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Hospital medicine

5,188 articles · Since 2004

Articles, page 73

Drugs and prescribing

Should only infectious disease specialists be allowed to prescribe antibiotics?

39

The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic…

The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use.

There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them …

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Should only infectious disease specialists be allowed to prescribe antibiotics?

Physician voices

A hospital leader speaks out against the transgender military ban

3

On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new…

On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: “Go Sox!” (or, depending on the season, “Patriots!” “Celtics!” “Bruins!”).

So I was not expecting that

…

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A hospital leader speaks out against the transgender military ban

Physician voices

The sad direction of hospital care

13

My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but…

My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined.

At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams …

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The sad direction of hospital care

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Physician voices

Make the patient feel like the absolute center of your world

Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get…

Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but …

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Make the patient feel like the absolute center of your world

Physician voices

Stop piling on physicians: The last straw in burnout

9

We are all familiar with the saying: "the last straw." It refers to the fable of the camel who could carry heavy loads. In the story, the camel is a beast of burden. Its owner, in an effort to transport…

We are all familiar with the saying: “the last straw.” It refers to the fable of the camel who could carry heavy loads.

In the story, the camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot. But at some point, even the strongest camel will …

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Stop piling on physicians: The last straw in burnout

Physician voices

Inappropriate patient behavior is not OK

12

"OK, one more patient to go," I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I…

“OK, one more patient to go,” I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major …

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Inappropriate patient behavior is not OK

Physician voices

Here’s how being a parent changes you as a physician

I sit in my living room at the end of a long day. I open my laptop to complete the day’s clinic notes. I look up to see my daughter busy painting (she’s two years old, so less than half…

I sit in my living room at the end of a long day. I open my laptop to complete the day’s clinic notes. I look up to see my daughter busy painting (she’s two years old, so less than half the paint is going on the coloring book and most is being smeared over her hands and feet). I hear the distant clatter of dishes as my husband loads the …

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Here’s how being a parent changes you as a physician

Medical education

3 reasons why July 1st should be a day to celebrate

Fireworks, champagne toasts, sparkly hats, and the ball drop are all items that we conger up in our minds as we think of the New Year. For the majority of the world, January 1st represents the transition from one year…

Fireworks, champagne toasts, sparkly hats, and the ball drop are all items that we conger up in our minds as we think of the New Year. For the majority of the world, January 1st represents the transition from one year to another on the calendar. New resolutions are made, and there is a global fresh start. However, for those of us in the medical field, there is another new year …

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3 reasons why July 1st should be a day to celebrate

Physician voices

5 communication mistakes physicians should avoid

2

Being a doctor is about as much of a social job as one can get. Even though computers and healthcare information technology mean that physicians are now spending a disproportionately large amount of their time staring at their computer screens,…

Being a doctor is about as much of a social job as one can get. Even though computers and healthcare information technology mean that physicians are now spending a disproportionately large amount of their time staring at their computer screens, there’s no getting around the importance of good old face-to-face interactions. That’s also what’s valued by your patients. In this time of great upheaval in healthcare, everything has …

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5 communication mistakes physicians should avoid

Physician voices

Against medical advice: When patients and doctors defy expectations

3

Mr. B. was ready to leave. A short, stocky Boston construction worker with an even shorter temper and a tough attitude, he was not going to stay in the hospital one minute longer than needed. Mr. B.’s life had taken…

Mr. B. was ready to leave. A short, stocky Boston construction worker with an even shorter temper and a tough attitude, he was not going to stay in the hospital one minute longer than needed.

Mr. B.’s life had taken a turn for the worse recently: He was going through a divorce, had lost his health insurance, and had become temporarily homeless at the time we met. He had brought himself …

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Against medical advice: When patients and doctors defy expectations

Physician voices

Neil Gorsuch and the case of Charlie Gard

4

Kenan Malik writes in the New York Times in support of Charlie Gard’s parents, presenting a secular, utilitarian argument for the continuation of the child’s treatment. In the article, Malik draws attention to a contradiction between the State’s position regarding…

Kenan Malik writes in the New York Times in support of Charlie Gard’s parents, presenting a secular, utilitarian argument for the continuation of the child’s treatment.

