It was a case that every physician dreads. I took a deep breath, mustered up some courage and walked towards my patient’s room. When I entered, I saw an apprehensive and anxious family who was patiently waiting for some answers. The mother was sitting at bedside with eyes closed, hands clung to a rosary and lips whispering a prayer. The patient’s sister was standing by the window, looking out with ...

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Recently, the online version of JAMA published an original investigation entitled "Patient Mortality During Unannounced Accreditation Surveys at US Hospitals." The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was ...

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Nonprofit hospitals have higher profit margins than most for-profit hospitals after accounting for their tax obligations. 3900 (62 percent) of U.S. Hospitals are nonprofit and therefore tax-exempt — they pay no property tax, no federal or state income tax and no sales tax. An article published in Health Affairs found seven of the nation’s 10 most profitable hospitals were of the nonprofit variety, each earning ...

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There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for ...

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The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland. In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private ...

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The setting: an inpatient unit in the Bronx, circa 2005. I was a resident (and hence was likely disheveled, groggy or exhibiting some other outward display of exhaustion) of the internal medicine program at Albert Einstein University Medical Center/Moses Division, aka Montefiore. The fact that the program was considered "malignant" by those in my industry — mainly due to the strict nature of the training program — likely strengthens the possibility ...

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It’s no secret that health care is an unbelievably complex subject. One of the most complex issues facing the health care system is that of surprise medical bills. Surprise medical bills happen when:

  • Patients receive emergency care by an out-of-network provider (one not included in their insurance plan);
  • Patients are unaware that one or more of the providers of their non-emergent care were out-of-network; and
  • Patients choose out-of-network care without ...

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In the market for a locum tenens position? If you search online "How to book a locum assignment?" you'll likely find vague advice such as "Develop a relationship with a recruiter." Or "Do your homework when choosing an agency." Thanks, Internet ... Having worked as a locum tenens recruiter for over 15 years, I have seen consistent trends in how the best clinicians are able to stand out and book jobs. ...

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One stunning afternoon I walked into a patient’s room to discuss our plan, informing her that the nurse would come to draw blood. “You can draw my blood, Miss,” said the male family member sitting in a corner of the room, as far from the patient as possible, his legs crossed, smirking, “We can go into the next room and lock the door.” His smug grin brought back memories of older men ...

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There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance and the government. It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs and, ultimately, reduce care quality as a result. Lawmakers should focus on this “first pillar” of cost control as they go back ...

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