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.
Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.
Even for people who’ve never struggled with drug abuse, studies …
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Stop opioid addiction where it starts: in the hospital
Let me say first that any woman who has ever been harassed or assaulted should never be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can be toxic.
I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve …
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How to avoid #MeToo in medicine
These are tumultuous times for practicing physicians. The health care landscape is changing at breathtaking pace and less and less of our time is spent doing what we were actually trained to do: taking care of patients. I absolutely love the patient care part of my job, do everything possible to always remember why I went to medical school in the first place, and maintain focus on the aspects of …
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10 steps to keep physicians sane
In the early 1960s, President John F. Kennedy said, “The time to repair the roof is when the sun is shining.” It was a clarion call, a full-throated warning against national complacency in an era of great prosperity.
It was during this same period that community hospitals stood as the dominant force in American health care. By the mid-20th century, some 6,000 inpatient facilities had spread throughout the country, often serving …
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Why hospital mergers are destined to fail
On September 1, 2017, four children and their grandparents drowned while their uncle was trying to drive them to safety. Their van was swept off the road by rushing floodwaters. The uncle was able to escape through a half-open window as the van sank headfirst into the bayou. As the van sank, he could hear the four children screaming and crying. Two days later, the van was found, with all …
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A lesson from Hurricane Harvey: Compassion has meaning
“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson
If you are a practicing physician, you need rest.
Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the …
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If you are a practicing physician, you need rest
The frontlines of health care have been transformed over the last decade as electronic medical records have been rolled out across America. Unfortunately, information technology has yet to live up to its immense promise in health care — a topic that I frequently write about. As somebody who has worked with every single major EHR on my travels, I am being brutally honest when I say not a single one …
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5 ways poorly thought out health IT can worsen patient safety
In 2017, more women than men were accepted into medical school for the first time. 2017 also brought attention to the sexual harassment many women face that often goes ignored. Medicine is not immune to behavior that objectifies women and ignores their complaints. My experiences are mild in comparison to many of my peers, but highlights the comfort both patients and physicians feel discussing the appearance of female trainees.
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I was …
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Please show more interest in your health than my looks
I am very resistant to burnout solutions that focus solely on the individual, as these seem to imply that the problem originates in the affected person. This approach pokes at a sore spot, because of the years I spent secretly worried that the reason I left practice was personal weakness or inadequacy, something I lacked or failed to do.
When in 2013, I ran across the research on burnout, I learned …
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Physician burnout is caused by systems problems. Here’s how to fix that.
For several years, Medicare has tied hospital reimbursement to its definition of quality of care. Poorly performing hospitals can be penalized as much as 2% of their Medicare payments.
As part of Medicare’s assessment of quality, surveys are used to measure patient experience and satisfaction. One of the components of the Medicare survey is pain management, which Medicare describes as follows:
I’m not sure who, if anyone, …
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Patient satisfaction surveys are worthless. Here’s why.
It was a typical weekend on call. The usual number of surgeries, ER calls and consults. I was called to consult on 47-year-old female who had been admitted with four days of left shoulder pain. She had gone through a cardiac workup and was cleared by her internist. So now, a consult was called to see if there was an orthopedic cause for the patient’s pain — not an uncommon …
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A patient accused this doctor of sexual harassment
In my travels up and down the East Coast, I have been fortunate enough to work with some fantastic nurses. From what I hear, there was much more of an authoritarian relationship between doctors and nurses a few decades ago — preceding the time I entered the medical profession. This has now morphed into much more of a collegial teamwork approach, as we battle to get our patients better at …
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Dear hospital administrators: Please value your amazing nurses
Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaires’ disease spreading through its HVAC system or cryptosporidium in its water supply?
When there is an unusual smell associated with headaches and nausea in a surgical unit or emergency department, do people continue to work there and show up for their next shift as though this is status quo?
Of course not.
Why is it …
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Why do health care CEOs permit toxic workplaces?
“Wow, cool case,” was the response from the residents in continuity clinic on Monday morning as I told them about a patient I had seen over the weekend at our main campus urgent care. Ironically, or maybe more tellingly, I thought the same thing; “that was a cool case.”
The “cool case” was a senior in high school who was eagerly looking forward to her college career but woke up with …
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The patients behind the cool cases
How excited would you be about a medication that lowered your risk of cardiovascular death, heart attack or stroke by 1.5%? Excited enough to spend a few thousand dollars a year on the drug? I expect not.
What if, instead, the drug reduced those same terrible outcomes by 20%? That’s probably enough benefit to interest some in the drug.
Well, those statistics come from the same clinical trial, evaluating the same drug. …
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Relative risk reduction is a troublesome way to convey the benefits of treatments
Many of the everyday coalface problems we face in health care are simply due to suboptimal communication. It could be the patient or family member who doesn’t know what’s going on in the hospital, the nurse who is confused about orders, or the doctor who doesn’t understand the reasoning behind the seemingly terrible administrative directive they are receiving.
Take it from me, as someone who has seen health care at close …
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Why is health communication so poor? Here are 5 reasons why.
It’s been 21 years since Drs. Robert Wachter and Lee Goldman, in an article in the New England Journal of Medicine, first described a new delivery model called “hospitalists” – clinicians whose primary professional focus is the care of hospitalized patients. Since that time the healthcare system has seen rapid growth of hospitalist programs across a variety of specialties.
In the OB world, I have had the opportunity to …
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Collaboration with hospitalists, rather than competition, improves patient care
Practicing medicine with all of its responsibilities often reminds me of a black hole. It seems each time something new is added it gets pushed into the vast vortex of the black hole, hidden from those around you and jumbled with everything you are expected to do.
People around you see the world as you present it. They rarely get a glimpse through the pinhole to the expansiveness that is beyond …
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5 ways to get out of the physician burnout black hole
