Two decades ago, I admitted a patient to the intensive care unit for a heart attack. His children were grown, and he looked forward to retirement purchasing an RV to relax and travel the country with his wife. Invasive cardiac technology had not evolved, so he remained in the ICU on intravenous medication to control his symptoms. On the fifth hospital day, his wife brought a letter from the insurance company ...

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Physician cure thyself. After 30 years of participation in multiple medical staffs, including small regional hospitals and large academic settings, there is one constant that continually undermines how content physicians are with their medical practice and the health care system. Many challenges in patient care seem insurmountable. From declining reimbursements to intensified quagmire of bureaucracy, the practicing physician, whether employed or not is berated by administrative authorities with no experience in ...

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“Help me stop doing this.” Mr. G was a 55-year-old homeless man who uttered these words to us during his fifth hospitalization for problems related to his alcohol use:  intoxication, falls and alcohol withdrawal. He was on a downward spiral through the hospital’s revolving door and felt helpless. As a medical team, we felt helpless too. We did not know how to address his real problem -- his cycle of addiction. Hospitalized ...

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With the depths of winter just around the corner, doctors and nurses everywhere know what’s about to hit them over the next few months. The inevitable surge in hospital admissions during colder weather is almost as predictable as knowing the leaves will be falling off the trees in the fall. As someone who has worked in several different hospitals over the last few years, ranging from small rural institutions to large ...

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There was a time within my professional lifetime when old records would arrive on the medical ward in a wheeled wire basket, multiple volumes with shabby pages. And in the VA of the 1980s, which still had veterans of World War I who never lived anywhere else the previous half century, the forklift could deliver not only the charts but the x-ray films that had not yet been sent to ...

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Incident reports are frequently submitted by hospital personnel. Did you ever wonder what happens to them? I have. Over the years, I estimate that I’ve heard of hundreds of such reports being filed, but rarely have I heard of a problem being solved or for that matter, any action being taken at all. In fact, I don’t even know where they went or who dealt with them. When I was a department ...

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Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items -- such as artificial hips and knees, surgical screws, stents, pacemakers and other implants -- develop over time, perhaps out of habit or acquired during their training. Of course, surgeons should have what they need to ...

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Readmissions to hospital, especially within 30 days of discharge, are on the radar of all health care organizations in the United States. This is due in no small part to stiff financial penalties that are now imposed on the worst performers by the federal government. On the surface, it may seem like a reasonable thing to penalize hospitals that don’t successfully “get their patients better enough” to avoid readmission. However, the ...

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I was talking with a colleague in another section today, and she was noting the difference between our hospitalist group and her section.  She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship.  She is a bit frustrated with her new home and its team members because she feels like there are a lot of “B's.”  You know ...

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As a fourth-year medical student in a sub-internship in internal medicine, I have something that no doctor in America has. I have as much time as I want to spend with my patients. Don’t get me wrong, I am still a student. I’m still paying hospitals to let me be there, and I only have a maximum of four patients per day, but I inevitably end up spending more time ...

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