Hospital medicine

5,188 articles · Since 2004

Articles, page 78

Disclaimer! Caution: There’s too much information

January 2, 2017Jan 2, 20172

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 …

Physician voices

Corporate health care is doomed. Here’s why.

Suneel Dhand, MD

January 1, 2017Jan 1, 20173

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 …

Physician voices

The American system for training doctors is broken

Elisabeth Poorman, MD

December 30, 2016Dec 30, 201619

"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…

“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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Physician voices

Why is this physician here? Because of connection.

Beverly A. Zavaleta, MD

December 30, 2016Dec 30, 2016

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 …

Physician voices

A letter to her physician husband

Charity Williams

December 28, 2016Dec 28, 20167

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…

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

Physician voices

A different consequence of 28-hour shifts

Stephanie Waggel, MD

December 26, 2016Dec 26, 201615

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 …

Physician voices

How administrators can earn the respect of the medical and nursing staff

Warren Holleman, PhD

December 26, 2016Dec 26, 201612

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…

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 …

Health policy

Pay-for-performance is here to stay. Hospitals better pay attention.

Peter Ubel, MD

December 26, 2016Dec 26, 20163

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…

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 …

Physician voices

When can I follow my intuition?

Tracy Cardin, ACNP

December 24, 2016Dec 24, 20163

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…

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?

Physician voices

Physicians take note: Get personal with your patients

Suneel Dhand, MD

December 23, 2016Dec 23, 20163

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 …

Physician voices

To the caregivers over the holidays: Thank you

Juliet B. Ugarte Hopkins, MD

December 21, 2016Dec 21, 20164

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 …

Physician voices

Leave judgment behind, lest our care be hindered

Chiduzie Madubata, MD

December 19, 2016Dec 19, 20162

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 …

Physician voices

Quality improvement shouldn’t be dirty words

Christopher Moriates, MD

December 15, 2016Dec 15, 20164

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…

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

…

Medical education

Be prepared mentally, physically, and socially for residency

Nora Ekeanya, DO

December 15, 2016Dec 15, 2016

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…

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 …

Physician voices

A difficult patient helps a doctor see the light. Literally.

Christine Todd, MD

December 13, 2016Dec 13, 2016

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…

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 …

Physician voices

How is lean working in health care? Not so well.

Skeptical Scalpel, MD

December 6, 2016Dec 6, 20167

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…

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 …

Physician voices

Medicine isn’t just about accuracy and efficiency

Christina Johnson, MD

December 5, 2016Dec 5, 2016

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…

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 …

Physician voices

The division in our country is barely visible in the hospital

Andrew Cruz, MD

December 4, 2016Dec 4, 2016

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…

The division you have been seeing in our country is barely visible in the hospital. Here, patients are assigned …

Physician voices

Give the outside hospital the respect it deserves

Jaan Peter Naktin, MD

December 4, 2016Dec 4, 2016

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”…

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

…

Physician voices

Get disruptive: 8 ways doctors create change at work

Thomas D. Guastavino, MD

November 30, 2016Nov 30, 201621

"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…

“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 …

Hospital medicine

Articles, page 78

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