The first time I cried as a doctor was in residency. I was taking care of a patient who had terminal lung cancer. The first time I met him, his wife was at his bedside. The couple displayed such a positive outlook on life and seemed to have accepted the poor prognosis. He was one of the first cancer patients I took care of. Being a cancer survivor myself, I felt a ...

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Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship. The problem is that it's extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn't exist. In other cases, it's hard or impossible for the public to find. For instance, if you're getting an esophagus resection ...

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I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest. But this note stood out. In it, the administrator was reminding the medical ...

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Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to ...

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For most of residency, I missed the opportunity to care for veterans -- mainly for selfish reasons, including my unwillingness to learn a new EMR and hospital. Once I became a chief resident, I realized that I would be spending four months at our local VA hospital. When I first came to the VA as a chief, my goals were similar to that at any other site at which I work: Get ...

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When Donald Trump announced that he was running for president last summer, most people didn’t know quite what to think. Was this serious or some sort of publicity stunt? Would he be in the race for more than just a few weeks of intense media spotlight? Would he be able to stand on a stage and debate other politicians? No matter what side of the political spectrum you fall on, ...

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On a typical day in a major hospital, patients pass through the emergency room with different ailments. Some of them are coming in to check out minor aches and pains, and others are coming in barely responsive with a life-threatening condition. Outside of the pediatric ward, all of the patients coming in are adults, and the majority of them are advanced in years, showing signs of chronic conditions taking effect ...

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I’ve written a lot lately about caring for our patients, and about caring for our spouses, and those things make me very happy. But now and then, things rub me the wrong way. I was recently working at TMH, or Tiny Memorial Hospital, my vague name for small facilities since I work at several and wish to preserve their anonymity.  While there a patient checked into the ED for a fairly unremarkable ...

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38 states currently have an apology act. This means that if doctors feel they owe a patient an apology, they may provide one without any ramifications, if future legal actions are taken by the patient/patient’s family. In 2006, I spent 218 days in the hospital after the healthy birth of my daughter. My chronic autoimmune disease, scleroderma, masked certain signs of preeclampsia, which went undiagnosed. This led to a massive infection ...

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A road trip from Georgia to New York was going splendid, dare I say, wonderful -- catching up with old friends and family -- when it took an unforeseen and slightly less desirable turn: I got admitted with a small bowel obstruction.  Thanks to truly excellent care from a community hospital, I am home and now subjected to endless computer questions from my father that has me briefly contemplating readmission ...

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