If you delve into the personal stories of health IT innovators, most journeys rest on their personal interaction with the health care system on behalf of themselves, a parent, a child, or perhaps a sibling. Just a few weeks ago, I had a small interaction with the health care system that confirmed many of the impressions I have developed of providers’ strengths and weaknesses.
There’s no way to start except with …
How health IT fails transgender patients
It’s tempting to blame it all on Henry Ford. I was standing alone at the empty counter, waiting to order in a fast food joint at 9 p.m. Off to my left, three or four carloads of customers had been served before anyone noticed me and came over to ask what I wanted. After all, Henry gave us the mass-produced (and therefor affordable) automobile. I wondered if the day …
Patient satisfaction surveys and accidental pickles
One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn’t shocking. The patient hadn’t been doing well lately, and I wasn’t surprised when I got the message that they were on the way to the emergency room.
Due to our …
Primary care is a story of misaligned incentives
One of the things that I love about my job as a hospitalist is the ease with which we can develop friendships with colleagues from other disciplines. Since I am an inpatient physician, it’s not surprising that some of my good friends are cardiologists, nurses, endocrinologists, physical therapists and, of course, other hospitalists. In fact, I met my neurosurgeon husband while co-managing his patients at the hospital. While thinking about …
Why can’t more hospitalists and emergency physicians be friends?
He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway.
Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries.
The day of …
Breaking the vicious cycles in medicine
The enormous push continues to reduce readmissions, due in no small part to stiff financial penalties from CMS for the worst performing hospitals. The most commonly cited statistic is that about 1 in 5, or 20 percent, of Medicare patients are readmitted within 30 days. A staggeringly high number when you think about it. Having discharged thousands of patients and seen the characteristics of those patients that are frequently readmitted …
3 ways to help reduce hospital readmissions
What is it worth to be treated in a hospital with a stellar patient safety record rather than one with lower performance?
For a large majority of survey participants in a recent study by researchers from the Altarum Institute and Drexel University, the answer is quite a lot. Published online last month in the Journal of Patient Safety, the study found that most respondents would choose a hospital with a …
How much more would you pay for hospital safety?
Improving patient engagement is a subject that’s being talked about in hospital boardrooms across the country. It’s become the in-fashion political buzz phrase. Certainly sounds very well and good, but what exactly does it mean?
Likely different things to different people depending on what angle they approach it — all the way from a care assistant up to the hospital CEO. In a nutshell, it’s all about allowing the patient to …
5 ways to improve patient engagement in hospitals
My earliest memories of medicine take me back to dinner table conversations with my mother, who is a physician. She would share with us her daily stories, telling us about patients she took care of in her clinics and in the hospital. As an internist, she often found herself traveling between many locations. I grew up knowing this to be medicine. As I have progressed in my career as a …
Is reactive scheduling for hospitalists a good idea?
My department had a problem that harmed patients on at least a weekly basis. It was well-known, but it seemed there was no viable solution.
My supervising attending was in his seventies and highly regarded at my hospital, having held powerful administrative positions for decades. About ten or so years ago, he stepped down from running the hospital, and …
An attending threatens patient safety. A resident blows the whistle.
I can recall, though it seems quite long ago, my first basic life support (BLS) course as a first-year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you OK?” Then hearing no response she showed us how to …
Should ACLS certification be mandatory?
I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second career path, I have been planning my career in hospital medicine since the beginning of my residency training.
The things that drew me …
A day in the life of a hospitalist
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work …
Hospital credentialing is one giant mess
ADVERTISEMENT
Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010. Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act. Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure.
But is consolidation the clear-cut answer?
Here are 4 reasons bigger actually may not be better for all hospitals:
1. Disparate …
Hospital consolidation: 4 reasons why bigger isn’t better
There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere.
Another excellent article in the Wall Street Journal last week extensively discussed the factors behind …
Don’t quit medicine. Here are 5 reasons why.
I think I will become a neurosurgeon. Tomorrow.
It shouldn’t be too hard, right? I’m a breast cancer surgeon, and that is kind of like being a neurosurgeon, isn’t it? I wear scrubs and know how to tie knots really well. OK, maybe I don’t know much about the brain, and the last time I was on a neurosurgical team was during …
Why hospitals have to dramatically change their missions
No one wants a hospital-acquired infection — a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak — better termed paranoia than legitimate concern.
The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, …
The paranoia surrounding hospital infection rates
“If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life.”
These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life.
I spend …
Medical errors: We can’t trust doctors to get it right
Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …
Health care’s future: An interview with a hospital CEO
There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …
The 80-20 rule: Apply Pareto’s principle to hospital medicine
Get free updates delivered free to your inbox.
