Although the Affordable Care Act’s second enrollment period is nearly over, politicians, medical professionals, and the public still debate its implications. According to David Houle and Jonathan Fleece, one-third of all hospitals in the United States will close or be reorganized into another kind of health care provider by 2020. What will differentiate the winners from the losers? Simply put, it will be high patient satisfaction. In consumer terms what ...

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shutterstock_136759886 As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged ...

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Patients admitted to the hospital ward sometimes get sicker instead of getting better right away.  Often this can happen acutely. Depending on the circumstances, ranging from a "rapid response" for unstable vital signs to a cardiac arrest (a "code”), previously uninvolved hospital staff might be called on to help.  Despite the commotion, these events are a period of time for the health care team to shine.  At inpatient emergencies, ...

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shutterstock_60295858 I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings. Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why ...

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shutterstock_113875279 Recently I received an elderly patient who had been transferred from another hospital where she had been admitted for two weeks. The pertinent information about this patient is that her son, a doctor, a pathologist, had arranged the transfer. The worst thing to have is a patient with a doctor for a relative. No, the worst thing is to have a patient ...

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shutterstock_140188489 Dear health IT staff, I know that, on many levels, physicians must be the absolute banes of your existence.  We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems.  We call you because we forgot our passwords, then because we forgot the new passwords.  We call because the system ...

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nursedoc gomerblog Nurse Shannon Wilkens on floor 4 west thought she saw someone she knew in scrubs walking into room 414. “He was tall, I swore he looked familiar. Our charge nurse informed me he was recently hired and volunteered to work nights,” Wilkens recalled. “So being that it was slow, and I had only three patients as opposed to ...

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The world of health care has made tremendous progress in the last several years in raising the quality and safety of clinical medicine. Despite this, the discharge process (when patients are discharged from hospital) is still fraught with potential pitfalls and opportunities for things to "slip through the net." If you ask most patients who are discharged -- particularly the elderly with multiple medical problems -- they will tell you that ...

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Atul Gawande is the preeminent physician-writer of this generation. His new book, Being Mortal, is a runaway bestseller, as have been his three prior books, Complications, Better, and The Checklist Manifesto. One of the joys of my recent sabbatical in Boston was the opportunity to spend some time with Atul, getting to see what an inspirational leader and superb mentor he is, along with being a warm and menschy human being. In my continued series of ...

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shutterstock_150490757 Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted?  Two recent studies in the Journal of the American Medical Association suggest that the answer is no.  In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented.  Their test scores ...

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