A hospital stay is a right of passage for any patient, but the road to health is often a marathon and not a sprint. Discharge is an essential step in the patient journey, but it can be as exciting for a family as it is daunting. Families can prepare ahead and put all the right pieces in place in order for a “soft landing” home. Here are some of our …
How to ease your transition home from the hospital
Why would a well-respected, venerable health care organization adopt a soft and squishy approach — tracking disrespect and other forms of emotional harm — to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has …
Place emotional harms on par with physical ones
When I was a third-year medical student, I was a victim of sexual harassment.
I had a patient (I no longer remember his name, so let’s call him Mr. X) who was in his eighties and I had to do a rectal exam on him. I had been on the team taking care of Mr. X for a while, and I was fine doing the rectal exam and checking for blood …
A victim of sexual harassment as a medical student
A pediatrician decides a struggling teen with mental illness needs hospitalization to neutralize psychologic demons impacting their personal and social life.
A workers’ compensation doctor requests a neck MRI in a powerline worker with growing right arm numbness and weakness to search for potential paralyzing nerve impingement.
An orthopedist orders special testing to determine if an elder patient with right hip pain which limits walking and driving might need surgery to improve …
Making medical decisions without accountability
I burned out, big and bad. I can see that now. My practice environment had become gradually untenable and every attempt I made to change it was blocked. My call schedule was inflexible and a lot more frequent than when I started my job. The hospitalists and ED kept sending me cases I didn’t feel qualified to manage, but as it was usually the middle of the night and I …
We need to start talking about what comes after physician burnout
America’s resident physicians have strict limits on how many hours they can work in the hospital. Many break that limit and keep quiet about it. Others lie.
Resident physicians are the doctors-in-training that millions of Americans come into contact with at teaching hospitals across the country. We work for three to seven years (it depends on the medical specialty) …
Your doctors may be lying about how long they worked today
Reducing the essence of a human being to a single sentence is impossible, but in taking care of patients, we doctors do it all the time
The one-liner attempts to summarize an individual and an illness into a single, typically run-on, sentence to expedite communication. It is a thesis statement for your diagnosis. Word choice and omission are critical. By the end of this thesis statement, your audience, in spite of …
Be careful of the labels we assign our patients
Danny rarely came to the clinic. He paid a sliding scale fee for the visit but this, in addition to the money he paid for his medicines, was already too much for him to afford. Now, in early November 2013, he had become concerned.
Danny had previously owned a jewelry boutique with his wife, Jacky. She made her own pieces and sold them in the store. Over time, the economy had …
A specter from the implementation and demise of the ACA
William Osler once said, “Listen to your patient; he is telling you the diagnosis.” Anybody who practices medicine knows that is easier said than done. The ability to take a skillful history takes years to develop. There are many nuances in a medical history and physicians must know the right questions to ask. The next step is to avoid asking the wrong questions and the wrong wording of the right …
How to navigate the language barrier with patients
Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on.
I dial the call-back number.
“Pod A,” a caffeinated voice chirps. It’s Candice, one of the nurses.
“Hi. Amy here, returning a page,” I murmur.
“Oh hi, …
Family visits: No one ever regrets coming too soon
Hospitals have lots of codes. The most famous one is Code Blue (medical emergency), but it turns out there are lots of color-based codes. This can be confusing, as the connection between the code colors and the situations they represent are usually tenuous at best. Today we explore all of the types of codes, and shed some light these arcane medical euphemisms.
Code Blue
What it sounds like it means: Aggressively-scented cologne from Armani.
What it actually means: …
Hospital color codes, and what they mean
For those who are not avid followers of President Trump or his decisions, often his decisions have far-reaching consequences that affect lives and people. As a health care provider, I understand quick decision making, but also the importance of risk versus benefit and consequences of your decisions. I would like to tell you my story and how his actions have affected my life, the lives of my patients and their …
How the government hiring freeze dishonors veterans
My brother-in-law, Ron, was a curmudgeon; grumpy, sullen, even downright mean at times.
By blood, he and my husband Bill were cousins. In the 1950s, when Bill was just a child, his mother died unexpectedly, and Ron’s mother took Bill in to live with her and her four children. They were an African-American family living in the midst of a middle-class, predominantly white Connecticut township. Their home, located on a wealthy …
Have a mean patient? Don’t take it personally.
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Bashing the Veterans Administration (VA) health care system has become a familiar pursuit following the 2014 expose regarding concealed wait times and concerns for substandard care. In the aftermath of the ensuing national scandal, Congress passed reformative legislation, and President Obama appointed Robert McDonald Secretary of the VA. A 2016 report from the Harvard Business School indicates that the Secretary has “made impressive progress over the past year.” Numerous veterans …
Stop bashing the VA: The culture of respect at our VA
Our recent paper on differences in outcomes for Medicare patients cared for by male and female physicians created a stir. While the paper received broad coverage and mostly positive responses, there have also been quite a few critiques. There is no doubt that the study raises questions that need to be aired and discussed openly and honestly. Its limitations — which the paper highlights — are important. Given the …
Men and women doctors versus correlation and causation
Dear hospital executive,
If you are like many of the hospital leaders with whom I regularly talk, you’re probably concerned that your hospitalist program isn’t delivering the value you need in this metrics-driven and cost-constrained environment. You may see your hospitalists as disengaged free agents who either don’t know or care too little about contributing to the success of your organization beyond seeing the patients on their list. They may repeatedly …
7 ways hospital executives can support their staff
“Who’s in charge of the case?” the doctor asked a bit impatiently.
My husband was in the hospital, and his care seemed disjointed and fragmented. I was concerned and called his primary care physician (PCP) to ask advice. He hadn’t known my husband was in the hospital again and seemed frustrated.
I thought about his question for a minute and answered, “I guess I am. I am the one who talks to …
Who coordinates patient care? Maybe no one.
As an intern, I once cared for an elderly gentleman who came in with heart failure. In no time, we grew fond of each other. It was almost like he looked forward to my visits. He sometimes called me “sunshine.” I am not sure if he meant it in a way that meant that I woke him up every morning. He was almost ready to go back home when he …
About three years ago, our hospital was abuzz about patient satisfaction. Our HCAHPS scores were lower than expected, and there was a push by the administration to improve them. As a hospitalist, I wondered to myself, what could I possibly do to improve them? I already believed I was doing a very good job communicating effectively with patients.
Many years ago, I developed the habit at the end of each encounter …
A 3-question patient satisfaction tool for hospitalists
While having coffee the other day, I came across a video called The Thank You Project. Watch it. I assure you, it’s worth 5 minutes of your time.
In 2004, Kellie Haddock, her husband, and their 14-week-old son were involved in a horrible car accident. Her husband was killed on impact, and their son was severely injured. In her heartbreaking tale, she recounts the roller coaster ride she endured …
This new year, a resolution to be grateful to the medical staff
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