I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.” I guess that would depend on your definition of clinical integration. The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, ...

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There is a saying in the world of education, “You have to care to teach.” Why is it then in health care, a profession of and about caring, we do such a poor job of teaching our patients?  Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient ...

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Ever wonder what a "gomer" is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

She was having excruciating pain in her pelvic area.  I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs.  I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart.  ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain. The emergency room physician had dutifully ...

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Dont forget to feed the doctors and nurses I went to the hospital cafeteria one day last year and experienced an epiphany. It was around 4:30 p.m. and the place was supposed to close at 6:00 p.m. As I entered, the folks inside were covering up the food and putting it all away. "Did you want something, I mean, we can make something for you." "Nope, I guess not," ...

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A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.” In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care -- the added cost of additional care, additional hospitalizations, and the additional ...

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I became a physician in 2001, after originally having a career in business. I wanted to become a doctor to be able to do something important. I felt that if I needed to work, and to leave my children in day care, I at least wanted to be doing something that was meaningful to me. My job as a business manager didn’t fulfill me in that way. Over the years, I’ve ...

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The nasogastric tube was killing me. It had been in place for twelve hours now, threading its way up my nose and down my throat, past my esophagus, into my stomach. Try as I might, I couldn’t swallow away the nasty lump stuck to the back of my throat. And every time I tried, it hurt. Decades before, as a physician-in-training in upstate New York, I’d put in more nasogastric (NG) ...

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A major debate taking place in the hospital medicine community over the last several years concerns the way in which we cohort patients on the medical floors. The traditional way is to have patients belonging to each doctor scattered across the hospital on several different floors. This is in contrast to designing a geographical system where all the patients for any one doctor are located on a single floor. On the ...

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Deciphering hospital bills is not for the faint of heartDeciphering hospital bills is not for the faint of heart An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry. Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered when comparing notes with a friend, there’s another puzzle: the huge ...

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