Once an alcoholic, always an alcoholic. This is one of the main tenets of Alcoholics Anonymous, and it serves to encourage its members to commit to absolute abstinence. It is also a belief, I have come to realize, held by the many medical residents I have encountered. When an alcoholic patient is admitted to the hospital, it is no secret that he (or she) is an alcoholic. This is because it feels ...

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Hospital leaders who are successful managers today are successful because they manage change. The great hospitals leaders by now have become masters at it. But there’s a difference between change you can see coming (bundled payments, EHR implementations, declining reimbursements) and change that shows up unannounced on the front door. That’s often what it feels like when a huge, publicly traded company acquires a smaller physicians group. It can feel like ...

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shutterstock_140803288 gomerblog A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday. In what experts are calling pure genius, emergency ...

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The non-medical reader may wonder what I am complaining about.  Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade.  But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order ...

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She is always a difficult admission. The long chart review. The vague complaints. The entitled attitude. The misdirection. These are expected. As is the cake at her bedside after a diabetic crisis. The two-liter soda after an emergent fluid dialysis. The urine toxicology was positive for cocaine. The staff knows her well. I know her well. I give her the attention, kindness and empathy that I give to every patient. ...

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shutterstock_167990879 No one ever wants to meet me.  Well, at least inside of a hospital.  If you are meeting me in a hospital, it is likely because you have been stabbed, shot, assaulted, or in a car accident.  Although the only advice I have about avoiding the first three mechanisms of injury is to stay away from "two dudes" and not try to sell ...

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Remember the Latin phrase “Primum non nocere”? It means “First, do no harm.” Most of us physicians committed to it when reciting the Hippocratic Oath, back when we were first embarking on our careers in medicine. Sadly, today’s technology threatens this sacred physician-patient relationship. Electronic health records (EHRs), although much-needed, have created perverse, unintended consequences for the patient experience. To be clear, EHRs are inherently good.  They’re the backbone of better-coordinated care, ...

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When I was in residency, sexual assault exams were part of our training.  We spent a lot of time learning how to ask the right questions, how to be gentle and empathetic, how to gather evidence appropriately and thoroughly. While many hospitals now have SANE programs (Sexual Assault Nurse Examiner), I have never enjoyed the privilege of working with one of them.  I have, for two decades, performed sexual assault exams on ...

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medpagetodayFrom MedPage Today:

  1. Anthem Data Breach: Potential Game Changer for Healthcare. Anthem Health's massive data breach announced Thursday sent shock waves through the healthcare information technology sector. As many as 80 million people may have had personal data compromised, placing them at risk of identity fraud, Anthem reported.
  2. No Link Between Oxytocin ...

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Walking around the ER in Tiny Community Hospital, I had a few realizations.  In medicine, we hold onto some things very tightly.  We love tradition; we love the known.  We don’t always know why, but we choose "the devil we know," almost every time, no matter how pointy his horns. For instance:  "No cell phones."  First of all, has anyone ever seen a cell phone interrupt anything we do?  No?  Neither have ...

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