Hospital Medicine

Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

What’s love got to do with it: lessons from a dying physician

Charles A. Odonkor, MD

Physician

February 14, 2018

They came from all corners of the globe to bid him farewell. He looked cachectic, his frail form interrupted by swelling in his abdomen and legs, a result of end-stage pancreatic cancer. It was Dr. Yeat’s last week in the hospital before being transferred to a nearby hospice. He was now on morphine, and despite severe fatigue and difficulty breathing, he always managed a smile.

Some of his visitors were former …

In defense of FOX’s The Resident

Rohin Francis, MD

Physician

February 13, 2018

The public’s apparently insatiable appetite for medical drama continues unabated as yet another prime-time TV show set in a hospital has hit our screens. FOX’s The Resident has generated discussion like no other. This may simply be due to the fact it’s the first major launch in the era of widespread social media, but it seems to have enraged a vast swathe of our ranks. Has The Resident crossed a …

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In defense of FOX’s The Resident

A system to identify doctors who’ve been working too many hours

Valerie A. Jones, MD

Physician

February 12, 2018

My shift had finally ended. As a second-year resident, I was driving home after 30 hours awake straight. The busy call included delivering several babies, two Cesarean sections, circumcisions, rounding, triaging new patients, and teaching medical students. Never during that 30 hours was a 5-minute nap possible; clinical load would not permit this.

I couldn’t wait to get home at the end of the shift as I was completely exhausted. So, …

Is residency an exercise in futility?

Brian Radvansky, MD

Physician

February 12, 2018

It was Saturday. My first day off in the last 14, which included three 26-hour calls. My wife was left home alone for these stretches to care for our 2-week-old son. I’m sitting on the couch, reading a book to my little man, enjoying a much-needed breather, and making up for lost time in seeing him grow into a person.

And the phone rings. Concurrent emergent cardiac surgeries: the only way that …

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Is residency an exercise in futility?

The way we treat young doctors is barbaric

David Penner

Health Policy

February 12, 2018

The exploitation and bullying of medical students and residents can only be meaningfully understood in the broader historical context of the New Deal’s dismantling and the destruction of the middle class that has followed in its wake. Moreover, it is fallacious to look at this inhumane treatment as something that happens only within the confines of the medical profession. For these exploitative working conditions have in fact become the norm …

The huge impact a dying infant had on this physician

Brian Han, MD

Physician

February 11, 2018

Lines are slowly being taken out of the small infant, his bruised and discolored arms continuing to ooze. Machines and circuits, one by one, are being shut up and turned off. Leads and wires are carefully taken off of the lifeless chest of the once critically ill, but alive infant. Just hours ago, physicians, nurses, and other providers were rushing in and out of the room, desperately doing everything they …

Think twice before you give a hug

Rabbi Chaya Gusfield, BCC

Conditions and Diseases

February 10, 2018

I’m usually a hugger. When I see people I haven’t seen for a while or want to acknowledge someone in an open-hearted way, I often will automatically reach for a hug. Physical acknowledgment is usually perceived as a sign of warmth. But not always. In the last few years, I have noticed that this automatic hug can actually cause harm or insult even though my intent is not to.

I learned …

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Think twice before you give a hug

Lifelong lessons from a medical student’s first rotation

Ezinwanneamaka Morayo Ejiofor

Medical Education

February 10, 2018

“How long have you been doing this?” he asked, eyes gleaming with admiration. I was unsure whether he was asking how long I had been conducting patient interviews or how long I had been a medical student. I decided on the latter.

“2 years,” I replied with a confident smile across my chin.

“Well, you’re very good!”

“Thank you,” I replied, almost a whisper. It was a compliment that I was definitely not …

Learn to see beauty in death

Jo Ann Gates, MD

Physician

February 9, 2018

We physicians stand witness to countless tragedies in our careers.

At some point, as we stand by the bedside of a dying patient, comfort a heartbroken relative or officially call a death. We learn that love and loss, sorrow and joy are intertwined. They depend upon each other. They are two sides of the same coin. Dealing with loss after loss, we learn to look for the beauty in all of …

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Learn to see beauty in death

All’s fair in love and medical school

Jennifer Udom

Medical Education

February 8, 2018

The third and fourth year of medical school are ridiculously difficult, but not for the reasons you think. Culture matters. Everyone and every specialty is distinct and it’s on you to effortlessly navigate all of the people and their respective idiosyncrasies. Although people are all individuals, each specialty seems to have their own overarching spirit.

