Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor's trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as ...
Posts tagged Hospital
Hospitalists should limit the number of patients they see
I was talking to a fellow physician and he inquired, "how many patients do you see in a day?" I said, "maybe around 20."He smirked and replied, "20 only! I can see around 40 in a day and still have time to hit some balls." There is something fishy here at Smallville.A few years ago I used to work for this company. I had no option but to see a ...
Hospitals that ban physicians from social media are long term losers
I've heard that a few academic medical centers, the identities which I will keep anonymous, are advising incoming medical residents to stay off social media. Meaning, they have to close their blogs, and shutter their Twitter or Facebook accounts.As hospitals and doctors try to best use social media, and prevent damage from its improper use, taking the extreme measure of forbidding doctors in training from utilizing social is ...
The difference between an ambulatory and hospital EHR
What difference is there between an inpatient EHR and an ambulatory EHR?The difference is quite significant, actually. Let’s start by looking a little deeper into hospital IT issues, and the evolution of tools that try to address them.The hospital EHR environment Traditionally, from an IT perspective, a hospital is not really a single system – it is a collection of systems in various departments.Over the past few decades, each ...
How far should hospitals go to treat obese patients?
Boston Emergency Medical Services recently debuted an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance.My problem is this: I think we need to do our best to provide medical care to all patients. But patients need to take some basal level of responsibility for their own health. If you’re saying that you got to ...
What big hospitals can learn from smaller ones
Every now and then a tonsillectomy patient bleeds after arriving back on the ward after surgery. On this occasion, there was nothing remarkable in the event itself. What was remarkable was the efficiency of the response.
I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital. I checked on my patient in the ward, confirmed the bleed, ...
How medicine can be like a scene in Jerry Maguire
Although the famous clip from Jerry Maguire is about a sports agent trying to negotiate a new contract for an entitled egotistical football player, every time I see it, it reminds me of work. Put a white coat on Tom Cruise, and transplant them from a shower room to an exam room, and it becomes a pretty accurate portrait of my daily conversations with patients.In fact, when I was on ...
Insurance companies cutting corners puts patients at risk
My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) ...
Hospital inefficiencies observed during a surgery rotation
by Anar MikailovI recently finished my surgery rotation at a Level 1 Trauma Hospital in Philadelphia and amidst the ephemeral eight weeks I quickly realized the immense demands of a surgical residency. So, as an avid technology enthusiast and a team member, I took note of inefficient workflows with potential for technology driven solutions. By discussing the observed inefficiencies and potential solutions I hope ...
Hospital bullying requires everyone to share in the blame and solution
The following column was published on May 28, 2011 in FoxNews.com.Theresa Brown’s New York Times op-ed, Physician, Heel Thyself, recently introduced hospital bullying into the national health care conversation.
In it, she recounted a hospital vignette while working as an oncology nurse. A patient asked a doctor who should he blame for a late test result. ...
Doctors don’t take snow days
Editor's note: This post was originally written this past winter.Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I've driven home in snow like that, and I find it terrifying. Your car won't do what you want it to, and worse, other people can't ...
ABIM Maintenance of Certification (MOC) internal medicine exam tips
This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.
7 weeks later, I received my results. Thankfully, I passed.This was not entirely a surprise, as the pass rate for first-time test takers was 88%. But it definitely requires some studying. It's not a gimmie.Considering that I last took my board ...
Why families and advocacy groups accept the torture of dying patients
by Aroop Mangalik, MDA man has lung cancer that has spread to the brain. The cancer in the brain has been growing despite full dose radiation. His lungs have failed and he has been on a respirator for 10 days with progressive worsening of lung function.Despite multiple discussions between the doctors and the Intensive Care Unit’s team ...
Prices should be readily available to save hospitals money
Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt.
Budget cuts to NICU admissions will have a ripple effect
What is wrong with the state of Texas? Have they no heart? Why is it that at the time of fiscal crisis, it’s always the “little” people whose services are eliminated first?The “little” people in this case would be babies who are either born sick or premature. The New York Times article, In Search of Cuts, Health Officials Question NICU Overuse, was shocking. The Texas state officials have ...
The growing disconnect between hospitals and post-acute providers
An interview by Curaspan Health Group with Mark Lachs, MDMark Lachs, MD, MPH, geriatrics physician, professor, researcher and author of the new book, Treat Me, Not My Age, says one of the hottest new areas of research is care transitions. He warns that there’s a growing disconnect between hospitals and post-acute providers.Curaspan: ...
How to minimize the costs of surgery
Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.In rank order, the costs of surgery come from (highest to lowest):
- Hospital Charges ...
Nurses who work in the cardiac catheterization lab
Ready to learn more about nurses who work beyond the bedside? Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care. Amy Sellers, RN blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.Amy has worked in the Cath Lab for about 6 months now. She previously worked in ...
What happened inside the hospital during the Joplin, MO tornado
Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22 when an EF-5 tornado struck the hospital.by Kevin J. Kikta, DOYou never know that it will be the most important day of your life until the day is over. The day started like any other day for me: waking up, eating, going ...
In medicine, the greatest save is not having to make a save at all
In the real world of medicine, "great saves" are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.I first met Mr. GR in the emergency room. As ...
