Hospital medicine

5,188 articles · Since 2004

Articles, page 97

A factory model of health care can only go so far

November 20, 2014Nov 20, 201410

What we are trying to do is create a system that gets rid of the human factor. - an internal medicine physician I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as…

What we are trying to do is create a system that gets rid of the human factor.
– an internal medicine physician

I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as a resident who writes poems and reads novels in my free time. To my surprise no else blinked an eye. And why should they? The concept that physicians’ humanity and empathy shape health …

Medical education

Disciplined physician communication saves lives

Val Jones, MD

November 14, 2014Nov 14, 2014

I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift change resulted in a 30 percent …

Health policy

Patients should not have to advocate for their own safety

Marc-David Munk, MD

November 14, 2014Nov 14, 20142

Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash. I wish we could say the same for the U.S.…

Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash.

I wish we could say the same for the U.S. health care system. Nationally, problems with health care quality (doing too much, doing the wrong things, and doing too little when indicated) are pretty clear. The bigger problem is that the progress …

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Health policy

Money has always been and will always be a big part of medicine

Edwin Leap, MD

November 11, 2014Nov 11, 201419

Medicine is not about money, except when it is. When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor's offices, clinics, hospitals and…

Medicine is not about money, except when it is.

When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor’s offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the …

Physician voices

When the patient treats the doctor

Wes Fisher, MD

November 10, 2014Nov 10, 2014

Another day, another pacemaker, at least so it seemed at first. The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were…

Another day, another pacemaker, at least so it seemed at first.

The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories. He laid there, smiling, knowing he’d made the right decision after years of struggling with his arrhythmia in other ways. His heart was showing signs of slight weakening and …

Read more…

When the patient treats the doctor

Physician voices

Glory days: Is a golden age of medicine on our doorstep?

Suneel Dhand, MD

November 9, 2014Nov 9, 20149

The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I’d say that a sizeable number of physicians that I work with are towards the…

I find that these doctors, typically over the age of 50, are struggling the most to keep …

Health policy

Medicare punishes hospitals for taking care of poor people

Peter Ubel, MD

November 6, 2014Nov 6, 20147

Such a no-brainer: If patients who receive care at hospital A are more likely to get readmitted to the hospital 10, 20 or 30 days after discharge than patients in hospital B, then hospital A must be doing something wrong. Perhaps clinicians at that hospital are less adept at diagnosing and managing patients’ problems. Perhaps the follow-up care at hospital A …

Health policy

As hospitals reduce costs, will patients see the savings?

Alexandra S. Brown, MD

November 5, 2014Nov 5, 20149

We’re ready to work on cost savings, just not for patients. There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care. One of the paradigm shifts is for hospitals to embrace the strategy…

We’re ready to work on cost savings, just not for patients.

There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care. One of the paradigm shifts is for hospitals to embrace the strategy of cost reduction as opposed to the traditional focus on top-line revenue. In a system that focuses on value rather than volume, increasing the amount of hospital resources a patient consumes …

Health technology

Transition of care: A letter to ACO General Hospital

Rob Lamberts, MD

November 2, 2014Nov 2, 20148

Dear ACO General Hospital: Thanks for contacting me about my most recent blog post. I'm sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy…

Dear ACO General Hospital:

Thanks for contacting me about my most recent blog post. I’m sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients. At your request I hid even more of that information.

I know it’s kind of embarrassing to have that kind of thing made public, and I am overall …

Physician voices

Hospital observation status: The truth must come out

Melinda J. Johnson, MD

October 31, 2014Oct 31, 201431

The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that…

The observation status problem has continued to grow both larger and worse.

My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status. CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic.

We don’t decide to make a patient observation …

Physician voices

The lessons hospitals and physicians can learn from Ebola

David Klein, MD

October 30, 2014Oct 30, 20148

Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element…

That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health …

Physician voices

Patient satisfaction: Should that be the real mission of health care?

Suneel Dhand, MD

October 29, 2014Oct 29, 201469

As the patient satisfaction movement races full steam ahead, the time is perfect to regroup and define what this whole thing is really all about. Anyone involved in health care, and particularly hospital care, knows that the term “patient satisfaction”…

As the patient satisfaction movement races full steam ahead, the time is perfect to regroup and define what this whole thing is really all about.

Anyone involved in health care, and particularly hospital care, knows that the term “patient satisfaction” has become a buzz phrase recently. Sadly too it’s also evolved into a bit of a bumper sticker in hospital administration circles …

Health policy

Health reform: Great for patients, but this doctor lost his job

Anonymous

October 28, 2014Oct 28, 201460

As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic …

Physician voices

Too many cooks in the kitchen can spoil medical care

Adam Bitterman, DO & Shalin Shah

October 28, 2014Oct 28, 201419

There are times when a common cliché may be the best way to describe academic medicine in today’s medical centers. In fact, I have heard patients and their families complain about this, way too often. Simply put, there are many…

When someone gets admitted to the hospital, chronic problems …

Physician voices

A physician undergoes hip surgery: 10 observations from bedside

Staci Mandrola, MD

October 28, 2014Oct 28, 20143

It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a shopping cart; Staci uses her head.”

I …

Medical education

What can be said about the Generation Y physician?

Brian J. Secemsky, MD & Joshua Liao, MD

October 27, 2014Oct 27, 20145

Tech-savvy. Attention-craving. Lazy, good-for-nothings. These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century. Commonly known as Generation Y, this demographical cohort of 20- to…

Tech-savvy. Attention-craving. Lazy, good-for-nothings.

These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century. Commonly known as Generation Y, this demographical cohort of 20- to 30-somethings has certainly sparked mixed reviews from its Gen X and Baby Boomer elders.

But what defines the particular subgroup of young …

Physician voices

Patient perceptions of the hospital experience

James Merlino, MD

October 26, 2014Oct 26, 201433

An excerpt from Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way. Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use…

An excerpt from Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way.

Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use the word experience in their comments: “I can’t believe how the experience in this hospital was.” “This place is amazing— everyone is so friendly and caring.” A …

Physician voices

What Apple can teach health care: Hire unorthodox applicants

Marc-David Munk, MD

October 26, 2014Oct 26, 20143

Recently, Apple introduced its newest product, the Apple Watch. According to Businessweek, Apple spent years researching watches before deciding to build one. The company flew watch historians to California and they worked to understand how wristwatches have traditionally been used, and how a new “wrist computer” might work. They have hired leaders from diverse backgrounds — none of them techies — to lead these efforts.

It struck me that health care could learn a lot …

Physician voices

Ebola: Local hospitals cannot be prepared

Manoj Jain, MD, MPH

October 25, 2014Oct 25, 201418

Recently at our community hospital, after we concluded a nearly two-hour standing room only Ebola preparedness meeting, I practiced donning and doffing the personal protective equipment (PPE) for Ebola cases. PPE is the protective wardrobe health workers wear when examining…

PPE is the protective wardrobe health workers wear when examining a patient with a contagious infectious disease. Each disease has a different level of transmission and requires an appropriate level of protection. I wear gloves 25 times a day to examine …

Conditions and diseases

An interdisciplinary approach to hospital malnutrition

Kelly A. Tappenden, PhD, RD

October 25, 2014Oct 25, 20142

Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition. Pardee UNC Health Care is implementing a new nursing protocol that…

Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition.

Pardee UNC Health Care is implementing a new nursing protocol that puts nutrition at the center of the care team and the locus for reducing readmissions, pressure ulcers and lengths of stay.

Pardee’s efforts come as more and more studies document the seriousness …

Hospital medicine

Articles, page 97

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