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.
Halfway through the “Bell Curve,” which is an analysis of differences in intelligence between races, I realized what had been bothering me about Charles Murray’s thesis. It wasn’t the accuracy of his analysis, which concerned me too. It was what he analyzed. The truth, I used to believe, was always beautiful, whether it was what happened in the multiverse at T equals zero or the historical …
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The deadly risk of being treated by a male physician
Since finishing my residency several years ago, I’ve worked in almost every type of hospital up and down the East Coast, from big urban academic medical centers to more rural community outposts. Although I primarily practice hospital medicine, working with both smaller private groups and being a hospital employee, I empathize a lot with my independent practice colleagues and brethren. I almost certainly would have gone down the route of …
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Stop pushing doctors out of practice!
How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?
It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.
“In despairing over …
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The double meaning of despair in the hospital
Are physicians unruly children?
That’s the attitude I see at hospital C-suite meetings. (As in, “Our doctors are protesting our new unproven proton beam therapy center. How cute! They think they know how hospitals work: Even cuter, they think their opinion matters.”) Chuckles all around.
That smiling dismissiveness doesn’t surprise me. Call me cynical, but when people have power over other people, they become contemptuous. And in today’s world hospital executives have that power …
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Why physician engagement is code for physician control
Do women make better doctors than men?
A recent study in JAMA Internal Medicine claims that they do. According to the authors, there is a 4 percent risk reduction in mortality for elderly patients treated by women. There is also a small but clinically significant reduction in readmission rates. By their analysis, this difference could translate to approximately 32,000 lives saved “if male physicians could achieve the same outcomes …
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Are women doctors better than men? Maybe they just see fewer patients.
“Orange is his favorite color. It’s all orange, all of the time in there.”
And, indeed it was. Like the deceptively soft glow from a garish, neon storefront light, passing his room, it was impossible for one’s eyes not to be drawn inside. Hunter blaze bedspread, pumpkin spice robe, marigold slippers, and even a persimmon beanie — wavelengths of orange permeated the otherwise drab, muted colors of the space.
It became a …
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A hospital gown to remember
I want to share a cool idea used at Mission Health in North Carolina. I recently interviewed Dr. Ron Paulus, CEO of the health system. Three years ago the organization launched “Immersion Day,” when board members leave their corporate meeting rooms to shadow the doctors and nurses in their hospitals.
Journalists and legislators are also invited to join. They don scrubs, go through an orientation, sign privacy forms, and spend 9 …
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When administrators shadow doctors and nurses, good things happen
If you understand statistics and possess the intestinal fortitude to examine a ranking methodology, you will recognize that it involves ingredients that have to be recombined, repackaged and renamed. It’s messy, like sausage-making.
This is not to say that the end product — hospital rankings — are distasteful. Patients deserve valid, transparent and timely information about quality of care so they can make informed decisions about whether and where to receive …
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We need more science in hospital quality measures
The mantra of striving for excellent customer service is a very American concept. I’m reminded whenever I travel around the world and experience general service expectations elsewhere — even in some very advanced nations in Europe — how far ahead we are in the United States. We totally take it for granted that we can expect high levels of customer care almost everywhere we go, and any complaints and feedback …
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5 ways doctors don’t give patients what they really want
About a year ago, Yusuke Tsugawa — then a doctoral student in the Harvard health policy PhD program — and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to Read more…
The difference between male and female physicians. Here’s what it means.
Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.
Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.
She had every possible attribute as a …
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An ode to a beloved ICU nurse manager
Even though I am over 40 — by a long shot — I am familiar with the abbreviation TMI. Today, we are inundated with so much noise, chatter and static. I feel that we are bombarded with information that we must sift through and ultimately delete. The news cycle is 24 hours and hits us from so many electronic sources simultaneously. I am deluged each day with so many unwanted …
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Disclaimer! Caution: There’s too much information
As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers.
Being someone …
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Corporate health care is doomed. Here’s why.
“I did a weekend of 72 hours in which I only got four hours of sleep. I would also secretly hope to get in a car accident and maybe break a leg so that I would be force to take off from work … just so I could get some rest. Thank God, I never got in an accident, but I have had colleagues fall asleep at the wheel.”
– Dr. …
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The American system for training doctors is broken
Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of …
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Why is this physician here? Because of connection.
Dear Husband, MD
I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”
I put quotations around “shift” because we both know you will not work 8 …
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A letter to her physician husband
Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public …
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A different consequence of 28-hour shifts
Have you heard of Dr. Kildare? When I was a kid, he was the most popular doctor in the world. He was smart, courageous, and handsome, and every week he did something amazing at Blair General Hospital.
Thanks to my mother, I grew up hearing stories about a real-life Dr. Kildare. We’ll call him Dr. B, and he was a legend in my home state of North Carolina.
My mother was a …
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How administrators can earn the respect of the medical and nursing staff
It used to be that hospitals billed Medicare for the services they provided, and Medicare — I know this is crazy! – simply paid the bills.
Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third-party payers, like insurance companies or the Medicare …
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Pay-for-performance is here to stay. Hospitals better pay attention.
In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation?
Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have …
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When can I follow my intuition?
