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.
Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.
During the first ICU …
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A child’s father knew when to let go. The health care team didn’t.
Twenty years of experience and research reveal two indispensable truths about hospitals and health care organizations that can no longer be ignored: Those institutions neglecting the basic fundamentals of patient care risk jeopardizing the quality and safety of care they provide.
Nothing can have a greater short and long-term impact on the cost of delivering health care services than nurses.
The central role of the nurse in patient care
For more than 60 years, …
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When things go wrong operationally, nurses feel the pain first
I received the sign-out from a colleague that he was to be transferred out of the medical intensive care unit to our service, as we were the team on call that evening. My intern and I prepared to see him in the unit before he was moved to our floor, which involved reviewing his chart and having preliminary discussions about continuing his care.
Soon after, we arrived to the unit, checked …
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A black doctor’s perspective on perceptions by race
A few weeks ago, I woke up feeling under the weather. It was day one of seven consecutive shifts. I looked into the mirror. A sullen face with sunken eyes stared back. As I was getting dressed, I felt fatigue trying to triumph over my body. Next came a nagging and rude cough that kept interrupting my sentences. I started to feel feverish, and sure enough, I measured a temperature …
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A sick doctor must show up to work. That’s wrong.
The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about the prevalence of serious medical errors and obscure the road to addressing the tragic phenomenon of death by medical error.
The analysis cites four observational studies on incidents that …
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The alarmist approach to medical errors solves nothing
Having recently watched a cable television recreation of the Clarence Thomas confirmation hearings, I am left thinking about how far some of us have come and how far some of us haven’t.
The confirmation hearings of Supreme Court Justice nominee Clarence Thomas in 1991 changed the concept of sexual harassment in the workplace by bringing the issue to the forefront. By the time, I started residency nearly 20 years after the …
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More needs to be done about sexual harassment in health care
You can’t pick your parents, and you can’t pick the side of your brain that you damage.
I always thought that injuries to the left side of the brain would be the worst, because that’s where the language centers generally are. And talking is basically all I do. But after seeing uncountable numbers of strokes and brain injuries, I’ve changed my mind. Right brain injuries are worse.
The right side of the …
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A patient with a right brain injury. And an accusation.
Here’s a leadership challenge: Get a group of highly independent, intelligent individuals to come together to build a boat. But imagine the blueprint for that boat is vague and untested. Now imagine that this boat must be built in choppy, progressively inhospitable waters, while said individuals are frantically treading water to stay afloat. Convincing these smart people that there’s a problem isn’t the issue. Convincing them to abandon their desperate …
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How I am leading doctors through change
Popular shows like Gray’s Anatomy, ER, and House, MD have given the television watching public a good eyeful when it comes to the inner workings of medicine, hospitals, and emergency rooms. They have also shown us how the personalities of those who take up the stethoscope and reflex hammer run the gamut from the sweet, demure, tentative types to the sons of bitches who cut first and ask questions later.
I …
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The stories of my medical school mentors
I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years.
But that doesn’t mean he’s always …
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What John Stossel gets right, and wrong, about health care
The last couple of decades have seen a dramatic shift of power and clout away from individual physicians and towards administrators and the business side of health care. In many ways, physicians have nobody but themselves to blame collectively; because for any large and respected group of people to surrender so much autonomy so quickly, a lack of strong leadership must always be a factor.
So many different reasons for this …
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The time a 28-year-old MBA told a physician where to round first
My father was killed by an Islamic fundamentalist in Cairo, Egypt when he was just 47 years old. It was October 1993, exactly eight months following the first World Trade Center bombing. Terrorism was still a new word — and a new concept — to many Americans, and so my father’s death was featured prominently on the evening news and in the New York Times.
For over 22 years, this has …
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Stories influence how I practice medicine. Here’s how.
Maybe it’s just me, and maybe this is a regional/local phenomenon, but I have noticed a sharp increase in the number of non-physicians who sport their white coats on a daily basis around the hospital.
First, let me preface this piece by saying I have absolutely nothing against any person who partakes in the care of patients; in fact, I commend all the helping hands that routinely dedicate themselves to health …
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Should white coats be only worn by physicians?
The practice of medicine has changed dramatically over the last couple of decades, with many of the changes unfortunately not so good for patients. It’s a well-known feeling among health care professionals, that among all the new elements of bureaucracy and information technology requirements and mandates, the one person who is often completely forgotten about is the patient. As someone who has worked up and down the east coast in …
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What would a patient’s dream doctor look like?
Heart of summer. Early August. All of Holland is on holiday. We are sitting in the flesh-colored morning light, in his back room, stuffed away behind the nurses’ station.
He is sick as hell and just 32. I am sitting next to his mother and his girlfriend. The intern and nurse are standing behind me, breathing carefully. He sits with his back to us, at his table. Visibly fighting for air. …
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This is what true patient care is about
Medicine has a fraught relationship with money. Dealing as they do with matters of life and death, doctors are loath to assign a dollar value to human life, preferring to avoid the subject altogether and instead provide the care that they deem appropriate no matter the cost. Insurance companies, on the other hand, make their business in rationing health dollars and have no such qualms: the consensus among them is …
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Academic medical centers balance dollars with resident education
