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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“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds. Mr. Jones just had a transhiatal esophagectomy (THE).  The esophagus is the muscular tube that connects the back of one’s throat to their stomach.  It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed. A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up ...

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How hospitals discourage doctors: A step by step guide Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily. Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me -- in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets -- feel out of place. Within a minute, an administrative secretary came out and ...

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A palliative care dilemma on the first day of the job It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician -- including a four-year pulmonary/critical-care fellowship in this very hospital -- I had just completed a palliative care fellowship. Now I was the hospital's palliative care consult attending. When I set eyes on the patient in room 1407, my first thought ...

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Where there is love there is life. - Mahatma Gandhi In this first month there is a lot I saw, learned and experienced.  Love tops the list. I became an expert in arterial punctures as I did 4 to 5 of them each day in the floors.  Each time I headed for an arterial puncture, many things automatically came to my mind: collect all of the required supplies, talk to and comfort ...

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Over the last year I’ve written a lot about the problems with health care IT and how we need to get better. Unfortunately, unlike other aspects of our life where information technology has actually made life easier, in health care the user experience been nowhere near as smooth. IT solutions, including electronic medical records, are for the most part slow, inefficient and cumbersome. They cause a great deal of frustration ...

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In a study in the American Journal of Infection Control, researchers coated a gloved hand in E. coli.  One person with the E. coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove.  Transfer of E. coli to the sterile glove was measured. Results:

  • highest transfer of bacteria: handshake
  • lowest transfer of bacteria: fist bump (high five was in the middle)
  • difference: fist bump less than 10% of ...

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This is what population health looks like It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so ...

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Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront. Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience. True, a large part of this is due to federal incentives and tying reimbursements ...

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