KevinMD.com: Social media’s leading physician voice
The KevinMD newsletterReal physician voices, twice a weekFree, and one click to unsubscribe.
Subscribe free →
NEWExperts by KevinMDPhysicians and health care experts, by specialty.Lynn R. WebsterPain medicine physicianChinyelu E. OraeduHospitalistShelly Haug MontiNeonatologistSarima ChindaDentistKenneth RoInternistJenny ShieldsClinical psychologistAmy Bourne RozellePhysical therapistJeremy HeffnerTrauma surgeonRavi S. AysolaPulmonologistAnthony GrandelisOB/GYN hospitalistShveta GuptaHematology physicianBarbara SparacinoPsychiatristAlexandro VasquezNurse practitionerGus W. KruckeInternistHomoud AldahashSkull base neurosurgeonAnne BaskakovaDigital health leaderSteve KaplanTechnology executiveJodie GreenNonprofit founderSyed NishatFinancial advisorBrowse experts

Hospital medicine

5,188 articles · Since 2004

Articles, page 82

Physician voices

This hospital was put out of its misery. Deservedly so.

7

Many stories have been shared by physicians detailing their experiences during their years as house officers. I trained at an inner city hospital in the early 1970s, and my story was unique. Hospital J was built in the early part…

Many stories have been shared by physicians detailing their experiences during their years as house officers. I trained at an inner city hospital in the early 1970s, and my story was unique.

Hospital J was built in the early part of the twentieth century. The structure was nine stories tall, with the ICU, the only air conditioned floor, located at the top. The elevators had not been automated and were still …

Read more…

This hospital was put out of its misery. Deservedly so.

Physician voices

The hospital’s homeless at night

Sometimes when I’m working at the hospital overnight, I go for walks. Every now and then, things calm down in the operating room, and you can get some time to relax. Life moves at such a break-neck pace, especially within…

Sometimes when I’m working at the hospital overnight, I go for walks. Every now and then, things calm down in the operating room, and you can get some time to relax. Life moves at such a break-neck pace, especially within the world of hospitals, that taking a moment to reflect, is beneficial.

Walking around a hospital at night is very different than during the day. During the day, it feels like …

Read more…

The hospital’s homeless at night

Physician voices

Doctors don’t have to wear a white coat to look professional

13

The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated…

The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated in a ballroom, which shared its building with a bowling alley, in the heart of Harlem.

It was particularly warm inside the building, and we were being served hot coffee while …

Read more…

Doctors don’t have to wear a white coat to look professional

Real physician voices, twice a week

Free, and one click to unsubscribe.

No spam. We never share your email.

Physician voices

As physicians, we learn much from our patients

5

When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of…

When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of strangers. She came to me hoping I could improve her appearance.

The abnormal connection between the arterial and venous halves of her circulatory system caused her cheek, jaw, and neck to …

Read more…

As physicians, we learn much from our patients

Physician voices

Physicians as innovators: 6 ways we help and hurt ourselves

4

The U.S. health care system is the world's top in health care spending per capita, but in terms of performance, we're dead last among developed countries. As a young physician embarking on a career in this landscape, it's glaringly obvious…

The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …

Read more…

Physicians as innovators: 6 ways we help and hurt ourselves

Physician voices

We let our professionalism suffer when faced with a difficult patient

14

“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s…

“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s blind.” Puzzled, I looked at my list of patients and, not sure whether I should write “violent” by this patient’s name, I decided instead to write “blind.” I paused. The …

Read more…

We let our professionalism suffer when faced with a difficult patient

Physician voices

5 things we can learn from the NHS doctor strike

5

The United Kingdom’s National Health Service has been facing something of a crisis over the last several months. For those of you unfamiliar with what’s been happening (the issue hasn’t really gained any media traction here in the U.S.), a…

The United Kingdom’s National Health Service has been facing something of a crisis over the last several months. For those of you unfamiliar with what’s been happening (the issue hasn’t really gained any media traction here in the U.S.), a majority of the country’s 55,000 junior doctors have been holding regular strikes. In the U.K., the way in which doctors train is very different from the U.S., with often over …

Read more…

5 things we can learn from the NHS doctor strike

Physician voices

Why young physicians should consider locum tenens

2

When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is…

When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be …

Read more…

Why young physicians should consider locum tenens

Medical education

The swastika-donning patient who refused his lactulose

4

As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis. His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and…

As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis.  His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and hepatic encephalopathy.

It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service …

Read more…

The swastika-donning patient who refused his lactulose

Physician voices

A child’s father knew when to let go. The health care team didn’t.

4

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…

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 …

Read more…

A child’s father knew when to let go. The health care team didn’t.

Health policy

When things go wrong operationally, nurses feel the pain first

7

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…

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, …

Read more…

When things go wrong operationally, nurses feel the pain first

Physician voices

A study on medical errors inflames, but doesn’t solve anything

18

For the last couple of days, the Twitter medical community has been discussing the latest in a long line of papers attempting to estimate the role of medical error as a cause of death. A recent entry appeared in the…

For the last couple of days, the Twitter medical community has been discussing the latest in a long line of papers attempting to estimate the role of medical error as a cause of death.

A recent entry appeared in the BMJ and was by a surgeon at Johns Hopkins, Dr. Martin Makary, who claims that 251,454 patients die from medical error every year.

Makary’s review extrapolated that figure from three papers …

Read more…

A study on medical errors inflames, but doesn’t solve anything

Physician voices

A black doctor’s perspective on perceptions by race

2

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…

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 …

Read more…

A black doctor’s perspective on perceptions by race

Physician voices

A sick doctor must show up to work. That’s wrong.

15

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…

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 …

Read more…

A sick doctor must show up to work. That’s wrong.

Physician voices

The alarmist approach to medical errors solves nothing

3

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 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 …

Read more…

The alarmist approach to medical errors solves nothing

Physician voices

Fixing medical errors is more difficult than you think. Here’s why.

16

Recently, a paper written by researchers at Johns Hopkins asserted that medical error was the third leading cause of the death in the United States. This received -- as you might imagine -- considerable coverage in the media. The researchers…

Recently, a paper written by researchers at Johns Hopkins asserted that medical error was the third leading cause of the death in the United States.  This received — as you might imagine — considerable coverage in the media.  The researchers proposed that death certificates should include a qualifier or indicator that medical error was linked to the death, if in fact it was, so that better statistics could …

Read more…

Fixing medical errors is more difficult than you think. Here’s why.

Physician voices

Hyperbole is seldom helpful. Especially when it comes to medical errors.

6

Josef Stalin famously said: "One death is a tragedy; one million is a statistic." Perhaps 250,000 preventable deaths from medical errors, according to an analysis by Makary and Daniel in the BMJ, maketh a Stalin. The problem with Makary’s analysis,…

Josef Stalin famously said: “One death is a tragedy; one million is a statistic.” Perhaps 250,000 preventable deaths from medical errors, according to an analysis by Makary and Daniel in the BMJ, maketh a Stalin.

The problem with Makary’s analysis, which also concluded that medical errors are the third leading cause of death, isn’t the method. Yes, the method …

Read more…

Hyperbole is seldom helpful. Especially when it comes to medical errors.

Physician voices

More needs to be done about sexual harassment in health care

2

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…

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 …

Read more…

More needs to be done about sexual harassment in health care

Physician voices

A patient with a right brain injury. And an accusation.

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…

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 …

Read more…

A patient with a right brain injury. And an accusation.

Physician voices

How I am leading doctors through change

10

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,…

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 …

Read more…

How I am leading doctors through change

152
pages