For example: surgery.

Surgeons do not respond well to the bleeding heart types. Instead of complaining on …

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All’s fair in love and medical school

Is “doing everything we can” at the end of life doing too much?

Jason J. Han, MD

Physician

February 8, 2018

In his soulful book, How We Die: Reflections on Life’s Final Chapter, the late surgeon and author Sherwin Nuland describes one of his patient encounters as a medical student. The patient, a 50-year-old man, presented to the hospital after a heart attack.

A few hours later, the patient suddenly collapsed pulseless and unconscious.

Training in an era when there was no defibrillator or CPR, the author notes:

For reasons I cannot explain to …

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Is “doing everything we can” at the end of life doing too much?

The unintended effects of physician side hustles

Millennial Doctor, MD

Physician

February 7, 2018

A movement is growing in the underbelly of the internet.

On Facebook, a group called Physician Side Gigs has over 11,000 physician members trading tips and words of encouragement with other doctors looking to supplement their clinical careers via side hustles. Physician on Fire and the White Coat Investor are encouraging doctors to achieve financial independence in order to relieve ourselves …

Sailors, surgeons, scheduling: the deadly consequences of fatigue

Suvas Vajracharya, PhD

Physician

February 7, 2018

Sailors are now the latest profession, along with truck drivers and airline pilots, taking the dangers of fatigue and the need for balanced shift schedules seriously. When will medicine finally catch up?

Recently, Navy officials sat down in front of Congress and talked about tiredness. With a $171.5 billion annual budget and some of the most sophisticated military technologies in the world, it is increasingly looking like human …

How hospitals can impact generic drug companies

Mark Kelley, MD

Medications

February 6, 2018

The costs of many generic drugs have skyrocketed. In some cases, the price of a single pill has increased over 500 percent.

But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.

Why has the price of generics skyrocketed?

Some large drug companies have purchased …

How racism affects this physician

Ameet Nagpal, MD

Physician

February 5, 2018

I was fortunate enough to be able to go to my friend’s wedding in Indianapolis in October. My three-year-old son called it “India with Apples.” This is a friend that I’ve known since I was in first grade, and my parents and his parents are good friends. We were at the Friday night celebration and enjoying ourselves and decided to walk back to our hotel. We made it to the …

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How racism affects this physician

What to do when a patient wants to leave the hospital against medical advice

Robert Donnell, MD

Physician

February 5, 2018

There’s an interesting article in the Journal of Hospital Medicine on what to do when a patient wants to leave the hospital against medical advice. After reading and rereading it, I had to disagree with the conclusion, but it took me a bit to get there because the article, with its confusing use of terms, is a masterpiece of obfuscation. The most obvious example is the oxymoronic use of the term “AMA …

Let academic physicians recover more of their clinical revenue. Here’s why.

Cory Michael, MD

Physician

February 2, 2018

I spent considerable time after college working in academic labs being indoctrinated with the theory that publication is the currency of academic value and that researchers should always want to have their work printed in the journal most cited by other journals. You are supposed to be impressed when somebody claims that he or she is from a highly ranked university or institution, as these well-regarded institutions are synonymous with high achievement.

That all changed for me during residency when I met …

It’s important to proactively manage your resident progress. Here’s how.

Todd Rice, MD, MBA

Physician

January 31, 2018

Physician training is an extremely high stakes business, not only for the patients that will be under the care of the eventual independent, fully-trained, board-certified doctor, but for the trainee herself. The financial and time costs of the entire training process are enormous. To become derailed from the board certification path can have significant and permanent career consequences. With so much at stake, what does a resident do when she …

Medical education systematically ignores the diversity of medical practice

Rebekah Fenton, MD

Medical Education

January 30, 2018

I remember the moment I first saw a female chest X-ray. It was my own. My lecturers in the first months of medical school showed a few chest films, but I failed to recognize that the bodies all looked the same. I proudly showed my sister my clear lungs. She laughed and said, “I can see your boobs.” I looked again at mine with new eyes, taking in the dull, …

How my skepticism brought about a culture change in how our residency functions

Michael Alpert, MD

Medical Education

January 30, 2018

“No one can know what you’re doing here.”

The resident across the table from me made this clear the moment we sat down. We were in her hospital’s cafeteria, talking discreetly at her request with the union coordinator. In an effort to generate more revenue for the hospital, her already substantial call duties had been increased yet again, leaving less time to spend with each patient with no discernible educational benefit. …

Hospital Medicine

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