Earlier this year, our hospital staff was weighing a new 24/7 family presence policy to allow immediate family members to stay with  patients 24 hours a day. We knew this was a step in the direction of delivering patient- and family-centered care. We presented the proposal at a meeting of our patient and family advisory council.  One of the members of the council told a story that drove home the importance ...

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Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of ...

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We recently had a readmission -- a straightforward case, really.  Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out.  He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia.  The discharging team had been meticulous in their care.  At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few ...

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As a physician, I enjoy listening to non-physicians tell me how to motivate doctors.  I don’t mean this in a totally snarky way (well, maybe just a little).  These conversations often highlight the chasm that exists between physicians and administration. What’s the most common motivator people throw out there? Money.  Certainly everyone wants to make more money, I don’t refute that.  What I take issue with is the notion that the ...

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How to improve doctor administrator relations A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks ...

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Dr. Danielle Ofri has an important piece in the New York Times: "The Physical Exam as Refuge." As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition? While I did outpatient medicine for ...

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As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it. In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist ...

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Where is compassionate end of life care for the elderly patient? When my 82-year-old uncle had a heart attack in the kitchen of his home, I was on the next plane to the East Coast. No one knew how long his brain had been deprived of oxygen before he’d been resuscitated. As I stood next to his bed in the hospital’s ICU, I feared that my uncle would not make it. I ...

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Around the country, doctors are leaving independent practice and joining large groups owned by health care systems. It’s a trend: the recruiting firm Merritt Hawkins predicts that if current growth continues, over 75% of newly hired physicians will be hospital employees within two years. There seem to be a number of reasons for this consolidation of physicians and hospitals into islands of care. One is the desire for larger groups to have ...

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She was sick.  Not sick like a high fever, body aches and a runny nose.  Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed.  There was oxygen, and dialysis, and a colostomy.  She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by ...

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