About three years ago, our hospital was abuzz about patient satisfaction. Our HCAHPS scores were lower than expected, and there was a push by the administration to improve them. As a hospitalist, I wondered to myself, what could I possibly do to improve them?  I already believed I was doing a very good job communicating effectively with patients. Many years ago, I developed the habit at the end of each encounter ...

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How can a doctor resist an essay entitled, "The Sickness Unto Death?" Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence? It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on. “In despairing over ...

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Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of ...

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It turns out that South Carolina is having a busy hurricane season. Recently, Charleston County was under a mandatory evacuation in anticipation of Hurricane Matthew. All I-26 lanes were converted into westbound traffic, gas stations were running low on fuel, and the local Wal-Mart was out of bottled water. It was T-minus 3 days to the landfall of Hurricane Matthew, with very variable predictions on the trajectory, speed, and strength. ...

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My mother-in-law died last week. She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now ...

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The first time I cried as a doctor was in residency. I was taking care of a patient who had terminal lung cancer. The first time I met him, his wife was at his bedside. The couple displayed such a positive outlook on life and seemed to have accepted the poor prognosis. He was one of the first cancer patients I took care of. Being a cancer survivor myself, I felt a ...

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My name is Dr. Neha Sharma, and I have a confession. Recently, a patient was transferred to me from New Mexico. He was found in his house, unresponsive. By the time I admitted him, he was connected to a breathing machine, and had a serious lung infection. Over a course of a few days, his condition improved. We were able to remove his breathing tube and successfully treat his infection. However, ...

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A road trip from Georgia to New York was going splendid, dare I say, wonderful -- catching up with old friends and family -- when it took an unforeseen and slightly less desirable turn: I got admitted with a small bowel obstruction.  Thanks to truly excellent care from a community hospital, I am home and now subjected to endless computer questions from my father that has me briefly contemplating readmission ...

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Part of a series. Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling. Why ...

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San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off. As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming ...

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