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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Why aren’t people in hospitals more attentive to the needs of patients? In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him. On the bike path where Jha ...

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I was recently chastised by a colleague for being too negative in one of my pieces on hospital care. His is a remarkable story of what happens when things go well, and it has made me think a lot about why, in some places, things seem to work while in others, not so much. He told me how a few months ago, soon after returning to Boston from a trip to China, ...

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I hate being told what to do.  I will scratch and claw when ordered around.  It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.” This is a problem since, as an anesthesiologist, I get told what to do all the time.  My kids order me around all the time.  When I was a nurse I used to bristle at the term ...

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If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick? It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place ...

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Ask physicians if our messed up malpractice system causes them to practice “defensive medicine,” and most will probably say yes --  hard not to be paranoid with so many lawsuits affecting so many physicians. Some experts even contend that major reforms of our malpractice system could go a long way towards controlling spiraling healthcare costs. On the other hand, if you ask physicians whether they ever order unnecessary ...

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Hospital administrators are scared of JCAHOHospital administrators are scared of JCAHO An excerpt from ASSUME THE PHYSICIAN: Modern Medicine's "Catch-22". I bled. With great pride, I skipped the obligatory required mandatory training session on "diversity awareness." I skipped both the primary session and the make up session. The session, and its mandatory nature, had been carefully announced every day for weeks. The ...

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