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Hospital medicine

5,188 articles · Since 2004

Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

Latest articles

Physician voices

Interruptions in health care cost patients and trainees

Earlier in my career, I rounded with interns, residents, a chart rack, and a charge nurse. We disagreed and had competing demands, but working alongside one another gave us some sense of what was happening down the hallway. I knew…

Earlier in my career, I rounded with interns, residents, a chart rack, and a charge nurse. We disagreed and had competing demands, but working alongside one another gave us some sense of what was happening down the hallway. I knew when a nurse was doing something that could not wait. The nurses knew when I was examining a patient, teaching, or helping a family understand that someone was dying. We …

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Interruptions in health care cost patients and trainees

Physician voices

Negative feedback changed me. Praise never did.

Positive feedback is all the rage these days. Parents (and grandparents) are hyper-focused on encouraging Junior. "Great job" may be the most common words out of this grandfather's mouth when on duty with the little ones. A crayon scrawl that…

Positive feedback is all the rage these days. Parents (and grandparents) are hyper-focused on encouraging Junior. “Great job” may be the most common words out of this grandfather’s mouth when on duty with the little ones. A crayon scrawl that only goes off the paper and onto the kitchen table a few inches merits a “well done!” Generous kudos are a big part of the work environment as well. All …

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Negative feedback changed me. Praise never did.

Physician voices

Patient satisfaction surveys grade the wrong thing

Nearly every hospital in America now asks its patients a question that no sane person has ever asked a friend: Would you recommend us? It arrives a few weeks after discharge, in an envelope or an email, along with its…

Nearly every hospital in America now asks its patients a question that no sane person has ever asked a friend: Would you recommend us?

It arrives a few weeks after discharge, in an envelope or an email, along with its relatives. Did the doctors listen carefully? Was the area around your room quiet at night? Were the room and bathroom kept clean? On a scale of zero to ten, how would …

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Patient satisfaction surveys grade the wrong thing

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Conditions and diseases

Hospital discharge forgets the caregiver who is afraid

A record kept catching on the same fragment of music. A few notes, a crackle, a pause. Then the melody struggled forward, only to break again. On October 16, in a theater in Taipei, that uneven sound seemed more honest…

A record kept catching on the same fragment of music. A few notes, a crackle, a pause. Then the melody struggled forward, only to break again. On October 16, in a theater in Taipei, that uneven sound seemed more honest than any polished speech about the courage of family caregivers.

I was onstage, playing the older brother of Xiao-Rui, an eight-year-old girl in a family-caregiver drama called One Day, We Will. …

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Hospital discharge forgets the caregiver who is afraid

Physician voices

Nurse-physician communication starts with 4 words

Every nurse who has ever called you at two in the morning remembers how you answered. You remember almost none of them. That asymmetry runs the hospital at night. The caller carries every response forward: the sigh, the pause, the…

Every nurse who has ever called you at two in the morning remembers how you answered. You remember almost none of them.

That asymmetry runs the hospital at night. The caller carries every response forward: the sigh, the pause, the question that was really a verdict. By the time the phone rings again, they have already decided how much it is going to cost them to tell you what they are …

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Nurse-physician communication starts with 4 words

Physician voices

Anesthesia standards should follow the patient, not the room

More procedures are now performed far from the traditional operating room. Endoscopy units, interventional radiology suites, cardiac catheterization laboratories, and MRI rooms routinely host patients who need sedation or anesthesia. That expansion is a clinical success. But the room label…

More procedures are now performed far from the traditional operating room. Endoscopy units, interventional radiology suites, cardiac catheterization laboratories, and MRI rooms routinely host patients who need sedation or anesthesia.

That expansion is a clinical success. But the room label can create a misleading sense that the anesthesia is somehow less consequential.

