A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.
Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …
Hospitals taking over private practices
I just finished another inpatient service stretch at our community hospital with some great cases and lots of good medicine. While attending rounds may have changed a lot in the last 40 years as highlighted in a recent Annals of Internal Medicine article, some things have not changed – the focus on medical student presentations during attending rounds.
Students spend hours through their call nights preparing for …
How medical students should present patients to their attendings
Abdominal pain is the bane of many emergency physicians.
Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.
In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …
When in the ER with abdominal pain, adjust your expectations
I was sitting on one of the hospital’s nursing units having a difficult telephone conversation. Anyone working nearby could have easily discerned the situation from my end of the call.
Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.
Having never had to make such a decision in my own life, I am left to imagine how …
Kind and thoughtful words from a fellow physician colleague
How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.
Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …
Intubating the combative patient
My mom doesn’t take any diabetes medicine. She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.
A few months ago, she had to be hospitalized for what she calls a “minor procedure.” The procedure went fine, but not the food. The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …
Hospital meals make it difficult to control blood sugars
Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.
And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …
The cost of keeping the terminally ill alive
I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …
Stercoral perforation as a deadly cause of colon rupture
It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.
According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …
Priapism is indicative of spinal cord injury in trauma
by Lyle Denniston
Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …
When does the duty to provide emergency medical care end?
by Winston F. Mitchell
I’m a 53 year-old male with no history of hypertension, no cholesterol problems and glucose count normal.
I was overweight but still in great physical shape. But over a period of weeks, walking to work, I started experiencing a shortness of breath. Finally I went to my doctor, he informed me he was going to admit me to the hospital immediately because a …
10 things you need to know before surgery and during the hospital stay
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.
We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …
Should CRNAs practice anesthesiology without physician supervision?
Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.
Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the …
Hospitalist: Long hospital stays are often due to poor planning
by Dennis Grace
So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.
Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big …
An advocate for patients might save your life in the hospital
At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.
Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …
Stop calling doctors fleas and teaching professionalism
A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.
His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news — a loved one going into a war zone. But, to me, 8-months …
Practicing medicine as a single parent requires finding balance
by Felasfa Wodajo, MD
Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians.
The summary of the …
Apple’s iPad on medical rounds, a hands on physician review
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.
The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.
These rewards (increasing salary, bonuses, …
Greed is not good when it comes to doctors, patients and medicine
At a recent meeting I attended, a vigorous discussion broke out about what medical students, residents and attendings should wear, and more importantly what they should not wear.
Interestingly, patients have been asked to weigh in on this discussion. What to wear is also on the mind of many current second year medical students who may find themselves trying to take study breaks from USMLE 1 to go buy …
What residents and medical students should wear in the hospital
One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).
At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires …
How to implement CPOE successfully at your hospital
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