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 85

Health policy

Am I a health care business metric or a physician?

50

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…

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 …

Read more…

Am I a health care business metric or a physician?

Medical education

A quantitative analysis of the first year of internal medicine residency

2

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…

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 …

Read more…

A quantitative analysis of the first year of internal medicine residency

Physician voices

A potential real-life consequence of alarm fatigue

2

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.…

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 …

Read more…

A potential real-life consequence of alarm fatigue

Real physician voices, twice a week

Free, and one click to unsubscribe.

No spam. We never share your email.

Physician voices

Physician engagement scores are poor. How hospitals can improve them.

31

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…

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 …

Read more…

Physician engagement scores are poor. How hospitals can improve them.

Physician voices

A Muslim-American doctor on the racism in our hospitals

90

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,…

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 …

Read more…

A Muslim-American doctor on the racism in our hospitals

Conditions and diseases

A nurse is confronted with the death of his mother

3

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…

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 …

Read more…

A nurse is confronted with the death of his mother

Physician voices

Noise pollution is an epic problem in hospitals

4

Me: Hello Mrs. Smith, my name is Dr. Gandolfo and I am a gastroenterologist. Your doctor wanted me to talk to you about something that showed up on your CT scan. Mrs. Smith: Who are you? I didn’t hear your…

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 …

Read more…

Noise pollution is an epic problem in hospitals

Physician voices

Customer service in health care: Does AIDET really work?

8

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…

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 …

Read more…

Customer service in health care: Does AIDET really work?

Physician voices

The evolution of the medical second opinion

5

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…

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 …

Read more…

The evolution of the medical second opinion

Physician voices

Create magic, one patient at a time

7

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…

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 …

Read more…

Create magic, one patient at a time

Physician voices

A side of doctors patients usually don’t see

"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…

“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 …

Read more…

A side of doctors patients usually don’t see

Physician voices

Reducing hospital readmissions shouldn’t be that difficult

55

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…

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 …

Read more…

Reducing hospital readmissions shouldn’t be that difficult

Health policy

The problem with penalizing poorly performing hospitals

4

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…

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.

A recent study from researchers in …

Read more…

The problem with penalizing poorly performing hospitals

Physician voices

The story of how this doctor lost his first patient

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…

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 …

Read more…

The story of how this doctor lost his first patient

Physician voices

Hospitals need a checklist for the patient experience

5

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,…

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 …

Read more…

Hospitals need a checklist for the patient experience

Physician voices

What physicians experience today is feigned intimacy

22

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,…

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 …

Read more…

What physicians experience today is feigned intimacy

Physician voices

A life-threatening condition cannot dampen the human spirit

2

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…

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 …

Read more…

A life-threatening condition cannot dampen the human spirit

Medical education

Sometimes I see my ghosts in the form of my patients

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…

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 …

Read more…

Sometimes I see my ghosts in the form of my patients

Physician voices

Discharged too early? The decision is more complicated than you think.

2

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…

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 …

Read more…

Discharged too early? The decision is more complicated than you think.

Physician voices

A patient is remembered. He lived life the way he wanted.

"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,…

“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 …

Read more…

A patient is remembered. He lived life the way he wanted.

152
pages