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.
Throughout training, I had an idea. And that idea was — I would be a great academic physician. I had the right training. I had done research from college through fellowship. I had received research grants from medical school through fellowship, published numerous papers and started defining a niche. Everything was going great.
Academia — here I come!
Then attending-hood arrived. I looked for positions in academic centers. I was limited by …
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Better care: Private practice or academic center?
I imagined it like a scene from the hit television show “House, MD,” only I had no “MD” after my name, and my striking discovery had come not from the accumulated wisdom of years of experience but from a whopping five hours scouring the internet. In my exhilaration, I was perhaps a bit delusional, for I was convinced I had single-handedly cracked a mystery case that had left an entire …
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As (not) seen on TV
Illness is a disappointing and frustrating time. Nothing could be worse than a sickness which suddenly jolts you out of your daily routine, and forces you to confront a harsh new reality. That’s something that physicians should always remember as they go about their hectic work days. Doctors see patients at extremely low points in their lives.
The vast majority of physicians, and indeed all other health care professionals, are among …
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You’re disappointed with your health care. Here are 5 reasons why.
The medicine model has changed since our predecessors practiced medicine in the days of Dr. William Osler. These days, medicine is a commercialized industry. The hospital makes this clear by prioritizing charting and patient satisfaction over patient care. Also, patients are accountable for making it feel this way. Some patients want to dictate their care completely, like making an order at Burger King. Physicians are encouraged to please patients, because …
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Imagining a world where Amazon runs hospitals
I scream in frustration as the flickering screen creates another required check box. Silently of course. I am on the hospital ward, and broadcasting the doctor’s frustration will not help patients or nurses. “Who created this tool?” I wonder for the thousandth time. Why don’t doctors make their own tools?
Contemporary philosopher Daniel Dennett ponders thinking tools. “Like all artisans, a blacksmith needs tools, but — …
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Doctors, we need to start making our own tools
Of course, it matters a lot — hospitals vary enormously on quality of care, and choosing the right hospital can mean the difference between life and death. The problem is that it’s hard for most people to know how to choose. Useful data on patient outcomes remain hard to find, and even though Medicare provides data on patient mortality for select conditions on their Hospital Compare …
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How much does it matter which hospital you go to?
It’s common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.
The Sacramento-based health system deleted the button physicians used to order daily blood tests. “We took it out and couldn’t wait to see the data,” said Ann Marie Giusto, a Sutter Health executive.
Alas, the number of orders hardly …
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Why it’s hard for physicians to order fewer tests
When we walked into the room, you could sense the anger and frustration on the patient’s face, as well as two other relatives in the room.
We knew that the patient had had lung cancer for several months and had failed radiation and chemotherapy. He had labored breathing and looked miserable.
I went to his bed and asked if I could sit down on his bed. I took his wrist and began …
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Patients appreciate our honest concern. And that takes time.
Maybe 10 to 15 years ago, my medical center at the time invited a prominent former resident to give grand rounds. He had become the statistical director for what was a large regional insurer absorbed by a national insurer shortly after that. He spoke very little about the prevalence of disease among his company’s beneficiaries but extensively about how his company assessed the performance of physicians. He also related how …
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Here’s what doctors really think about where they work
“sonder – noun. the realization that each random passerby is living a life as vivid and complex as your own.”
– from the “Dictionary of Obscure Sorrows,” a compendium of invented words written by John Koenig.
I followed the chaplain into the patient briefing room, not quite sure what to expect. The room was dimly lit. The overhead lights were off, and only one small lamp gave off a weak glow, with …
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The unlucky privilege of seeing someone’s last moments
As we enter into the hospital each day, our goal is giving patients the best care we can provide. We get a list of patients that we will take care of each day, and as we get that list, we start thinking about what we should monitor in terms of their physical exam, lab results, and vital signs to ensure that their hospital course runs smoothly for the day. However, …
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Being superhuman in the most human circumstance
A good relationship between a patient and his or her physician is the cornerstone of superb medical care. That relationship is important when you know the doctor well. It may be even more important when you don’t, say when you are in the hospital.
Growing competition for new customers is inspiring American hospitals to focus on providing …
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8 traits of excellent hospital doctors
It was a case that every physician dreads. I took a deep breath, mustered up some courage and walked towards my patient’s room. When I entered, I saw an apprehensive and anxious family who was patiently waiting for some answers. The mother was sitting at bedside with eyes closed, hands clung to a rosary and lips whispering a prayer. The patient’s sister was standing by the window, looking out with …
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Nurses make me a better doctor
Nonprofit hospitals have higher profit margins than most for-profit hospitals after accounting for their tax obligations. 3900 (62 percent) of U.S. Hospitals are nonprofit and therefore tax-exempt — they pay no property tax, no federal or state income tax and no sales tax. An article published in Health Affairs found seven of the nation’s 10 most profitable hospitals were of the nonprofit variety, each earning …
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Are nonprofit hospitals a fairy tale?
There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for …
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Other jobs have strict rules on hours worked. So should doctors.
The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland.
In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private …
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Facility fees are ruining quality care
The setting: an inpatient unit in the Bronx, circa 2005.
I was a resident (and hence was likely disheveled, groggy or exhibiting some other outward display of exhaustion) of the internal medicine program at Albert Einstein University Medical Center/Moses Division, aka Montefiore. The fact that the program was considered “malignant” by those in my industry — mainly due to the strict nature of the training program — likely strengthens the possibility …
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A patient thought she knew who the real doctor was. She was wrong.
It’s no secret that health care is an unbelievably complex subject. One of the most complex issues facing the health care system is that of surprise medical bills. Surprise medical bills happen when:
- Patients receive emergency care by an out-of-network provider (one not included in their insurance plan);
- Patients are unaware that one or more of the providers of their non-emergent care were out-of-network; and
- Patients choose out-of-network care without …
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The fundamental cause of surprise medical bills and how to fix it
