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…
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.
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…
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 …
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…
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:
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,…
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.
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…
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 …
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…
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, …
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 a lot of…
“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.
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…
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 …
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…
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 safety concerns that keep clinicians awake at night often aren't issues that you could fit onto a safety and quality dashboard. They aren't the kinds of things that feed metrics on the CMS Hospital Compare website or any of…
The safety concerns that keep clinicians awake at night often aren’t issues that you could fit onto a safety and quality dashboard. They aren’t the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so.
This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based …
Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to…
Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. …
Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything…
Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008…
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
My husband and I both like to run. I run about 3 miles once or twice a week -- if the weather’s not too bad, and if I don’t have something else going on. Keith, on the other hand, runs…
My husband and I both like to run. I run about 3 miles once or twice a week — if the weather’s not too bad, and if I don’t have something else going on. Keith, on the other hand, runs half marathons. He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week. He runs in the heat, rain …
In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers…
In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately affect those …
I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on…
I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together.
Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don't…
Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don’t find their news worth passing along, but occasionally a pitch sparks a column idea. That’s the case with the press …
“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed. I was also shaking. I had been covering…
“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed.
I was also shaking.
I had been covering nine patients that night. Almost none were stable. In the span of one shift, we called three rapid responses. One person went into cardiogenic shock right in front of me was transferred to …
Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the…
Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. …
Since the first day of medical school, I was in breathless anticipation of my third year. I came to Harvard with a background in creative writing and the big draw of medicine for me lay in its compendium of human…
Since the first day of medical school, I was in breathless anticipation of my third year. I came to Harvard with a background in creative writing and the big draw of medicine for me lay in its compendium of human stories.
In college, I volunteered at local hospitals where my primary responsibility was to go knock on patients’ doors and keep them company for a little while. This was awesome. Few …
