User friendly recording of data often seems like an EHR afterthought As I began logging on to my third different hospital EHR (electronic health record) recently, I contemplated how much more of this I could take. Being less than a year from planned retirement, the nuances of learning a new EHR and CPOE (computerized physician order entry) system is not fun. Furthermore, every hour I spend learning a new and unique system is ...

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To resuscitate or not to resuscitate, that is the question. Whether 'tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing. The United States has come a long way in the last 2 decades since 1991 when the ...

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In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment. That’s a good thing. Unfortunately, the University of Chicago press release ...

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One reason is to apply an extra “facility fee” to patients’ bills. Another reason is that primary care docs generate a ton of money for the hospital.  A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do. PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a ...

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I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system ...

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I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they ...

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I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I’ve had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their—hopefully very short—hospitalization. We take ownership ...

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Why I rely on non physician providersI still recall my first rotation as an inpatient attending at Memorial Sloan-Kettering Cancer Center (MSKCC). Perhaps it was the anxiety that I remembered most; that I was “in charge” of a service. Fortunately, having done fellowship at MSKCC, the system was not a foreign one, and I knew exactly where to go to get oriented—I went to Jane and Dorothy, ...

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Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks.  During that time, the unit kept him safe and provided medication for mood stabilization and thinking.  After seeing my family member, my first priority was to talk with the attending physician and care team. Evidently, the attending doesn’t like to ...

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What Ive learned from saving physicians from suicide A psychiatrist in Seattle had picked out the bridge. At 3am he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep. A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late. An internal medicine resident in Atlanta heard an anesthesiologist joking about the ...

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