the groundskeepers cleaning the promenade in front of the medical school before the foot traffic arrived. Discovery Walk, as it’s called, is a beautiful promenade with stone murals commemorating the significant discoveries made at Stanford. It’s a beautiful scene, especially during sunrise or sunset, which many of my classmates have …

Physician voices

What do the Challenger disaster and medicine have in common?

Shannon Casey, PA-C

March 15, 2019Mar 15, 2019

On January 28, 1986, the space shuttle Challenger disintegrated shortly after liftoff, resulting in the death of the entire seven-person crew. The subsequent investigation revealed that a joint in the right solid rocket booster failed during liftoff, which occurred due to the inadequacy of the O-ring seals. It was about 28-degrees on the morning of the space shuttle launch, and the O-ring seals were not designed to perform at such …

Physician voices

All corners of the world meet in the hospital

Julia Michie Bruckner, MD, MPH

March 14, 2019Mar 14, 2019

The pediatric emergency department’s fluorescent light cast its glow on our heads, drifting and drooping, at 3 a.m. Torn between taking a chance on rest and anticipating the next fever, headache, abdominal pain, wheezing or rash that came through the…

The pediatric emergency department’s fluorescent light cast its glow on our heads, drifting and drooping, at 3 a.m.

Torn between taking a chance on rest and anticipating the next fever, headache, abdominal pain, wheezing or rash that came through the doors, we sat suspended.

The nurses tried to stay awake with a parade of old cat videos and Kardashian memes, their Facebook feeds stale – no one really posts much at that …

Health policy

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

Benjamin Davison, RRT

March 11, 2019Mar 11, 20192

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 …

Conditions and diseases

Communication in the hospital setting from a medical student perspective

Ton La, Jr., MD, JD

March 11, 2019Mar 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 …

Medical education

The hidden curriculum of medical school can be overwhelming and unforgiving

Prerana Chatty, MD

March 10, 2019Mar 10, 20194

I met Mr. B during my week on the endocrine service of my internal medicine rotation. My attending told me we were being consulted for this patient’s high sugars and a foot ulcer, and asked me to take the history.…

I walked into Mr. B’s room and was immediately struck by its stench. Mr. B had undergone a resection of his bladder tumor the day before and as a result was …

Medical education

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

Timothy S. Kelly

March 8, 2019Mar 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…

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 …

Drugs and prescribing

A paradigm shift in acute pain assessment and management

Myles Gart, MD

March 8, 2019Mar 8, 20196

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.…

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 …

Conditions and diseases

The most loving thing: end of life and saying goodbye

Jonathan Staloff, MD

March 6, 2019Mar 6, 20192

“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…

“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 …

Medical education

Respect the duty to care for all patients equitably

Anonymous

March 5, 2019Mar 5, 2019

In my first year of medical school, I attended a lecture on health disparities that focused on the difference in patient outcomes based on race and socioeconomic status. The lecture cited multiple peer-reviewed studies that extensively demonstrated these disparities and how health care professionals, not solely social determinants of health, contribute to them. The lecture concluded with an appeal to improve our cultural awareness and acknowledge our conscious and unconscious …

Physician voices

5 tips for interns tackling a busy schedule

Abeer Arain, MD, MPH

March 1, 2019Mar 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. …

Physician voices

Sharing administrative pain might give us more joy in medicine

Walter J. O'Donnell, MD

February 28, 2019Feb 28, 20192

I’m still trying to figure out what happened. I don’t want to be put on suicide watch by the wellness office. It definitely began during our weekly noontime mindfulness session. I came in late, furtively signed in (gotta make that metric) and slipped into a back corner seat. I went zero to REM in 10 seconds, thanks to last night’s click-boarding my panel into their patient-centered medical i-homes.

I awoke to …

Medical education

This residency interview season: Be the rebel

Bryan Pardo, MD

February 28, 2019Feb 28, 2019

Ours is a chaotic and overburdened medical system. As a senior resident, there is every temptation to seek in our incoming classes more obedient interns and junior residents who would obey my orders as their senior without question. I challenge…

The explosive growth in the health care industry has seen a shift in priorities to traumatic, urgent and emergent care. And we see profits …

Physician voices

Every physician will kill a patient

Michael Grzeskowiak, MD

February 26, 2019Feb 26, 20192

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

Physician voices

A research attending starts his month on the wards

Jack Rubenstein, MD

February 26, 2019Feb 26, 2019

An excerpt from The Perfect Dose. Walking towards the clinical rotation to take care of patients after weeks in the research labs was never easy. The long hallway between the two buildings had an almost transformative effect on Mann as…

An excerpt from The Perfect Dose.

Walking towards the clinical rotation to take care of patients after weeks in the research labs was never easy. The long hallway between the two buildings had an almost transformative effect on Mann as he transitioned his persona to that of Dr. Mann. His clothing changed from jeans and V-neck …

Physician voices

It’s time to view hospitalization as a procedure

Steve M. Grant, MD

February 25, 2019Feb 25, 2019

I previously suggested that transitioning from the traditional inpatient care model to the hospitalist model inadvertently motivated providers to hospitalize more patients, specifically borderline sick patients. Our example was a 74-year-old woman with pneumonia whose path to admission met less resistance with a hospitalist at the helm. The question I posed at the end was this: model aside, should we admit that patient or not? What’s best …

Conditions and diseases

Turning a patient: a nurse’s act of duty and compassion

Justin Millan, RN

February 25, 2019Feb 25, 20199

I met a fellow nurse at a wedding recently who, upon hearing that I worked at a long-term acute care hospital (LTAC), shrugged his shoulders and said, "Oh, sure. A lot of turns." I shrugged, too. He had belittled my…

I met a fellow nurse at a wedding recently who, upon hearing that I worked at a long-term acute care hospital (LTAC), shrugged his shoulders and said, “Oh, sure. A lot of turns.”

I shrugged, too. He had belittled my work, but in a way, he was right. We do execute “a lot of turns” at my hospital. We complete at least one turn every 2 hours per patient. With an …

Hospital medicine

Articles, page 42

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