The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very ...

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When they’d first entered their medical practice, some of my clients had asked an instructor or mentor to review their prospective employment agreement for them. Although these people may have been excellent physicians or teachers, they weren't acting in the best interests of their charges. When it comes to your livelihood, it's important to have an attorney, especially one who’s experienced in health law and has drafted hundreds of these ...

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There's been a lot of hype about the "Ban Bossy" campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously "bossy," or at least referred to as such. I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, "You ...

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Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face. The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several ...

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It was a particularly challenging case.  On the car ride into the hospital, I found myself doing something that I rarely do.  I called a local allergist for an inpatient consult.  Most allergy issues are not an emergency.  So it is odd indeed to summon this particular kind of physician into the medical wards.  His nurse took the message and promised that she would plug my mobile number into his ...

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One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine -- putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle ...

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If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the ...

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Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, ...

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Improving patient satisfaction and enhancing the hospital experience is all the buzz today in health care. Every hospital executive across the country is talking about it, and coming to terms with how their organization’s reimbursements will be directly tied to their performance in this area. A decade ago, none of us had ever heard of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, the core metric by which health ...

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Recently, a study in the New England Journal of Medicine called into question the effectiveness of surgical checklists for preventing harm. Atul Gawande, one of the original researchers demonstrating the effectiveness of such checklists and author of a book on the subject, quickly wrote a rebuttal on the Incidental Economist. He writes, “I wish the Ontario study were better,” and I join him in that assessment, but want to take it a step further. Gawande first criticizes ...

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