Hospital medicine

5,188 articles · Since 2004

Articles, page 99

What personal responsibility means to a physician

September 27, 2014Sep 27, 20142

She was sick. Not sick like a high fever, body aches and a runny nose. Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed. There was oxygen, and dialysis, and a colostomy. She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by …

Physician voices

To reduce health costs, everyone needs to be on the same page

David Tom Cooke, MD

September 27, 2014Sep 27, 2014

“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds. Mr. Jones just had a transhiatal esophagectomy (THE). The esophagus is the muscular tube that connects the back of one’s throat to their stomach. It can…

“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds.

Mr. Jones just had a transhiatal esophagectomy (THE). The esophagus is the muscular tube that connects the back of one’s throat to their stomach. It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed.

A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up …

Physician voices

How hospitals discourage doctors: A step by step guide

Richard Gunderman, MD, PhD

September 26, 2014Sep 26, 201427

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily. Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me -- in my rumpled…

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.

Within a minute, an administrative secretary came out and …

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Physician voices

A palliative care dilemma on the first day of the job

Jessica Nutik Zitter, MD

September 25, 2014Sep 25, 201428

It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician -- including a four-year pulmonary/critical-care fellowship in this very hospital -- I had just completed a palliative care fellowship.…

It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician — including a four-year pulmonary/critical-care fellowship in this very hospital — I had just completed a palliative care fellowship. Now I was the hospital’s palliative care consult attending.

When I set eyes on the patient in room 1407, my first thought …

Medical education

Lessons from the first month of residency

Pramod Theetha Kariyanna, MD

September 25, 2014Sep 25, 2014

Where there is love there is life. - Mahatma Gandhi In this first month there is a lot I saw, learned and experienced. Love tops the list. I became an expert in arterial punctures as I did 4 to 5…

Where there is love there is life.
– Mahatma Gandhi

In this first month there is a lot I saw, learned and experienced. Love tops the list. I became an expert in arterial punctures as I did 4 to 5 of them each day in the floors. Each time I headed for an arterial puncture, many things automatically came to my mind: collect all of the required supplies, talk to and comfort …

Health technology

5 examples of what health care IT should look like

Suneel Dhand, MD

September 25, 2014Sep 25, 2014

Over the last year I’ve written a lot about the problems with health care IT and how we need to get better. Unfortunately, unlike other aspects of our life where information technology has actually made life easier, in health care the user experience been nowhere near as smooth. IT solutions, including electronic medical records, are for the most part slow, inefficient and cumbersome. They cause a great deal of frustration …

Physician voices

Handshakes transmit germs: What are doctors to do?

Alex Smith, MD

September 22, 2014Sep 22, 201417

In a study in the American Journal of Infection Control, researchers coated a gloved hand in E. coli. One person with the E. coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove. Transfer…

Results:

highest transfer of bacteria: handshake
lowest transfer of bacteria: fist bump (high five was in the middle)
difference: fist bump less than 10% of

…

Health policy

This is what population health looks like

Janice Boughton, MD

September 18, 2014Sep 18, 201428

It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so …

Physician voices

The worst-case scenario: When patient satisfaction goes too far

Suneel Dhand, MD

September 15, 2014Sep 15, 201413

Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront.…

Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience. True, a large part of this is due to federal incentives and tying reimbursements …

Health policy

Buying physician practices does not equate to clinical integration

Alexandra S. Brown, MD

September 14, 2014Sep 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…

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, …

Patient voices

Teach back: Reduce the costs of poor patient education

Anonymous

September 13, 2014Sep 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…

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 …

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

Admin

September 12, 2014Sep 12, 20142

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…

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?

Physician voices

There is no concern for the discomfort of the patient

Jordan Grumet, MD

September 10, 2014Sep 10, 201412

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 …

Patient voices

Miscommunication added to the cost of neurosurgery

Kelly Cosgrove

September 8, 2014Sep 8, 20142

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…

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 …

Physician voices

Her life made her into the physician she is today

Diana Brozyna, MD

September 6, 2014Sep 6, 20142

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 …

Physician voices

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

H. Lee Kagan, MD

September 6, 2014Sep 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…

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

Physician voices

Should hospital physicians only work on one floor?

Suneel Dhand, MD

September 5, 2014Sep 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 …

Physician voices

Deciphering hospital bills is not for the faint of heart

Paul Ruggieri, MD

August 30, 2014Aug 30, 20149

An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry. Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered…

An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry.

Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered when comparing notes with a friend, there’s another puzzle: the huge variation in charges between hospitals and surgi‐centers for the same operation. For surgeons, too, trying to figure …

Physician voices

How to be a great health care administrator

Suneel Dhand, MD

August 29, 2014Aug 29, 201414

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…

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

Health policy

Hospitals are taking a page from the big pharma playbook

Trudy Lieberman

August 28, 2014Aug 28, 20143

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 …

Hospital medicine

Articles, page 99

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