I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …
Mr. U* came to the hospital overnight with severe heart failure. His breathing was supported by a ventilator and he was sedated. Thus, our primary means of communication was via his daughter. His daughter, distraught, stayed awake through most of the night. She appeared suspicious about her father’s care, immediately asking my credentials when I entered the room and demanding that we discuss treatment decisions with her alone. The next …
The story of Chesley “Sully” Sullenberger — the “Miracle on the Hudson” pilot — is a modern American legend. I’ve gotten to know Captain Sullenberger over the past several years, and he is a warm, caring, and thoughtful person who saw, in the aftermath of his feat, an opportunity to promote safety in many industries, including health care.
As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other …
Managing diabetes is all about control: controlling what you eat, when you eat, and the amount of insulin you give yourself. As someone with type 1 diabetes, I understand how control over one’s blood glucose levels is vital to maintaining a healthy lifestyle. When I was hospitalized due to a car accident, however, I saw how the hospital’s desire to control my care ended up costing my insurance company more …
As a traveling physician, I’m often asked if I have a favorite place to work. Since I have licenses in 14 states, I have an unusual vantage point from which to compare hospitals. I know that people who ask this question presume that my answer will be heavily influenced by the town where the job is located, and all the associated extra-curriculars, environmental peculiarities (ocean, mountains, desert), and potential amenities. …
Our specialty of hospital medicine has grown exponentially over the last decade and now finds itself at the forefront of American medicine. I’m proud to be part of such a growing movement and must say that I find the job just as rewarding as when I first became an attending physician when the specialty was still in its fledgling stage.
As the number of us soars towards the 50,000 mark, the …
Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay, so I agreed to provide feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay, I would have filled the form more enthusiastically.
The July Effect is a relatively well-known reference to the influx of new trainees entering hospital systems annually on the first of the month. Researchers have attempted to investigate the impact of the new trainees on patient outcomes with divergent conclusions. Despite the ongoing debate, educators in medicine recognized the need to prepare medical students for day 1 of residency training, by establishing core competencies to evaluate the preparedness of students. One such example …
Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession — usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor …
American physicians have had it. We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers. The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore. “You have it better than most people.” “You are still making good money.” “Your …
Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small …
As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.
Same with the doctors. The hospital would pretty much let us do what …
In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 — a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month.
This is such a familiar story by now that it hardly makes …
No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damages … “
– Assaults Upon Medical Men. Journal of the American Medical Association, 1892
It’s happened again: A well-liked doctor is killed by his patient. Last year’s horrific death of a physician in our community, a …
The Centers for Medicare and Medicaid Services (CMS) has put its foot down, this time on the side of patients. Many hospitals charge you more for the same outpatient tests you get in your doctor’s office. Sixty-six different services are being targeted by CMS to leverage the playing field.
Are the tests really all that different?
We are not talking about inpatient tests that happen when you are sick enough to be …
Even as I lay perfectly still in the near-complete silence of my car, I could hear Dr. Tierney’s adenoidal voice in my mind. He always seized every opportunity to assure us that his diagnostic or therapeutic approach to patients was firmly supported by the …
One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider. This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters. The format is pretty standard no matter what medium is chosen. You thank the referring doc for the consult request, you give some brief background info about the patient in question, and …
In the busy world of hospital medicine, where doctors and nurses find themselves rushed off their feet for most of the day, time to sit down and actually listen to patients is at a premium. Every doctor knows that our primary focus has to be on the most important aspects of the history and clinical examination in order to get to …
