Our specialty of hospital medicine has grown exponentially over the last decade and now finds itself at the forefront of American medicine. I’m proud to be part of such a growing movement and must say that I find the job just as rewarding as when I first became an attending physician when the specialty was still in its fledgling stage. As the number of us soars towards the 50,000 mark, the ...

Read more...

EverythingIsAwesome Recently, I was asked to fill a questionnaire during check-out at a hotel in India. I was very pleased with my stay, so I agreed to provide feedback. It is worth pointing out that if I was only mildly satisfied I would not have agreed. If I was disappointed with my stay, I would have filled the form more enthusiastically. When I ...

Read more...

A big challenge facing academic medical centers is how to maintain a focus on patient care in an artificially divided environment.  Most academic medical centers developed in a system with abundant resources, cost-based reimbursement and a traditional academic departmental structure.  This led to individual departments growing as microsystems formed around particular specialties. The untoward effect of this is that the different silos within the system tend to operate with their own ...

Read more...

The July Effect is a relatively well-known reference to the influx of new trainees entering hospital systems annually on the first of the month. Researchers have attempted to investigate the impact of the new trainees on patient outcomes with divergent conclusions. Despite the ongoing debate, educators in medicine recognized the need to prepare medical students for day 1 of residency training, by establishing core competencies to evaluate the preparedness of students. One such example ...

Read more...

shutterstock_263182502 Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession -- usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor ...

Read more...

shutterstock_141195013 American physicians have had it.  We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers.  The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore.  “You have it better than most people.”  “You are still making good money.”  “Your ...

Read more...

Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small ...

Read more...

As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well. Same with the doctors. The hospital would pretty much let us do what ...

Read more...

shutterstock_86451016 In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 -- a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month. This is such a familiar story by now that it hardly makes ...

Read more...

Many readers know that I favor empiric antibiotic treatment for adolescent/young adult pharyngitis when the clinical signs and symptoms strongly suggest a bacterial infection. I favor narrow target antibiotics and only in the patients with Centor scores of 3 or 4 (and perhaps some 2s when the patient looks very ill). This would exclude over 50 percent of patients from antibiotics. Most organisms already have developed resistance to penicillin, amoxicillin, and ...

Read more...

Most Popular