After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA.  Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true.  The place is a mess. Let’s start with the computer system.  The VA medical record system has been held up as an example of an effective EMR system, in which ...

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In 2010, I lost my mother to cancer.  She was a fighter and had survived well past her prognosis, but her hospital costs outlived her. Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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Recently in one of the Johns Hopkins Hospital's intensive care units, a patient was dying from cancer and sepsis, and there was nothing that I, nurse Mandy Schwartz or anyone else could do to stop it. Yet as the patient’s family -- two daughters and a husband -- suffered at her bedside, Mandy saw their need for comfort, and she responded. Although she was busy with nursing tasks, she delved ...

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As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and ...

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I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more. Hospital administrators and insurance company executives do ...

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I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA hospital knows: 1. The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of ...

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The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz ...

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Recently, I began to think of death as a friend. My grandfather was hospitalized on Mother’s Day, and by the time my parents called me on Monday morning they couldn’t tell me anything more than, “He’s in the ICU with multiple seizures. They’re taking him off ventilation tomorrow.” Reaching for the knowledge I’ve spent all year chipping away at textbooks to acquire, I asked about neurologic exams, autonomic drugs and ...

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Dr. Arlen Myers, president of the Society of Physician Entrepreneurs, can give you ten good reasons why doctors make great entrepreneurs.  However, in my many years of working with physicians, I have learned when it comes to a business idea, doctors, like most new entrepreneurs, often need help getting the nuances wrestled to the ground. For example, I remember the conversation with an ED medical director about the importance of using “ER” ...

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