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.
Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know …
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Physicians take note: Get personal with your patients
In my former life as a hospital-based, shift-working physician with young children at home, this time of the year inevitably brought the same question from at least a handful of individuals: “Isn’t it hard on your kids not to have you home on Christmas?” Thankfully, I was always able to answer truthfully, “no.” With consistent effort and a no-nonsense attitude, my kiddos either didn’t know the difference because they were …
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To the caregivers over the holidays: Thank you
For any health care professional, a typical day in the hospital brings about its unique challenges. Depending on the patients that we see, one second the situation can be routine, and the next second, it can become complex. In the midst of this flux, there is an expectation for us to make important decisions, with the speed of these decisions dependent on how a patient is doing at a given …
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Leave judgment behind, lest our care be hindered
With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace:
Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and …
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Quality improvement shouldn’t be dirty words
Nothing compares to the apprehension of starting residency.
OK, that’s not true, but it’s really high up there on nerve-wracking firsts.
I remember my first day as a resident. In a matter of a few hours, I went from being human furniture to being asked to make life-altering decisions. I was overwhelmed, to say the least. Here are some pieces of advice that I wish senior residents would have emphasized before I started this …
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Be prepared mentally, physically, and socially for residency
In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when I headed back home. I’d picked up the service on the cancer ward from an intern named Bob, and he left me six handwritten pages on the subject of Jim Franklin.
This was the deal: Jim Franklin, thirty-seven years old, was in the cancer ward …
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A difficult patient helps a doctor see the light. Literally.
A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, “Virginia Mason Health System … has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota.”
The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value.
Attempts …
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How is lean working in health care? Not so well.
As a family practice resident, I’ve found that a premium is placed not only on my clinical acumen but also on how well I respond to my patients’ mental and emotional experience of illness.
Yet the work of learning to be a doctor is just that — work. (And in overwhelming amounts.) Time management becomes ever more vital: As I take the time needed to gently break bad news and to …
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Medicine isn’t just about accuracy and efficiency
In a time when the deep divisions in our country have become increasingly apparent, I, perhaps like you, have been seeking hope. I supposed hope would come in the form of an enlightened article or a profound speech, but it did not. Hope came to me in the form of my patients.
The division you have been seeing in our country is barely visible in the hospital. Here, patients are assigned …
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The division in our country is barely visible in the hospital
OSH, or “outside hospital,” is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny.
What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):
This is ten percent …
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Give the outside hospital the respect it deserves
“If you do not cooperate, doctor, we will have no choice but to label you as being ‘disruptive’ and take whatever steps are necessary to remedy the situation.”
What physician does not dread hearing these words? Over the past several years, the term “disruptive” has been increasingly used to characterize and intimidate a physician who is perceived as not being a “team player.” With hospitals increasing the difficulty in navigating a …
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Get disruptive: 8 ways doctors create change at work
Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather adept at healing his fellow man.
The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive …
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Doctors are taught how to balance blood pressure, not budgets. Don’t blame them.
I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing.
I may know about your criminal past. I see that tattoo underneath …
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The hospital is a microcosm of what I want the world to become
Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last “walk” on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by hundreds of family, friends, and supporters (human and canine alike), Walnut was put down. His last moments were spent as near to Heaven on earth as his owner could create …
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Death and dying: Do dogs have it better?
While visiting a family member in the hospital recently, I noticed the unkempt attire of one of the lab people coming in to draw blood. As she knelt down to better reach my family member’s arm, I noticed her scrub pants were frayed and dirty from her walking on them.
Shortly after I made note of this, one of her co-workers came in the room to see …
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What is essential professional dress in health care?
Part of being a resident or fellow is to be on call overnight and on the weekends. As any new resident, you’ll be nervous the first time because you think you don’t know anything.
Over time, you’ll gain the knowledge and expertise to be able to ask the right questions, improve your exam skills and make the right clinical decisions. Trust that you know more than you think you do.
Throughout your …
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3 things that make doctors successful
Performance in the practice of medicine has always drawn scrutiny and evaluation. Lives are at stake and years of education, practice and certification are required, simply to have the chance to be a physician or nurse. But today we’re witnessing an unprecedented rise of ranking, rating, and scorekeeping of performance in our hospitals. And there’s growing evidence that more patients are making their hospital choices based on these ratings and …
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Welcome to Yelp for hospitals. What should we do next?
“It won’t be the last sacrifice you make for medicine.”
These were the words my surgical intern said between yawns as I expressed regret at having to miss a distant cousin’s wedding. The digital wall-clock read a blurry 3:15 a.m. as we sat together in the on-call room, the coffeemaker dripping black gold into the pot.
She had three pagers affixed to her scrub pants which would beep intermittently in turn, signaling anything …
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The sacrifices we make for medicine
There are so many insightful stories out there about what happens when physicians experience life as a patient or family member. They always make sobering reading for everyone in health care. Over the years I’ve heard dozens of these stories from fellow physicians, describing experiences when they’ve unfortunately been sick themselves. It’s an inevitable fact of life for everyone that they will be the patient one day, but it’s often …
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5 things physicians realize when they’re patients
We were a team of women. A strong, intelligent female attending, a fellow, me as the resident, and the eager intern. Gunners in the ICU. Throwing in lines and throwing out numbers and grilling newly published papers for truth.
Then I got a call from the head of the department. I was asked about another fellow in the program. A male fellow. His behavior was in question. I was asked if …
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We must break the circle of sexism
