Hospital medicine

5,188 articles · Since 2004

Articles, page 74

Nothing could help my patient, but ministering to him helped me

July 2, 2017Jul 2, 2017

"Mr. Jones, how are you this morning?" I ask. A muffled, incoherent reply. "Are you in pain?" "No." I perform a brief, perfunctory exam — it's unchanged from yesterday. I then glance at his breakfast tray on the bedside table…

“Mr. Jones, how are you this morning?” I ask.

A muffled, incoherent reply.

“Are you in pain?”

“No.”

I perform a brief, perfunctory exam — it’s unchanged from yesterday. I then glance at his breakfast tray on the bedside table — still untouched. The plastic mug is still full of watery, lukewarm coffee, and the rubbery pancakes on the plate are still intact. This is at least the third morning that my patient — …

Conditions and diseases

Expanding our definition of spiritual competence

Eric Nelson

June 30, 2017Jun 30, 2017

The first thing I remember as I regained consciousness, lying in a hospital emergency room, was hearing a nurse ask my mom if I was allergic to any foods. With my eyes still closed, I said, “asparagus,” thinking this might…

“Asparagus,” repeated the nurse, making a note on my admission form.

And then, with a chuckle and what must …

Physician voices

Toward the stars: On humility and pain in medicine

Michael Kaplan, MD

June 25, 2017Jun 25, 20174

Your brain is a three-pound hunk of biological tissue. And though it’s nothing more than a conglomeration of specialized cells, it generates the taste of cheesecake, the ecstasy of enchantment, and the misery of suffering. Amazing, right? I certainly think so, though I find myself among a shrinking minority. Whereas the eyes of our medical forefathers were turned toward the heavens in search of answers to seemingly unknowable questions — …

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Physician voices

Quality is this physician’s religion

Kjell Benson, MD

June 23, 2017Jun 23, 20175

My hospitalist medical group consists of as great collection of atheists, agnostics, and skeptics as you will ever find. But we all agree that quality is our religion. We believe to our last breath that patient care is sacred and an invaluable gift. And so, as with all faith, there is no halfway. You believe, or you stand around scratching your head asking what those other fools are worshipping. Just …

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Quality is this physician’s religion

Physician voices

Customers come second: That’s something health care can learn

Ankit Garg, MD & Megha Garg, MD

June 22, 2017Jun 22, 20179

"Management's overall aim should be to create a system in which everybody may take joy in his/her work." - W. Edwards Deming "Your skin is not thick enough to hear me yell for even ten minutes!" a 92-year-old patient's family…

“Management’s overall aim should be to create a system in which everybody may take joy in his/her work.”
– W. Edwards Deming

“Your skin is not thick enough to hear me yell for even ten minutes!” a 92-year-old patient’s family member shouted at me while attending a care plan meeting. I was soon asked to leave the room left with case manager, social workers and mid-level managers.

Later that evening, as I claimed …

Physician voices

Want to fight burnout? Embrace the suck.

Sasha K. Shillcutt, MD

June 21, 2017Jun 21, 20173

I was approaching 24 hours in the hospital and waiting for my partner to come into my operating room so we could do “hand-off." That's when I spend 15 minutes going over all of the events of the surgical case…

I was approaching 24 hours in the hospital and waiting for my partner to come into my operating room so we could do “hand-off.” That’s when I spend 15 minutes going over all of the events of the surgical case and explain my patient’s health history, his current status, my current treatment strategies, the heart ultrasound findings, and our plan for the rest of the case. As I was awaiting …

Medical education

Doctors will inevitably make mistakes because they are also human

Natalia Birgisson

June 20, 2017Jun 20, 2017

Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared. Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process…

Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared.

Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process which was only being controlled by a new drug his oncologist had decided to try. But one day, Kalanithi had severe nausea and had to be hospitalized to stay hydrated. A …

Physician voices

Interested in being a locum tenens physician? Read this first.

Val Jones, MD

June 16, 2017Jun 16, 2017

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question …

Physician voices

Burned out? Just say no and teach others to as well

N. Bande Virgil, MD

June 15, 2017Jun 15, 20173

Without question, the interconnectivity created by social media is a plus when it comes to talking about physician burnout, suicide and policies affecting our practice of medicine. We are no longer in independent silos with the surgeons suffering in one corner and pediatricians elsewhere. Physicians are no longer isolated contemplating if what they are experiencing is just unique to them. We are developing collective voices. It is incredible to believe …

Physician voices

Better care: Private practice or academic center?

Dads Dollars Debts, MD

June 12, 2017Jun 12, 201711

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…

Academia — here I come!

Then attending-hood arrived. I looked for positions in academic centers. I was limited by …

Physician voices

As (not) seen on TV

Robert Spencer, MD

June 9, 2017Jun 9, 20172

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…

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

Physician voices

You’re disappointed with your health care. Here are 5 reasons why.

Suneel Dhand, MD

June 8, 2017Jun 8, 20172

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…

The vast majority of physicians, and indeed all other health care professionals, are among …

Physician voices

Imagining a world where Amazon runs hospitals

Mary Branch, MD

June 6, 2017Jun 6, 2017

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 …

Physician voices

Doctors, we need to start making our own tools

Kjell Benson, MD

June 5, 2017Jun 5, 2017

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…

Contemporary philosopher Daniel Dennett ponders thinking tools. “Like all artisans, a blacksmith needs tools, but — …

Health policy

How much does it matter which hospital you go to?

Ashish Jha, MD, MPH

June 3, 2017Jun 3, 20174

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…

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 …

Health policy

Why it’s hard for physicians to order fewer tests

Chad Terhune

June 2, 2017Jun 2, 20177

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…

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 …

Physician voices

Patients appreciate our honest concern. And that takes time.

Robert Centor, MD

May 25, 2017May 25, 2017

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…

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 …

Physician voices

Here’s what doctors really think about where they work

Richard Plotzker, MD

May 24, 2017May 24, 2017

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 …

Medical education

The unlucky privilege of seeing someone’s last moments

Michael Tien

May 18, 2017May 18, 2017

“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…

“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 …

Physician voices

What’s wrong with health care leaders today

Suneel Dhand, MD

May 14, 2017May 14, 20178

The world of health care continues to change at a breathtaking pace. For reasons too long to go into during a short article, there’s been a huge shift of power away from individual doctors and patients, and towards administrators and big corporations. Health care in its most raw primary form used to be about Dr. Johnson’s small office around the corner,which would serve you and your …

Hospital medicine

Articles, page 74

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