Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

Buying physician practices does not equate to clinical integration

Health Policy
September 14, 2014

I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.”

I guess that would depend on your definition of clinical integration.

The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, …

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Buying physician practices does not equate to clinical integration

Teach back: Reduce the costs of poor patient education

Patient
September 13, 2014

There is a saying in the world of education, “You have to care to teach.” Why is it then in health care, a profession of and about caring, we do such a poor job of teaching our patients?  Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient …

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Teach back: Reduce the costs of poor patient education

What is a gomer? And why should you know about it?

Video
September 12, 2014
YouTube video

Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

What is a gomer? And why should you know about it?

There is no concern for the discomfort of the patient

Physician
September 10, 2014

She was having excruciating pain in her pelvic area.  I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs.  I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart.  ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain.

The emergency room physician had dutifully …

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There is no concern for the discomfort of the patient

Miscommunication added to the cost of neurosurgery

Patient
September 8, 2014

A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.”

In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care — the added cost of additional care, additional hospitalizations, and the additional …

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Miscommunication added to the cost of neurosurgery

Her life made her into the physician she is today

Physician
September 6, 2014

I became a physician in 2001, after originally having a career in business. I wanted to become a doctor to be able to do something important. I felt that if I needed to work, and to leave my children in day care, I at least wanted to be doing something that was meaningful to me. My job as a business manager didn’t fulfill me in that way.

Over the years, I’ve …

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Her life made her into the physician she is today

Once more, I had learned my lesson about pain and vulnerability

Physician
September 6, 2014

The nasogastric tube was killing me. It had been in place for twelve hours now, threading its way up my nose and down my throat, past my esophagus, into my stomach. Try as I might, I couldn’t swallow away the nasty lump stuck to the back of my throat. And every time I tried, it hurt.

Decades before, as a physician-in-training in upstate New York, I’d put in more nasogastric (NG) …

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Once more, I had learned my lesson about pain and vulnerability

Should hospital physicians only work on one floor?

Physician
September 5, 2014

A major debate taking place in the hospital medicine community over the last several years concerns the way in which we cohort patients on the medical floors. The traditional way is to have patients belonging to each doctor scattered across the hospital on several different floors. This is in contrast to designing a geographical system where all the patients for any one doctor are located on a single floor.

On the …

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Should hospital physicians only work on one floor?

How to be a great health care administrator

Physician
August 29, 2014

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In no other field is unity and collaboration between administrators and frontline staff more important than in health care. Unfortunately my own experience is that the disconnect and mistrust, especially from doctors and nurses, towards hospital administration is growing larger all the time.

Let me start off by saying that I have intimate experience of both sides of the divide. Obviously as …

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How to be a great health care administrator

Hospitals are taking a page from the big pharma playbook

Health Policy
August 28, 2014

I recently wrote about a hospital system in Colorado that had discovered a way to cross market its more profitable emergency room services if a patient first came to its urgent care center. Pretty clever! Then recently I came across another health care marketing trick close to home and just as sly. As I sat on a New York subway one sizzler of a day, an ad for an ice cream …

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Hospitals are taking a page from the big pharma playbook

DNR/DNI: More code than status

Physician
August 25, 2014

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …

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DNR/DNI: More code than status

Sleep isn’t a luxury. It’s a medical necessity.

Conditions and Diseases
August 24, 2014

Most hospitals are strapped with a massive amount of debt.  Not monetary debt, but sleep debt.   Amongst both the staff and patients, sleep is severely lacking.  In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day.  But sleep isn’t a luxury.  Rather, it’s a medical necessity.

Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood …

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Sleep isn’t a luxury. It’s a medical necessity.

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What a golf course taught me about patient satisfaction

Physician
August 20, 2014

Over the last year I’ve become rather addicted to golf. Having always been more into cardiovascular sports I’m actually quite surprised with how much I’ve taken to it. Fresh air, outdoors, lots of walking in beautiful nature and spending time with friends — what is there not to like?

Anyway, I’ve frequented several different courses in the Boston area in just the last few months. Last week, we were due to …

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What a golf course taught me about patient satisfaction

Quality measures benefit from quality improvement

Health Policy
August 16, 2014

I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes.

Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA).

But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can’t always …

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Quality measures benefit from quality improvement

A letter from a hospitalized patient to a hospital CEO

Physician
August 13, 2014

We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few …

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A letter from a hospitalized patient to a hospital CEO

At the hospital, I’m Dr. Nobody

Physician
August 12, 2014

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.

I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …

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At the hospital, I’m Dr. Nobody

10 potential benefits of robot caregivers

Health Technology
August 10, 2014

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My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy.

I have to admit that my own first reaction to the topic was captured in the Times’ letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … is …

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10 potential benefits of robot caregivers

Learning from the lessons of night float

Medical Education
August 9, 2014

No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving …

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Learning from the lessons of night float

MKSAP: 72-year-old man with community-acquired pneumonia

Conditions and Diseases
August 9, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old man is hospitalized for treatment of community-acquired pneumonia. Despite 4 days of treatment with intravenous fluids and antibiotics appropriate for the bacteria cultured from sputum and blood, he remains febrile with mild tachycardia. The patient subsequently develops mild hypotension and is transferred to the intensive care unit. Results of two …

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MKSAP: 72-year-old man with community-acquired pneumonia

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