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.
Periodically we should reflect on what challenges face patients and physicians. Over the past few days, I have worked on a list of the issues that concern me the most. I welcome suggestions for expanding the list.
1. Diagnostic errors. All patient care requires that we make the proper diagnosis. Too often we make errors. A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis. A similar …
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These are the biggest medical issues of 2017
He struggled to hear when people talked to him. He asked the same questions over and over. He fell asleep when really important conversations were going on around him.
But it wasn’t until he missed an emergency call that I knew I had to act.
I spoke to a higher-up about this elderly doctor out of concern for patient …
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Reporting an elderly doctor. And suffering from snitch guilt.
A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared.
This article, part two of a series that began with a look at primary care disruption, examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, health care’s rising …
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Hospitals are struggling and the future is grim
Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people. Many Americans have suffered and died because of a broken health-care-delivery system. One of us lost a 19-year old son due to lack of certain patient rights – specifically the right to evidence-based medicine and the right to a complete discharge plan from his hospital. …
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Got real rights? Not when seeking health care.
Interview season is upon us, and with the excitement of those dings from ERAS comes twenty tons of added stresses. Being in the new age of lightning speed communication via phones, tablets, laptops, etc., we no longer have use for invitations via snail mail. For obvious reasons, this makes for a much more effective process. However, giving thousands of high-strung Type A applicants the ability to respond to an invite …
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There’s a problem with ERAS
Recently, I was challenged by the mother of a trauma patient. She had read about traumatic spleen injuries online and was concerned about the risk a hematoma presented and wanted the ultrasound to look at the hematoma. I found myself floundering around trying to explain how this study was unnecessary. In frustration, I turned to my nurse practitioner and said, “Heather, can you translate for me?”
This is a common problem. …
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Maybe the reason patients don’t understand us is because we don’t speak in plain English
Why do we want to become doctors? What was our main motivation that we have written in our motivation letters and repeated in our interviews? Regardless of the specific incident or the general motivation, it can be all summarized in one sentence: We are here to save lives. After all, this is what the physicians do, isn’t it?
Preventing deaths is actually hinted to by the original Hippocratic Oath, written between …
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We need to accept our failure as doctors
Here’s some advice for your career in health care: Leave the country as soon as possible.
This has nothing to do with the president’s attempts to euthanize the Affordable Care Act. Or with EMRs, Medicare reimbursements, or the burnout surveys you get from your employer, who also sends emails aimed at getting you to work faster and more efficiently.
It’s none of that. You need to leave the country, just for a …
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Do yourself a favor: Leave the country and see how health care is abroad
Giving birth and running a marathon. They are two seemingly different entities but have many similarities. The inevitable pain, the highs, the lows, the feeling that you may falter or can’t survive the pain and, in the midst of it all, that you will never do it again … but then you do.
Marathons take months to train for by growing your strength and endurance as you increase your training miles. …
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Giving birth is like running a marathon
The hospital I work in used to have posters hanging up, describing patients’ rights. The right to have their medical care explained to them, the right to refuse treatment, the right to be treated courteously and the right emergency care regardless of the circumstances.
These posters are no longer displayed, but the concept hasn’t gone away. The health care team I work with makes every effort to treat people fairly and …
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Patients’ rights? What about the nurses’ rights?
Do you know we have record rates of physician burnout, dissatisfaction, and suicide? Ongoing shortages in primary care, without improvement in sight? Physicians exiting medicine earlier than in the past?
What about burnout? Do you know it affects patients as well as their doctors? Affects physicians’ families and friends? Increases mistakes and malpractice risk? Affects patient adherence and outcomes? Is costly to the entire system?
How do we start to fix this? …
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Physician wellness at the personal, institutional, and cultural levels
In the movie Malice, Alec Baldwin plays Dr. Jed Hill, a surgeon who gives a famous speech during a deposition in a medical malpractice case. “”If you’re looking for God, he was in operating room #2 on November 17th, and he doesn’t like to be second-guessed … I am God.”
No one wants a doctor like that. And yet, maybe we do. We yearn for someone capable of healing all of our …
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It’s time for medicine to share its power
The practice of medicine is a lot like the practice of parenting. It is full of highs and lows, moments of pure joy and those of devastating heartache.
When I talk to my friends who are parents, they agree with me. Some of the most difficult times as a parent is watching your kids fail. When your child is hurting, it hurts far worse than if you had experienced it first …
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The practice of medicine is a lot like parenting
After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.” Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”
After it’s told to you over and over again by your male co-residents and even some of my …
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Physicians: Be nice to your pregnant colleagues
Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.”
We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain …
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What man’s best friend taught me during a patient’s death
It is not enough to know that a patient’s medical condition warrants an MRI. For most insurance companies, a diagnostic test of this sort requires what is known as a prior-authorization. But, the doctor saying the patient needs this test often fails. The insurance company has a certain guideline the patient must travel first before they will consider the test.
For example, a patient with back pain and numbness in one …
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How can patients navigate our complicated health care system?
To accomplish certain tasks, we need a little help from our friends. No one can do it all, although many of us are more resourceful than others. Some folks are adventurous and dive into a new arena with excitement. They may be tinkerers who aren’t afraid to play with new gadgets. Sure, they might break some china, but they are apt to widen their skill set and enrich their lives. …
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The rise of patient navigators is a sign that medical billing needs to be reformed
T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native …
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The patients that make you realize that we are part of a larger human family
When I walked into the hospital room with my team to meet him for the first time, what struck me was how young he looked. He was listed as 26 years old, but he looked younger than that. He looked so young that it was hard to believe he had served a tour in Iraq a few years prior, or that he likely saw things there that no one would …
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Veterans deserve our full attention
In loving memory of my grandfather, my first physician mentor.
Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …
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We all treat the whole patient. We must avoid tunnel vision at all costs.
