Posts tagged as:

hospitalist

Learn how to conduct a family meeting by using a structured approach

November 16, 2009

by Alex Smith, MD
On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My [...]

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Doctors spend more time on social work than medicine

October 23, 2009

Originally published in HCPLive.com
by Alan Berkenwald, MD
William Osler is known as the Father of American Medicine. He was a world class physician, the “Doctor’s Doctor” – as physicians all along the Atlantic seaboard would sent their family members to him.
He wrote the first American medical textbook. He was so good, he was recruited from [...]

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Is incident reporting effective in reducing medical errors and increasing patient safety?

October 6, 2009

by Bob Wachter, MD
When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the [...]

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How to reduce the risk of medical errors from patient hand-offs

September 25, 2009

One of the consequences of capping resident work-hours is increasing the frequency of patient hand-offs.
In a recent column in The New York Times, surgeon Pauline Chen cites a somewhat frightening statistic that during a course of a typical 5-day hospitalization, patients “are passed between doctors an average of 15 times.”
And residents sign over patients several [...]

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How hospitals should deal with disruptive physician behavior

September 20, 2009

by Mark N. Simon, MD
What can hospital medical staff leaders learn from University of Oregon football coach Chip Kelly? In the morning of September 4th, Kelly had an opportunity to review video tape from the conclusion of his team’s game with Boise State University the night before. What he saw was his senior [...]

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Should elderly patients always be admitted to the hospital?

September 8, 2009

95-year old patients who go to the emergency department, more likely than not, will get admitted to the hospital.
But is that always what’s best for the patient? Emergency physician Graham Walker suggests not. He notes, correctly, that, “the group with the highest odds of having something seriously wrong with them are probably also [...]

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How can you convince doctors to limit care?

September 4, 2009

In the discussion of cutting health care costs, it’s often pointed out that the doctor’s pen is the most expensive piece of technology.
Hospitalist Bob Wachter talks about the medical profession’s zeal to “do everything” as a major driver of health spending. So, how can we stem this tide?
Doctors are programmed to advocate passionately for [...]

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How hospitalists can provide high quality patient care at the lowest possible cost

September 3, 2009

by Bob Wachter, MD
Much has been made of the superior performance – on both cost and quality – of integrated health care organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated history, few believe that the rest of us – namely [...]

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Are relationships being lost in medicine, and are hospitalists partly responsible?

August 29, 2009

by Edwin Leap, MD
An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.
See, the county I [...]

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A borderline admission from the ER, or not

August 13, 2009

A woman on Medicaid is newly diagnosed with lung cancer in the emergency department. Although medically stable, should she be admitted to facilitate the coordination of the care she will require?
That’s a question emergency physician Jesse Pines asks in a recent WSJ op-ed. In the end, despite the resistance of the admitting hospitalist, [...]

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Should ER doctors be immune from medical malpractice?

August 4, 2009

Emergency physicians are forced by EMTALA to treat everyone who comes through the ER doors.
Should these cases be exempt from medical malpractice? The Happy Hospitalist argues that the standard of care within the community sets an unreasonable bar. Consider this situation, for instance:
The [problem] I see in today’s malpractice environment is the irrational [...]

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Are patients refusing doctors who no longer do hospital work?

July 29, 2009

As the numbers of hospitalists increase, more primary care doctors are no longer doing hospital rounds.
Communication problems can arise from this, as discharge summaries and other hospital notes often are not transferred back to the outpatient physician in a timely manner, if at all. And indeed, some patients are unhappy with this trend, and [...]

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Why rationing is a dirty word, and can we ever limit care in America?

July 27, 2009

Peter Singer confronts rationing of medical care head-on two weekends ago in a piece in The New York Times.
It’s gained plenty of traction within the blogosphere, but none better than hospitalist Bob Wachter’s opinion on the issue. In his take, he channels Joseph Stalin, saying, “A single death is a tragedy, a million deaths [...]

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5 top medical comments, June 7th 2009

June 7, 2009

Here are some of the more interesting comments readers have left recently.
1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, [...]

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A surgeon dumps post-op patients to hospitalists

June 5, 2009

Is it ever ok for a hospitalist to be the primary physician in post-op cases?
The answer is no, but as The Happy Hospitalist reports, it’s happening in some cases.
He details an instance where a hospitalist program is being asked by an orthopedic surgeon to provide care for his post-op cases, with the surgeon only coming [...]

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