A great deal of effort in the current health care environment is being put into improving communication - between patients and families and members of the health care team, among family members, and among members of the team. The case can be made that good communication is at the heart of patient safety, cultural sensitivity, and the pillar of palliative care -- aligning patient’s wishes and goals with treatment plans.So ...
Posts tagged Hospital
Insider tips to surviving your hospital stay
Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.10. Bring your own pillow. Trust me.9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.8. Bring an accurate and updated medication list ...
Why the family meeting is important
“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.“I’m afraid so.” I replied.“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown ...
Paperwork causes unintended distractions for physicians and nurses
I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.There is no question that electronic devices distract physicians as the article pointed out. But that's like complaining about a leaky faucet when there's a flooded basement ...
The ambiguity of a hospital charge
It all started while out to dinner with a couple of my fellow Brigham/Massachusetts General Hospital OB/Gyn residents. We were discussing our favorite old TV shows and one fellow resident's love of The Price Is Right with Bob Barker. After talking about the game show, a light bulb went off in my head and I thought, "Why can't we play The Price is Right with hospital charges to our patients?"With ...
Why palliative care and hospice is the ultimate gift
Dear Doctors:I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother's team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blindsided by this.While no one likes to talk about the topic of death, it is important to remember that ...
How hospitals are gaining leverage over physicians
Most hospital managers have never had the power to exert leverage over their most valuable resource, the physician, who, after all, admits the patients who make the hospital’s economic existence possible in the first place.So I wrote in introducing a chapter in my first book in 1988. I hastened to add, however, at the close of that chapter, these admonishments:1. The economic powers of the hospital is shifting from those ...
Cost denies an undocumented immigrant a kidney transplant
You’re in your 30s. You work hard. You strive to master your craft. You support your extended family. You are liked by both your co-workers and boss.Problem: You unexpectedly become unhealthy–you find out your kidneys are failing.Solution: Regular kidney dialysis can keep you alive, by filtering toxins out of your blood.Problem: Dialysis is time consuming (>3 hours/session, 3 sessions/week) and leaves you feeling tired and weak.Solution: Your brother, who is ...
How patients can remember their doctor’s name
“Do you remember my name?”Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”In a busy teaching hospital, it is not uncommon ...
Why I miss practicing medicine
I recently left medical practice in order to pursue a career in mobile health technologies, for which I have had a passion for many years. I had wanted to become a physician since I was very young. The intellectual challenge and curiosities of the natural science and the human body stirred my intellect like nothing else.What I will surely miss most are the priceless personal interactions I experienced on a ...
ACP: Making transitions better for patients
A guest column by the American College of Physicians, exclusive to KevinMD.com.Many patients see multiple doctors and receive care in a variety of settings. Some patients receive care in more than one hospital. As an internist who is in the process of transforming into a patient-centered medical home, I have been taking steps to help my patients when they ...
Requiring doctors to give orders on patients they have not seen
To meet Federal patient satisfaction goals, our hospital administration is requiring community based physicians to give patient admission orders before we have a chance to see the patient. Patients who self-refer themselves to the emergency department, are evaluated by the emergency room staff, and who are determined to require admission must be admitted by their community physician within 20 minutes of receiving a call from the ER staff advising the ...
What kind of shoes should you wear in the hospital?
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.What kind of shoes should you wear in the hospital?There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide ...
The positive effects of palliative care on quality of life
“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had worked all his life as a plumber with no health insurance. When he was healthy, it was okay. But now he was sick.I was meeting him for the first time in the community health center where I work as a family physician, tending ...
Reduce sedation in critically ill patients
I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking ...
Quality indicators can harm the elderly
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve ...
A culture of fear permeates the healthcare system
The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.In Korean culture, questioning authority is unacceptable and led to ...
Conflict between physician and nurse
When it comes to doctor- nurse interactions, when is enough, enough?Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to ...
Making tailored health education standard of care
The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for "dayfloat" services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their ...
Doctor, why is your hospital better than any other?
I took a deep breath. I had to think carefully. It's not that this was unexpected - Johns Hopkins has been anointed the country's best hospital for 21 years running by US News. But I wanted to tell the patient the truth without alienating them or failing to mention the many admirable aspects of my institution.One truth, however, cannot be denied: to call one hospital the best is not simple.Let's ...
