Hospital medicine

5,188 articles · Since 2004

Articles, page 57

Taking off the training wheels and becoming a real doctor

April 12, 2018Apr 12, 2018

Working in a clinic as a medical student is the best of all worlds. We have the opportunity to expand our knowledge and skills by working with some incredible patients, all while knowing that we have the support and backup of our fully trained, expert attending physicians every step of the way. This apprenticeship type of system is absolutely essential to medical training, allowing us to get our feet underneath …

Health policy

A radical proposal to save America’s hospitals

Robert Pearl, MD

April 12, 2018Apr 12, 20187

Hospitals serve as the economic lifeblood of their communities. They are the second-largest source of private-sector jobs in the United States, employing 5.4 million Americans who, together, embrace a virtuous mission to heal and help others in need. And yet,…

And yet, every year, more and more of them are forced to shut their doors. With soaring costs, eroding margins and mounting pressure from competing providers, the American hospital industry is on life …

Physician voices

How physicians dress matters. Here’s why.

Suneel Dhand, MD

April 11, 2018Apr 11, 20186

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

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Physician voices

I experienced trauma working in Iraq. I see it now among America’s doctors.

Elizabeth Métraux

April 9, 2018Apr 9, 20187

I was on my honeymoon in Colombia when I first became aware of the true extent of my post-traumatic stress disorder. My husband and I were walking across a smooth, granite platform to take a closer look at a fountain in downtown Cartagena. As we neared the structure, mist from the fountain’s jets dampened the ground …

Physician voices

Why your physician wellness programs aren’t working

Kristi Grall, MD & Larry DeLuca, MD, EdD & Matthew Freeman, DNP, MPH

April 9, 2018Apr 9, 201815

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

Physician voices

Want a resilient organization? Address physician burnout now.

Diane W. Shannon, MD, MPH & David Brendel, MD, PhD

April 9, 2018Apr 9, 2018

Physician burnout rates hover around 50 percent, and the adverse consequences are serious. Burnout is associated with increased medical errors, suboptimal care, turnover and personal costs, including substance use, depression, and suicide. The financial cost to health care organizations is…

The financial cost to health care organizations is significant: replacing a physician is estimated to cost at least $500,000. Plus, physician turnover results in care disruption, patient access issues and lost revenue for hospitals to which the physician referred …

Physician voices

Is compassion a two-way street?

Carey Candrian, PhD

April 9, 2018Apr 9, 20182

I am an assistant professor of health communication. Since 2008, as a volunteer, educator and researcher, I have been active in hospice care. As many people know, hospice teams (nurses, social workers, doctors, chaplains, volunteers) help dying patients and their…

In November 2016, right before the presidential election, I started a project aimed at identifying the best practices in communicating …

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Is compassion a two-way street?

Health policy

Medicine could use more common sense

Leonard Zwelling, MD

April 6, 2018Apr 6, 2018

A hundred years ago, the practice of medicine was just that: the practice of professionals specially trained to alleviate suffering and heal the sick. Doctors had a fiduciary responsibility to put the needs of their patients before their own. A…

Flash forward.

Medicine is big business. Trillions of dollars are spent every year in the health care …

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Medicine could use more common sense

Physician voices

Physicians must learn to say no

Varun Verma, MD

April 4, 2018Apr 4, 20186

As a physician, is it acceptable to say no? After working as a hospital medicine physician across five different states and internationally, I’ve realized that saying no is actually imperative. Physicians are stretched thin, abused, demonized and expected to be superhuman when it comes to patient care. We secretly complain in online forums, we commiserate with other physicians in on-call rooms, sometimes we even seek mental health help, but rarely …

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Physicians must learn to say no

Medical education

A silent moment with a dying patient

Anonymous

April 2, 2018Apr 2, 2018

I used to work as a nurse in a medical-surgical floor a few years ago during the night shift. I met a patient that changed the way I look at and treat patients. This patient was in her 50s, and…

I used to work as a nurse in a medical-surgical floor a few years ago during the night shift. I met a patient that changed the way I look at and treat patients. This patient was in her 50s, and she was just diagnosed with metastasized lung cancer that was likely terminal. She had just found out that same day, and she was flooded with a million emotions. I worked …

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A silent moment with a dying patient

Patient voices

Care coordination is more than a T-shirt slogan

Bonnie Friedman

April 2, 2018Apr 2, 2018

A T-shirt advertised online reads, “Keep calm and let the patient care coordinator handle it.” The shirt must be popular, or maybe just a source of gallows humor, for those engaged in this noble pursuit. But the underlying question of…

But the underlying question of who is coordinating our medical care is a serious one. By one estimate, inadequate care coordination costs between $25 to $45 billion annually. For the individual patient with a chronic illness, …

Physician voices

5 things pathologists want other doctors to know

Collin O'Hara, MD

April 1, 2018Apr 1, 2018

1. Clinical history is important. What did you see when you took the biopsy? Was there a mass there? Does the patient have a history of malignancy? These are all important questions, and they help pathologists arrive at the most…

