A dozen set of eyes stared upwards. The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl. I had given this lecture many times and said the words over and over again. And yet the response was always surprising.
“Why do you think physicians get angry and …
Why do physicians behave badly? Maybe because they’re scared.
Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound.
As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along …
5 things that make U.S. health care great
I have never experienced a military boot camp. I have however completed a rather intense three-year residency in internal medicine followed by another grueling, three-year fellowship in pulmonary and critical care medicine. I like to think that my experiences were not unlike those of military training.
As a matter of fact, being on the medical wards at the county hospital was referred to as being, “in the trenches.” It was true. …
The difference between medical practice and medical training
I performed my first paracentesis in November of my intern year. It was 3 a.m., and I was on overnight call in a packed ICU. The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name. He didn’t know I was an intern. He didn’t know I’d never even attempted a paracentesis before.
After I finished, I added the patient’s name to my procedure card. I hurried to get an ABG …
The ethics of trainee-patient encounters: Are we practicing on the poor?
November, 1999 was a watershed for physicians. It is then that the infamous “To Err is Human” report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact.
To anyone who took the time to read the …
The problematic impact of To Err is Human
July as a newly minted intern: It was the best of times, it was the worst of times.
The only analogy I can make is you feel like a middle school kid sitting in a PhD course, desperately trying to back-learn everything in a language of acronym alphabet soup you’ve never heard before.
If medical school is drinking from a fire hose, this is trying to sip from Niagara Falls. You have …
Reflecting on the first month as a new physician
You’ve changed.
No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other.
We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night. Your persistence to move …
Working the night shift as a resident physician
I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is …
Patient satisfaction has come full circle. Why you need to care.
When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time.
It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference. It was …
It’s time to bring back morbidity and mortality conferences
Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed — whether it was lab results or patients’ notes.
However, the road to this …
5 ways health care IT must improve
Many hospitals rely on bond funding for their expansion and the purchase of new equipment. Revenue that is created by the hospital is then used to pay back the bondholders. The risk to bondholders is that they are generally paid after the hospital pays its operational expenses. Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk.
Hospitals have historically been rated …
The effect of health care quality on hospital credit ratings
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow my …
3 ways to master the art of teaming in medicine
If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to …
Excessive turnover in inpatient care can wreak havoc
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The Veteran’s Administration is under fire for covering up deaths. Men and women who were eligible for care languished on impossibly long waiting lists and even worse when some died waiting for care their deaths were covered up. This is horrific and everyone wants to know how this tragedy could have happened?
Veteran’s hospitals have long waits in my experience because they are underfunded, many (if not all) patients with complex …
The VA scandal exposes the folly of metrics
As most everyone knows, medicine is not an exact science. Every patient and every family must be treated individually. We all recognize that many things have the possibility of not going perfectly, especially when an ill child presents to the hospital. I am lucky enough to be a part of many families’ experiences at the hospital that go so well that you want to tell people about them.
Goodness knows, there …
A case that illustrates the way medicine is meant to be
Adverse events — when bad things happen to patients because of what we as medical professionals do — are a leading cause of suffering and death in the U.S. and globally. Indeed, as I have written before, patient safety is a major issue in American health care, and one that has gotten far too little attention. Tens of thousands of Americans die needlessly because of preventable infections, medication errors, surgical …
The difficulty of moving the needle on patient safety
When I was a boy, my dream was to become an airline pilot. The job seemed glamorous and exciting, and appeared to be held in high regard by all the people around me. I actually used to have a bit of an obsession with airplanes, and living so close to Heathrow Airport, had plenty of opportunities to see planes and visit the airport: both as a passenger and whenever we …
The future of doctors? Airline pilots provide a clue.
Over the last few years I’ve had numerous encounters with vets and vet hospitals. Domino, the dog that we had since I was in medical school, was sadly very sick. He was a Jack Russell-Corgi cross, black and white, with the loveliest sweetest nature. He lived till almost 13-years-old, bringing an immense amount of joy to our whole family. Sadly, he passed away last summer. My parents felt a huge …
5 things medicine can learn from veterinary care
In an effort to promote transparency in healthcare, the Association of Health Care Journalists (AHCJ) has published a database of recent hospital deficiencies discovered by Medicare and Medicaid inspectors. They then highlighted 168 reports containing the phrase “immediate jeopardy.” This, of course, piqued my interest as I presumed that hospitals who were putting patients in “immediate jeopardy” must be some pretty bad actors.
After sifting through the hospital names, I …
True patient safety cannot be regulated
Imagine this: You are sick. You are the sickest you’ve ever been. You want to die. You almost did die. You want to bury your head in your cozy bed for the next two years.
But you’re not in your bed. This bed has plastic for covers and sandpaper for sheets. You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, …
Do everything you can not to get admitted to the hospital
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