Every business on earth has an angle on the market. Business leaders around the world work tirelessly, attempting to edge out their competitors by delivering the best service to their customers. When all is said and done, physicians want to deliver the best care they can to each patient. As medical students who are eager to serve, we are committed to examining the space where business and medicine intertwine …
Create magic, one patient at a time
“What is your personal experience with human suffering?” he asked. Fellowship interview season. Interviewing for pulmonary and critical care, one may expect such a question. I thought I was ready for it. But the simple truth is that I didn’t really have the right answer; I probably never will.
During the morning rounds, my attending physician heaved a weary sigh: “150,000 people die every day!” Out of the blue. I quizzingly …
A side of doctors patients usually don’t see
Part of a series.
Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling.
Why …
Reducing hospital readmissions shouldn’t be that difficult
All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients.
The problem with penalizing poorly performing hospitals
During medical school, we are taught the physiology, anatomy, and pathophysiology of hundreds of disease processes. One thing medical schools don’t teach well is how to cope with losing a patient. Some physicians will go many years as a physician before having their first patient die on them. Others will lose a patient earlier on during their career. I was the latter. I hadn’t even graduated from medical school yet …
The story of how this doctor lost his first patient
Earlier this year, when my mother was briefly hospitalized, nobody gave her the wrong medication (her wristband was checked before each medicine was dispensed). Nobody missed a high or low blood pressure (her vital signs were taken every few hours, like clockwork). She was usually assisted to the bathroom so she wouldn’t fall (a sensor on her bed triggered an alarm if she started to get up).
Thank goodness for hospital-based …
Hospitals need a checklist for the patient experience
Walter was far older than his chronological age. A mere thirteen years, he kept company with a much older crew. Doctors, nurses, and CNAs were his constant companions. The other kids on his floor were either too sick to interact, or came and left within a matter of days. But not Walter. His heart was too weak to allow his departure, but too strong to be first in line for …
What physicians experience today is feigned intimacy
My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better …
A life-threatening condition cannot dampen the human spirit
On my medicine sub-internship, I took care of an elderly man who was a retired military surgeon. When he first came into the hospital, mentally altered from an underlying infection, he was irascible and unpleasant towards many staff members, swatting their hands away as they attempted to draw blood for lab tests.
As the infection came under control, the shell of rage fell away to a quiet dissatisfaction. The bed was …
Sometimes I see my ghosts in the form of my patients
Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right?
First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right …
Discharged too early? The decision is more complicated than you think.
“Donald passed away.”
We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces. The smiles were born out of a personal experience with him in …
A patient is remembered. He lived life the way he wanted.
Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?
After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily …
Why it’s time for doctors to ditch their white coats
I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader. In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts: 1) I must be getting old; and, 2) This isn’t going to be easy.
I came up with the following list of lessons that I’ve learned …
6 tips to be a great physician leader
ADVERTISEMENT
Her nails were painted.
She probably had them done just a couple of days ago. The bright red polish glistened on her perfectly filed fingernails. She had her toes done too.
Was she preparing for the holiday season? Had she begun her Christmas shopping yet? Was she making a list of new year’s resolutions?
It didn’t matter anymore.
She was lying there. The cold metal table provided the platform for her lifeless, still body. …
A vow to live a little more and worry a little less
Dear Fizzy, MD:
Your article on part-time physicians “ruining” medicine really struck a chord with me. That you, as a mother and a wife, chose to prioritize your wholeness and family above career is commendable. I applaud your courage to chart your own course in the face of a work culture that undermines your wellbeing while at the same time, expects you to deliver health and healing to others …
The guilt and shame heaped on part-time physicians must stop
Two decades ago, I admitted a patient to the intensive care unit for a heart attack. His children were grown, and he looked forward to retirement purchasing an RV to relax and travel the country with his wife.
Invasive cardiac technology had not evolved, so he remained in the ICU on intravenous medication to control his symptoms. On the fifth hospital day, his wife brought a letter from the insurance company …
The corporate practice of medicine is overwhelming American health care
Physician cure thyself.
After 30 years of participation in multiple medical staffs, including small regional hospitals and large academic settings, there is one constant that continually undermines how content physicians are with their medical practice and the health care system. Many challenges in patient care seem insurmountable. From declining reimbursements to intensified quagmire of bureaucracy, the practicing physician, whether employed or not is berated by administrative authorities with no experience in …
How to change from a divisive to a collaborative medical staff
“Help me stop doing this.”
Mr. G was a 55-year-old homeless man who uttered these words to us during his fifth hospitalization for problems related to his alcohol use: intoxication, falls, and alcohol withdrawal. He was on a downward spiral through the hospital’s revolving door and felt helpless. As a medical team, we felt helpless too. We did not know how to address his real problem—his cycle of addiction.
Hospitalized patients like …
Hospitalization for patients with alcohol use disorder: A teachable moment
With the depths of winter just around the corner, doctors and nurses everywhere know what’s about to hit them over the next few months. The inevitable surge in hospital admissions during colder weather is almost as predictable as knowing the leaves will be falling off the trees in the fall.
As someone who has worked in several different hospitals over the last few years, ranging from small rural institutions to large …
Hospitals and doctors should better prepare for winter. Here’s how.
There was a time within my professional lifetime when old records would arrive on the medical ward in a wheeled wire basket, multiple volumes with shabby pages. And in the VA of the 1980s, which still had veterans of World War I who never lived anywhere else the previous half century, the forklift could deliver not only the charts but the x-ray films that had not yet been sent to …
The demise of the hospital discharge summary
Get free updates delivered free to your inbox.