1. Clinical history is important. What did you see when you took the biopsy? Was there a mass there? Does the patient have a history of malignancy? These are all important questions, and they help pathologists arrive at the most accurate diagnosis possible. Rarely, the best we can give you is a differential, but the more clinical information given to us, the more likely we can narrow things down and pinpoint …

Physician voices

3 ways to better deal with negative interactions

Suneel Dhand, MD

April 1, 2018Apr 1, 20182

Following a recent article about 3 things we need to be teaching more to our students, I received some good and thoughtful correspondence. The part which seemed most interesting (for me as well to write) was about being more resilient.…

Following a recent article about 3 things we need to be teaching more to our students, I received some good and thoughtful correspondence.

The part which seemed most interesting (for me as well to write) was about being more resilient. I wanted to expand a bit more on this, since I know people may have questions about what I do myself, to be a more resilient person. …

Physician voices

The first time this doctor hated a patient. And what he did next.

Joshua Goldman, MD

March 31, 2018Mar 31, 20183

“Dr. WHAT?!” she spat. “Gold … man. Gold, like the precious metal, and, y’know — a man.” This carefully crafted response was curated and vetted by countless returned pages, and it rarely failed to produce a chuckle. The patient was…

“Dr. WHAT?!” she spat.

“Gold … man. Gold, like the precious metal, and, y’know — a man.” This carefully crafted response was curated and vetted by countless returned pages, and it rarely failed to produce a chuckle. The patient was not amused, and she referred to me, instead, with a disdainful, “Rosenberg.” Every day I re-introduced myself, and every day — “Rosenberg.”

This 36-year-old female admitted for road rash and multiple rib …

Physician voices

What should physicians look like? Should it matter?

Maria Yang, MD

March 28, 2018Mar 28, 201829

I don’t remember her name, but I do remember her light brown hair, the simple nose ring that looped out of her left nostril, and the calm and centered presence she had with patients. She came across as unassuming, professional, and caring. We were both in medical school, though she was two years behind me. I admired how she treated people.

I don’t remember his name, but I do remember that …

Health technology

Clinical plagiarism: the problem of copy and pasting in EMRs

Eric R. Gottlieb, MD

March 26, 2018Mar 26, 20186

It is all too common for a section in a progress note to look something like this: # Aspiration pneumonia: Continue vancomycin 1 g bid Continue Zosyn 3.325 g q6h Follow-up blood cultures Follow-up sputum cultures MRSA nares screen negative…

It is all too common for a section in a progress note to look something like this:

# Aspiration pneumonia:

Continue vancomycin 1 g bid

Continue Zosyn 3.325 g q6h

Follow-up blood cultures

Follow-up sputum cultures

MRSA nares screen negative

Blood cultures negative

Discontinue vancomycin

Yesterday, a version of this note (lines 1 to 5 to be precise) had my name on it. Today, it is signed by someone else. Read it …

Physician voices

Medicine isn’t a competition. It’s a team sport.

N. Bande Virgil, MD

March 25, 2018Mar 25, 2018

I love sports analogies. There is so much in competition and team play that mirrors the way departments work in many sectors of medicine. "There is no 'I' in 'team,'" as the adage says. Michael Jordan, for example, did not…

I love sports analogies. There is so much in competition and team play that mirrors the way departments work in many sectors of medicine. “There is no ‘I’ in ‘team,'” as the adage says. Michael Jordan, for example, did not win his championships in the NBA until he had fairly decent and dependable team of support around him. The stars in many sports cannot achieve the greatest height of success …

Physician voices

Sometimes death is not an option

Kevin Haselhorst, MD

March 23, 2018Mar 23, 2018

At 69, Bob appeared to be a broken man. He left the hospital the day before and returned to the emergency department (ED) because he wasn’t “acting right.” Bob became upset when a second injection to his abdomen burned, and…

After four years of receiving treatment for metastatic colon cancer, Bob had reached the breaking point of persecution, but …

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Sometimes death is not an option

Physician voices

5 ways to build a relationship with hospital administrators

Amy Baruch, MD

March 23, 2018Mar 23, 20184

My desire to write this piece stems from my recent realization that I wasted a good part of my early career in medicine. While I was happily working in my pathology “bubble,” I was completely oblivious to the great untapped potential I had to affect change not just within, but also outside of, my department. In an effort to encourage other physicians to find ways to make an impact, I …

Physician voices

The difficult conversations physicians have with patients

Uzma Khan, MD

March 21, 2018Mar 21, 20184

A 60-year-old lady came for follow-up after a recent stay in the hospital. She was diabetic — horribly uncontrolled — the result of which was that she had already been on dialysis for four years. She ended up in the emergency room with chest pain. Diabetic patients are at higher risk than the general population of having heart attacks.

She underwent studies to evaluate for blockages in her heart. The cardiologist …

Hospital medicine

Articles, page 57

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