Recently I was asked to intervene on behalf of a patient who, trapped by circumstance, was paying off an enormous bill for a lithotripsy procedure. What I uncovered wasn’t news, but it drove home how egregious the current system can be, why it so badly needs to be fixed, and how the Affordable Care Act (ACA) helps move us in the right direction. The patient had health insurance through her husband’s ...

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As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from ...

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Before you can even form a thought, emotions are influencing your judgments. -Zimmerman and Lerner It’s 9am on a Monday, and our palliative care team circles a table to prepare for the workday. Before us is a list of names, each representing a patient and his or her needs, support system and care team. Many are referred to us because they are suffering -- be it pain, agitation, emotional distress, existential crisis ...

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I recently participated in a small conference devoted to “physician alignment in the academic medical center.” The meeting was sponsored by a health care consulting firm, and drew about a dozen participants from around the country. The title refers to ways in which academic centers figure out how to work with their traditionally autonomous if not completely independent physicians to advance the institutional mission. An informal format allowed us to ...

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“Ms. M,” the resident says, “I saw in your chart that the last time you had surgery you had a pulmonary embolism.” She nods with recognition: “I felt like I couldn’t breathe. It was really scary.” Then: “I sure don’t want that again.” The resident lifts up the covers and sees that the patient’s calves don compression boots. “Make sure you keep the boots on,” he says, pointing. What do boots ...

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If you had to pick a single metric to a measure a hospital, which would you choose? Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing ...

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In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership.  So, it is in this context, that we recently published some pretty disappointing findings that are worth reflecting on. We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than others.  ...

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Here’s a familiar story in America’s hospitals. An “old fashioned” surgeon decides that the protocols and procedures put in place by the medical executive committee or other governing body don’t apply to him. “I’ve done it this way for 30 years, and it works fine. I’m the busiest surgeon here, and no one is going to tell me how to do my job.” People in the risk management field will advise ...

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The lack of access to primary care physicians is a well known problem impacting our healthcare system. The problem sends all sorts of negative ripples through the system, not the least of which is increasingly crowded emergency rooms packed with patients whose conditions could have been addressed earlier and cheaper had primary care been available. What is less talked about is the mixed reaction of primary care physicians to the kinds ...

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I will do anything not to be in a hospital bed. I checked myself out as quickly as I could each time I was admitted (three obstetrical admissions) and once, after a day-surgery procedure, got in trouble with the recovery room nurse because she found me out of bed, getting dressed, before I was supposed to be on my feet. Still, as a doctor, I am capable of taking great comfort ...

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