As an American medical student doing an elective in Thailand, I was initially troubled when I saw how Thai patients were treated. I'm not speaking of the way Thai physicians apply medical science, mind you -- they rely on UpToDate and sundry U.S. guidelines just as we do -- but that was mostly where the similarities ended. Morning rounds with the team of residents (sans attending, but apparently there was one ...

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Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER. You may get lucky, and find yourself ...

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I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed ...

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I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help.  I have deep respect for the challenge of medicine and the committed practitioners. When I left graduate school in 1988, it was the beginning of the movement from fee ...

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Twenty years of experience and research reveal two indispensable truths about hospitals and health care organizations that can no longer be ignored: Those institutions neglecting the basic fundamentals of patient care risk jeopardizing the quality and safety of care they provide. Nothing can have a greater short and long-term impact on the cost of delivering health care services than nurses. The central role of the nurse in patient care For more than 60 years, ...

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The Merriam-Webster dictionary has many definitions for the term system, but the most straightforward, and arguably the most applicable to our health care conversation is “a regularly interacting or interdependent group of items forming a unified whole.” The common wisdom is that our health care system is broken, and hence, our government is vigorously attempting to fix it for us through legislation, reformation, and transformation. We usually work ourselves into ...

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unnamed When nurses stand on the steps of our nation's capital, it is a warning that something is seriously wrong in health care. Much like a canary in the coal mine, nurses are the barometer of the health of our hospitals, nursing homes and health care facilities. On May 12th 2016, nurses from around the United States convened on our nation's capital for the ...

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Most industrialized nations have long supported the idea that access to health care is a fundamental right, and have built centrally planned systems to accomplish that goal. The result has been universal coverage that delivers excellent-quality outcomes at lower costs than the United States. In some countries, such as England and Canada, the government controls both financing and certain aspects of health care delivery, while in others, including Australia, Sweden, and ...

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With all the changes happening in health care and the increasing weight of federal mandates and requirements, it’s easy to view the Centers for Medicare & Medicaid Services (CMS) as the big, bad enemy. After all, if they just left all physicians and health care institutions on their own, everything would be OK, wouldn’t it? It’s an occasional line of thinking I’ve heard from many esteemed colleagues and also appears to be ...

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I am forced to attend one of these mandatory continuing medical education (CME) events. My malpractice insurance provider has a deal with the state medical association. To get lower rates, I have to be a member of the association and every 2 or 3 years attend a risk management training session. I make it on time, despite the traffic. As I walk into the lobby of this rather nice building, looking for ...

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