The hospital is never a quiet place.Walk through the wards on a typical day, and you'll hear a cacophony of alarms, bells, and other tones coming from both computers and medical equipment.American Medical News recently discussed so-called "alarm fatigue." They cite a study showing find that "16,934 alarms sounded in [a medical] unit during an 18-day period."That's astounding, and for those who are wondering, that's about 40 alarms ...
August 2010
All Stories
Stop calling doctors fleas and teaching professionalism
At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this ...
Health care blog posts of the week, ending August 13, 2010
Here are the top posts from this past week, based on the number of times they were viewed.1. Missed diagnosis in the ER, and the need to look2. 3 tips to stick with an exercise program3. A primary care direct pay model that works4. Laugh, Sing, and Eat Like a Pig: Facing death, with hope5. Will patients embrace Health 2.0?
Being a good mother is not about specific mothering choices
Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it's worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering.Simply put, I believe that good mothering is about choosing mothering and not about mothering choices.What does choosing mothering mean? It means actively embracing ...
Competitive parenting and raising children in an opinionated world
Raising children in a world full of accessible opinion is a funny thing.Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to ...
Practicing medicine as a single parent requires finding balance
by Katherine Chretien, MDA couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news -- a loved one going into a war zone. But, ...
Hospice care and what patients and their families can expect
by Aldebra Schroll, MDI often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process.Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their ...
Comparative effectiveness research (CER) in patient care
Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled "From Evidence to Practice: Making CER Findings Work for Providers and Patients" in Washington, DC.How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group.The target audiences for CER findings include: patients, ...
Apple’s iPad on medical rounds, a hands on physician review
by Felasfa Wodajo, MDRecently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians.The summary of the ...
Can a health insurer provide affordable care when its CEO makes millions?
In 2005, we entitled a post, "How Can a $124.8 Million a Year CEO Make Health Care More Affordable?"At that time, we contrasted the enormous compensation given to the then CEO of UnitedHealth, Dr. William McGuire, with the stated mission of his corporation. Since then, we have traced the travails of UnitedHealth and its leadership. Dr. McGuire was eventually accused of receiving backdated stock options (which at one time ...
Will the new resident duty hour rules improve patient safety?
One of the mantras of performance improvement is that caregivers and provider organizations should learn from their experiences. That’s all well and good, but how about policy-setting organizations?Recently, in the New England Journal of Medicine, two of the Biggest Kahunas in the safety and quality worlds – the Joint Commission (TJC) and the Accreditation Council for Graduate Medical Education (ACGME) – announced bold new policies. To their credit, both organizations ...
Depressed elderly at risk for dementia or Alzheimer’s disease
by John GeverElderly people who are depressed may be at twice the risk of developing dementia or Alzheimer's disease over time -- but it's unclear whether depression causes dementia or vice versa, researchers said.Among more than 900 participants in the original Framingham Heart Study, almost 22% of those who were depressed when screened between 1990 to 1994 were diagnosed with dementia over 17 years of follow-up, compared with 16.6% of ...
Touch humanizes the doctor patient relationship
I've written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically advanced, and expensive, tests.In fact, I alluded to traditional physical exam advocates as "arguing for staying with a horse and buggy when cars are rapidly becoming available."In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting ...
Pelvic exam etiquette that doctors need to know
I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: "Language Matters: Women-centered talk during pelvic exams."Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs ...
Why DTC drug marketing still clings to TV
Top of mind positioning has been replaced with top of page positioning. The old ad model of informing, persuading and reminding are being replaced by involvement, community and empowerment. So why are the nightly network newscasts still being subsidized by drug direct to consumer (DTC) ads?From all the latest research that I have done, coupled with the research from other sources like Manhattan Research, Pew and Rodale, it’s quite clear ...
The 80 hour resident work week balances fatigue and independence
by Danielle Ofri, MD, PhDHow many hours can a doctor work?The residency regulators are back. About ten years ago, the national organization that accredits residency programs (ACGME) set out its first guidelines about how many hours a doctor-in-training can work. Interns and residents finally achieved the vaunted 80-hour workweek. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby ...
Medicare needs to take the lead for health care cost control
One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts:
- First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing
- Second, health ...
AMA: A roadmap to qualifying for EHR incentives
A guest column by the American Medical Association, exclusive to KevinMD.com.by Steven J. Stack, MD
The high cost of an electronic health record (EHR) system, the often challenging process of implementing new technology into a physician practice, and the difficulty in deciding which system best meets a practice’s needs have deterred many physicians from ...
Being admitted to the ICU over the weekend increases risk of dying
by Nancy WalshPatients admitted to an intensive care unit (ICU) over the weekend face a greater likelihood of dying compared with those admitted on a weekday, a meta-analysis suggested.The meta-analysis, encompassing more than 180,000 weekend and weekday ICU admissions, found that even after adjusting for disease severity, the odds ratio for death among those admitted to an ICU over a weekend was 1.08 (95% CI 1.04 to 1.13, P<0.001), according ...
Draw a Person test to help with pain management diagnosis
by Leonard R. Friedman, MDIn diagnosing areas of chronic pain for adult pain management, I have come across a helpful test which I have unable to peer review.It is the Draw a Person test. Pain management physicians have not used this easily identifiable test to evaluate the subconscious of the patient. This is done by asking the patient to draw a male and a female, with ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