In the article, Malik draws attention to a contradiction between the State’s position regarding Gard and its position regarding the wishes of a patient with a terminal neurological condition who wishes for assisted suicide.

The practice of withdrawal of care is often invoked in the …

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Neil Gorsuch and the case of Charlie Gard

Health policy

5 steps to create medical quality without trying

The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our…

The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” …

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5 steps to create medical quality without trying

Physician voices

Helping a patient can help with grief

The constant hum of the subway car over the tracks plays in the background as I sit there with my mind running over the tasks of the day. I never quite thought of myself as a particularly intense person, yet…

The constant hum of the subway car over the tracks plays in the background as I sit there with my mind running over the tasks of the day. I never quite thought of myself as a particularly intense person, yet here I was three years later working with an underserved population between a state and county hospital in my first week as one of the new administrative chiefs. The very …

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Helping a patient can help with grief

Physician voices

3 steps to be a better medical professional. Even if it seems impossible.

I came into work last night for the last time. Though I was on a service full of sick patients, I was not nervous. After three years of this, three years of people trying to die in creative ways, and…

I came into work last night for the last time. Though I was on a service full of sick patients, I was not nervous. After three years of this, three years of people trying to die in creative ways, and my friends and I trying to stop them — I have no nervousness left. There is just nothing left for the hospital to throw at me.

“Dan,” I asked my intern, …

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3 steps to be a better medical professional. Even if it seems impossible.

Physician voices

Important considerations in how we use advanced care planning documentation

There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live,” but rather on the “right to die.” These cases have involved patients who received aggressive treatment, despite…

There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live,” but rather on the “right to die.” These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost …

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Important considerations in how we use advanced care planning documentation

Physician voices

Good communication is at the core of all good medical care. Here are 3 examples.

There are many different theories out there about the direction that health care should go, and what we need to be doing in the future. Passions run high, and peoples’ opinions vary wildly. It’s frequently difficult to find agreement on…

There are many different theories out there about the direction that health care should go, and what we need to be doing in the future.

Passions run high, and peoples’ opinions vary wildly. It’s frequently difficult to find agreement on anything. There is, however, one universal truth I’ve found about the everyday practice of medicine, and what constitutes great medical care for any individual in any health care system. Having worked …

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Good communication is at the core of all good medical care. Here are 3 examples.

Medical education

Dear intern: Some advice about your first year

Dear intern, It will be the best of times, and it will be the worst of times. But what a special time this will be. It will be a time of learning the details and nuances of clinical medicine —…

Dear intern,

It will be the best of times, and it will be the worst of times.

But what a special time this will be. It will be a time of learning the details and nuances of clinical medicine — the diagnostic features of sarcoidosis and the second, third and fourth line treatments for community-acquired pneumonia. You will learn how to learn, and you will forget what you learned, only to learn …

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Dear intern: Some advice about your first year

Physician voices

It’s time to stop the bullying in medicine

6

In a recently published JAMA meta-analysis, medical students were found to have a higher prevalence of suicidal ideation and depressive symptoms than the general population. From the mental exhaustion that begins in medical school to the physical fatigue that peaks…

In a recently published JAMA meta-analysis, medical students were found to have a higher prevalence of suicidal ideation and depressive symptoms than the general population.   From the mental exhaustion that begins in medical school to the physical fatigue that peaks with residency, it is not shocking that medical trainees are suffering.  Current discussions have ignored one of the biggest hindrances for the …

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It’s time to stop the bullying in medicine

Physician voices

10 ways for doctors to think outside of the box

Thinking outside the box is a somewhat cliché way to illustrate thinking beyond the norm and imagining what “could be” with an innovative mindset. This imagery of being stuck in a box rings true for many physicians, given how many…

Thinking outside the box is a somewhat cliché way to illustrate thinking beyond the norm and imagining what “could be” with an innovative mindset. This imagery of being stuck in a box rings true for many physicians, given how many of us are quite literally surrounded by the four white walls of an exam room most of our lives.

Physicians work hard to treat each patient individually, but this feeling of …

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10 ways for doctors to think outside of the box

Physician voices

My patient is dying, and I don’t know what to do

2

The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an…

The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for …

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My patient is dying, and I don’t know what to do

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