Sedative and anesthetic drugs affect breathing, airway tone, blood pressure, and consciousness wherever they are given. In an endoscopy room, …

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Anesthesia standards should follow the patient, not the room

Health policy

Workplace violence in health care needs a national standard

My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood. I looked over my shoulder and froze. A…

My foot slid on something wet as I entered the medical/surgical unit. Glancing down, I wondered vaguely who had spilled cranberry juice before registering the red droplets for what they were: blood.

I looked over my shoulder and froze. A patient stood in the deserted hallway, blood streaking his arm from where he appeared to have ripped out an IV. A pair of bandage scissors hung loosely in his hand.

I ran …

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Workplace violence in health care needs a national standard

Health technology

Administrative bloat in hospitals is a design choice

The secretary who became fifteen executives' assistant A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel…

The secretary who became fifteen executives’ assistant

A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel went through an agency. Over the next twenty years, email replaced the mail, voice recognition replaced the typist, and a website replaced the travel agent. By the time he retired, one …

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Administrative bloat in hospitals is a design choice

Physician voices

A national hotline could track bias in physician discipline

Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training…

Becoming a physician is one of the longest professional journeys in America. The path typically requires four years of college, four years of medical school, and three to seven or more years of residency and fellowship training. For surgeons, training routinely extends well beyond a decade after college.

The investment is financial, professional, and deeply personal. Medical graduates routinely carry substantial educational debt, spend thousands of hours studying, take licensing examinations, …

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A national hotline could track bias in physician discipline

Physician voices

Observation status is a clinical choice, not a billing one

One night, during cross coverage with residents, I was called to provide clinical oversight for a frail older woman admitted from the emergency department. She had multiple comorbidities and a deteriorating clinical picture, but she had been placed under observation…

One night, during cross coverage with residents, I was called to provide clinical oversight for a frail older woman admitted from the emergency department. She had multiple comorbidities and a deteriorating clinical picture, but she had been placed under observation status. I was perplexed.

When I asked residents why observation was so often selected, the answer was usually some version of this: “It is easier to change the patient to inpatient …

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Observation status is a clinical choice, not a billing one

Physician voices

Fragmented care made my family her care coordinator

I recently read Kara Wada's September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer. When my wife Kathy was dying, nobody did. Kathy…

I recently read Kara Wada’s September 7, 2026, KevinMD essay asking a simple but profound question: Who holds the telescope? Her article resonated with me immediately because I know the answer.

When my wife Kathy was dying, nobody did.

Kathy was not the victim of one catastrophic mistake. There was no single dramatic error that changed the course of her illness. What I witnessed instead was something more common and, in many …

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Fragmented care made my family her care coordinator

Conditions and diseases

Overtreatment at the end of life is a spiritual problem

My name is Tony Grandelis. I'm an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what the principles of addiction recovery (honesty, surrender, humility, community) can…

My name is Tony Grandelis. I’m an OB/GYN hospitalist, a medical educator, and a person in long-term recovery from substance use disorder. Through my brand Recovering Healthcare, I explore what the principles of addiction recovery (honesty, surrender, humility, community) can teach us about fixing a broken health care system. Recovery gave me something medicine never did: a framework for sitting with what cannot be fixed, for accepting what cannot be …

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Overtreatment at the end of life is a spiritual problem

Conditions and diseases

How does the halo effect in medicine harm patients?

I have spent decades in health care. I know how much physicians rely on clinical judgment, pattern recognition, and experience. Those skills matter, and they also carry a risk: The human brain is constantly filling in gaps, and sometimes the…

I have spent decades in health care. I know how much physicians rely on clinical judgment, pattern recognition, and experience. Those skills matter, and they also carry a risk: The human brain is constantly filling in gaps, and sometimes the story we create about a patient can become more powerful than the information the patient is trying to give us.

I experienced this recently during a telehealth visit with a physician …

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How does the halo effect in medicine harm patients?

Physician voices

The grief health care workers carry after maternal death

She was a young mother. We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped. CPR began immediately. The obstetric…

She was a young mother.

We had never met her before. She arrived gasping for air. Within moments, the room was full. Everyone came together with one purpose, to save her. Then her heart stopped.

