When Donald Trump announced that he was running for president last summer, most people didn’t know quite what to think. Was this serious or some sort of publicity stunt? Would he be in the race for more than just a few weeks of intense media spotlight? Would he be able to stand on a stage and debate other politicians? No matter what side of the political spectrum you fall on, …
Is there a Donald Trump at your hospital?
On a typical day in a major hospital, patients pass through the emergency room with different ailments. Some of them are coming in to check out minor aches and pains, and others are coming in barely responsive with a life-threatening condition. Outside of the pediatric ward, all of the patients coming in are adults, and the majority of them are advanced in years, showing signs of chronic conditions taking effect …
How a young doctor treats young patients
I’ve written a lot lately about caring for our patients, and about caring for our spouses, and those things make me very happy. But now and then, things rub me the wrong way.
I was recently working at TMH, or Tiny Memorial Hospital, my vague name for small facilities since I work at several and wish to preserve their anonymity. While there a patient checked into the ED for a fairly unremarkable …
HIPAA doesn’t apply to rich hospital donors
38 states currently have an apology act. This means that if doctors feel they owe a patient an apology, they may provide one without any ramifications, if future legal actions are taken by the patient/patient’s family.
In 2006, I spent 218 days in the hospital after the healthy birth of my daughter. My chronic autoimmune disease, scleroderma, masked certain signs of preeclampsia, which went undiagnosed. This led to a massive infection …
Medical mistakes happen. It’s what doesn’t follow that is unforgivable.
A road trip from Georgia to New York was going splendid, dare I say, wonderful — catching up with old friends and family — when it took an unforeseen and slightly less desirable turn: I got admitted with a small bowel obstruction. Thanks to truly excellent care from a community hospital, I am home and now subjected to endless computer questions from my father that has me briefly contemplating readmission …
True confessions of a hospitalized hospitalist
As standardized exam scores increasingly define success for students, teachers and schools, parents worry about the dangers of “teaching to the test” — and of their children being judged by tests with low or unknown validity. We want our children to perform well on tests, of course, yet only if they measure something that students, patients, and teachers believe really matter. We also want the education system to inspire students …
Doctoring to the test: The unintended consequences of performance measures
Most physicians are smart and very talented. They’re skilled clinicians and technically superb. But despite such abilities, they fail to get others to follow them, once they take on the role of leader. As a consequence, they’re unable to get physicians to change or improve performance.
Jay Conger, a professor of business at Claremont McKenna College who has devoted his career to the study of leadership, has helped me understand why …
5 reasons why physicians fail as leaders
I’ve been following Marissa Mayer’s tenure for nearly four years at Yahoo. Not just because I was initially tapped to lead athenahealth’s integration of another mature advertising-driven mobile company — Epocrates — but because Yahoo, with its complexity and technology legacies, and highly competitive, fast-paced market environment, reminds me of many of the country’s largest health care delivery systems.
Both are facing significant headwinds to stay relevant in their respective industries …
What health care leaders can learn from Yahoo’s failure
It’s 2:00 a.m., and the fluorescent bulbs flicker gently overhead along the quiet hallways of the intensive-care unit.
Tonight I’m the ICU resident on call, and the weight of that title sits heavily on my shoulders. My team is in charge of keeping our critically ill patients safe from harm overnight. Although the supervising physician is only a phone call away, I’m the acting team lead for any codes called during …
No textbook can teach doctors the stages of grief
I recently finished 2 weeks of inpatient hospital service, and the sense of relief was so palpable it felt like taking a breath after swimming the length of a pool underwater. At first, there is anxiety and a sense of excitement at the challenge, but soon you feel strong and assured that you’ve got this under control. The house …
An oncologist reflects on his inpatient internal medicine service
An excerpt from Road Warrior Physician: Locum Tenens a How-to Guide.
There are few things that are more frustrating than to be delayed while en route to your assignment. It happens, so be prepared for it. Keep all travel emergency contact numbers handy. This is one of my prime Evernote …
Helpful tips for your first day at a new hospital
The title of Noam Scheiber’s January 9, 2016 New York Times piece on hospitalists, “Doctors Unionize to Resist the Medical Machine,” skirts the bigger issue for doctors, which has less to do with contracts, salaries and labor relations, and much more to do with the question, “Is health care just another business, and if so, can physicians be managed that way?”
I’m a silverback hospitalist, and when I started …
Am I a health care business metric or a physician?
In a few weeks, thousands of medical students find out where they have matched for residency. I still remember the excitement and anxiety of peeling back that envelope and hoping I would see my top choice. My medical school had a tradition of putting each 4th year’s name in an old doctor’s bag. One by one, our dean would pull out a name, the student would contribute $1 to the …
A quantitative analysis of the first year of internal medicine residency
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I felt like the stack of charts rose past my head and all the way to the ceiling. I pulled out my pen, opened the first, and started charting. I took a moment before each note to collect my thoughts. The patients were complex, the problems sometimes insurmountable. The nursing station at the facility was buzzing with activity around me. Phones were ringing, alarms were crying for attention.
On the desk …
A potential real-life consequence of alarm fatigue
Many hospitals around the nation have been stung by dreadful physician engagement scores. Engagement is a problem not only for demoralized physicians, but for health care organizations, their employees, and everyone they serve. They should take note, because low levels of engagement are associated with higher physician turnover, increased error rates, poorer rates of patient cooperation in treatment, and lower levels of patient satisfaction.
Definitions of engagement vary, but it generally …
Physician engagement scores are poor. How hospitals can improve them.
Recently, the wife of a prominent Boston businessman — one of my many wealthy, white patients at Massachusetts General Hospital — greeted me this way: “So what foreign medical school did you go to anyway?”
For background, I’m a petite, Middle Eastern young woman with a headscarf, and I’m guessing I do not resemble her vision of what a doctor “should” look like. That image is probably taller, whiter, male and …
A Muslim-American doctor on the racism in our hospitals
It will be six months since my mother passed away.
I kept my mother’s illness a secret. Not because I was ashamed and embarrassed but I did not want to advertise to the entire world of what she was going through out of respect to her and my family. So you sit there, put on a front like everything is cool and continue on your daily routine, until one day everything …
A nurse is confronted with the death of his mother
Me: Hello Mrs. Smith, my name is [BEEP!] Dr. Gandolfo and I am a [BEEP!] gastroenterologist. [BEEP!] Your doctor wanted me to [BEEP!] talk to you about something that showed up on [BEEP!] your CT scan.
Mrs. Smith: Who are you? I [BEEP!] didn’t hear your name?
Me (louder): It’s Fred Gandolfo, I am the [BEEP!] stomach doctor. [BEEP!] I need to talk to you about [BEEP!] that CT scan you had. You see, there was … [BEEP!] [BEEP!] [BEEP!] Can you straighten your …
Noise pollution is an epic problem in hospitals
Mnemonics can be incredibly cool. When I was in medical school, there was just too much stuff to remember and memory aids were so very helpful. Most specifically I refer to the vile and inappropriate one that helped me remember the cranial nerves which I remember to this day and will not share in print.
In ancient times orators used memory palaces to memorize long speeches or poems, associating words with …
Customer service in health care: Does AIDET really work?
Requesting a second opinion can be a touchy subject for a patient. I’d like to think that when I was in practice, I was never offended when a patient’s family requested a second opinion, but that probably doesn’t universally reflect my response in every circumstance. But I am confident in saying that as often as not, I would be the one suggesting that we get another pair of eyes to …
The evolution of the medical second opinion
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