Hospital Medicine

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.

Why hospitals shouldn’t use their miracle cases to advertise

Eric Beam, MD

Physician

September 16, 2016

On the way to work the other day, I heard a radio commercial advertising a local hospital network’s cardiac care services. In it, a patient’s daughter related her overwhelmingly positive experience with the hospital team that treated her 90-year-old father with a transcatheter aortic valve replacement (TAVR), a minimally-invasive alternative to open heart surgery.

It was a good commercial. It had all the elements: “I was worried at first, the doctors …

Doctoring requires developing relationships with people

Jean Robey, MD

Physician

September 14, 2016

Cleveland Clinic published an article that cited the work of Cynthia Kubu, PhD, a neuropsychologist in Cleveland Clinic’s department of psychiatry and psychology. She examined the potential of focusing on relationship center care to help provide good care and long-term care giving for physicians. Cleveland Clinic uses the REDESM (relationship, establishment, development, and engagement) which focuses on the provider-patient relationship as the premise for care. The idea is a physician …

The hospital is a microcosm of America’s melting pot

Roxana Daneshjou, MD, PhD

Physician

September 14, 2016

“Doctor, why can’t my mother breathe?” he asked, eyes full of concern as he watched his mother’s chest heave like someone who has spent too long underwater.

I turned up her oxygen as we discussed the possibilities we were testing for: infection, a reaction to chemotherapy, blood clots. Her breathing eased as we spoke, and in turn, I saw some of her son’s anxiety dissipate. As our conversation came to a …

Fostering wellness: Tips and practical advice from front line physicians

Sima Pendharkar, MD and Tiffany I. Leung, MD

Physician

September 7, 2016

“If physicians aren’t happy, they can’t heal others”
– Vivek Murthy

Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians …

Death by hospital: Who’s right?

Dan Walter

Patient

September 7, 2016

Dr. Kaveh Shojania, a prominent patient safety expert who scoffs at the numbers and laughs at the tragedy inflicted on countless victims of medical error, should step down as editor of a leading hospital safety journal.

About three years ago, a scientist named John James published a study proclaiming that — at minimum — 210,000 people die every year from hospital errors, making it the third leading cause of death in …

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Death by hospital: Who’s right?

Why we should remember our moments of vulnerability

Michelle Zhang, MD

Physician

August 24, 2016

During my first rotation of intern year, we took care of a woman who walked into the hospital with a kidney stone and never walked out. 52 years old, diabetic but otherwise healthy, she had been vacationing in Vermont with her son and extended family when she became sick with high fevers. When her symptoms didn’t improve, her son rushed her to our emergency room where an imaging scan revealed …

Doctor, you are not alone

James C. Salwitz, MD

Physician

August 23, 2016

2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime.

My first night in the unit and my first patient’s chart. Papers spill from the accidentally opened binder …

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Doctor, you are not alone

The evolution of a hospital admission

John Schumann, MD

Physician

August 17, 2016

Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce.

The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really — if you had it).

This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for …

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The evolution of a hospital admission

I am very much a student of the Zen of call

Michael P. Jones, MD

Physician

August 15, 2016

I can’t believe I’m writing something with this title. Anyone who knows me and sees my name next to that title will probably spit their coffee all over the kitchen counter. And to all the people who have dealt with me on call, let me begin by saying, I’m truly sorry for anything I might have said, done, thrown or broken. Mostly. Kinda mostly.

Those who know me will likely think …

The part of your day that will be most remembered by patients

Suneel Dhand, MD

Physician

August 14, 2016

Being a doctor is often more about talking to people and communicating than it is about the scientific practice of medicine. This is something that is unfortunately not taught in medical school, and it’s left to newly qualified doctors to realize very quickly as they start their careers.

Throughout the busy and hectic day of any hospital-based physician — no matter what their specialty — one of the most common requests …

Let’s learn from our nurses and make medicine great again

Miriam A. Knoll, MD

Physician

August 12, 2016

Sometimes, I wish I was a nurse.

As a nurse, my work-life balance would greatly improve because my three 12-hour shifts would constitute a rewarding and flexible full-time medical career. I would care for all kinds of patients, not just stick to one medical specialty. Maybe I’d go for an advanced nursing degree; I would enroll in school full-time and also maintain a paid full-time job. Like many nurses, my hospital …

Who cares about our turf wars? Patients don’t.

Amanda Dean, RN

Physician

August 6, 2016

Recently a measure was proposed to allow APRNs full practice authority in the VA health care system. With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right?

Nothing is ever that simple in American medicine. The professional organizations are, once again, …

A medical student’s first trauma

Shama Patel, MD

Medical Education

August 1, 2016

“Code fifty-two, emergency room. Code fifty-two, emergency room,” blared over the loud speaker in the hospital. Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.

I glanced down at my pager that echoed the same message “CODE 52, EMERGENCY ROOM.” The same message flashed across the screen three more times as I ran quickly down the main hallway. Code 52 meant trauma. I was about to …

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A medical student’s first trauma

Healing at the hospital begins with peace and quiet

Pallabi Sanyal-Dey, MD

Physician

July 31, 2016

The space can make a difference. I had already spent over two years working as a hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges. Fast forward to the end of May 2016 to one of my first shifts working in the new building, a.k.a “The Zuck”: Zuckerberg San Francisco General (ZSFG). Change had never felt so good.

I walked across the …

Should doctors and nurses wear scrubs outside the hospital?

Skeptical Scalpel, MD

Physician

July 29, 2016

Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end).

He pointed out that it …

The story of the man who could see the invisible

Mark E. Williams, MD

Physician

July 25, 2016

Once upon a time long, long ago there lived a man who could see things that other people simply could not see. He was not born with this skill but cultivated it slowly and continuously with years of focused attention.

He worked as a physician in a large hospital and would sometimes have students go with him to see patients. As far as the students were concerned, he could really see …

Today happens once. And we are guaranteed nothing.

Michael P. Jones, MD

Physician

July 22, 2016

As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day now. I was sure that she knew that something was wrong but did she know that she’d be dead in a few hours?

One of the most profound things about being a …

We were promised death panels

Physician on FIRE, MD

Physician

July 18, 2016

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there’s free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We’re prepared to handle them.

“Where is the patient?” I inquired.

“On the way down from ICU. The surgeon’s on his way in,” I was told.

Hmm … …

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We were promised death panels

What does quality mean in the eyes of a patient?

Kerri Vincenti, MD

Physician

July 1, 2016

One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as …

For hospitals to thrive, they need to value nurses

Anonymous

Health Policy

July 1, 2016

Three weeks ago, I changed jobs. I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital. Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting.

I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I …