CPR began immediately. The obstetric team delivered the baby while compressions continued. Thirty minutes passed. No pulse. We kept going. Every voice in the room was thinking out loud. What are the reversible causes? Keep going. Don’t …

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The grief health care workers carry after maternal death

Conditions and diseases

The true meaning of compassion in health care

The most profound lessons in compassion did not come from textbooks or training. They came from the patients who invited me into their stories. "Will you stay for a little while?" A patient asked me this question after receiving news…

The most profound lessons in compassion did not come from textbooks or training. They came from the patients who invited me into their stories.

“Will you stay for a little while?”

A patient asked me this question after receiving news that would change the course of her life. I had no medical solution to offer. I could not take away her fear or change her diagnosis. All I could do was pull …

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The true meaning of compassion in health care

Conditions and diseases

Care orchestration should start in the patient portal

After years of working with numerous health systems and my own experiences as a patient and caregiver, I have come to realize how challenging it can be to manage one's own care. Care doesn't stop when patients leave a health…

After years of working with numerous health systems and my own experiences as a patient and caregiver, I have come to realize how challenging it can be to manage one’s own care. Care doesn’t stop when patients leave a health care facility. It is often just the beginning of a long journey for them. Most often, after a doctor visit or surgical procedure, a patient has an extensive to-do list: …

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Care orchestration should start in the patient portal

Physician voices

Is racial bias in physician discipline being measured?

The central limitation in evaluating racial parity in physician discipline is not the absence of concern, but the absence of standardized upstream data. Existing national systems primarily capture terminal outcomes. The National Practitioner Data Bank (NPDB), for example, receives reports…

The central limitation in evaluating racial parity in physician discipline is not the absence of concern, but the absence of standardized upstream data. Existing national systems primarily capture terminal outcomes. The National Practitioner Data Bank (NPDB), for example, receives reports of certain adverse clinical-privileges actions, including review actions restricting privileges for more than 30 days and certain surrenders while under investigation. It does not comprehensively capture the discretionary …

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Is racial bias in physician discipline being measured?

Conditions and diseases

A second opinion abroad should clarify, not just differ

The messages usually arrive with the same tension: "My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?" Patients who contact us for second opinions abroad are rarely looking for a medical…

The messages usually arrive with the same tension: “My doctor recommends surgery. A hospital overseas says it may have another option. Which answer should I trust?”

Patients who contact us for second opinions abroad are rarely looking for a medical argument to win. Most are trying to make a difficult decision without regretting it later. They want to know whether the diagnosis is complete, whether the proposed treatment is necessary, and …

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A second opinion abroad should clarify, not just differ

Conditions and diseases

Reduced to a diagnosis: I was the patient in bed 27

The longer I spent in the mental health system, the harder it became to remember who I was outside the pages of my medical record. Because when people stopped referring to me as the young girl I was, and instead…

The longer I spent in the mental health system, the harder it became to remember who I was outside the pages of my medical record. Because when people stopped referring to me as the young girl I was, and instead as a diagnosis or simply as “the patient in bed 27,” how was I supposed to remember who I was outside those hospital walls? The staff had read through my …

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Reduced to a diagnosis: I was the patient in bed 27

Conditions and diseases

Medical uniform design is quietly shaping the runway

Until recently, I believed I understood uniforms. For more than fifteen years, I covered the fashion industry, attending runway shows, interviewing designers, and writing about the ways clothing reflects culture. Fashion has always borrowed ideas from uniforms, whether military tailoring,…

Until recently, I believed I understood uniforms.

For more than fifteen years, I covered the fashion industry, attending runway shows, interviewing designers, and writing about the ways clothing reflects culture. Fashion has always borrowed ideas from uniforms, whether military tailoring, aviation jackets, or workwear. I thought I knew why.

Then, after a serious leg injury at Paraiso Miami Swim Week, I unexpectedly found myself in a hospital, not as a journalist, but …

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Medical uniform design is quietly shaping the runway

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