by John Trahanas She was not my patient. Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had been severely demented for many years; however, it was only in the past few months that he required such intensive inpatient care. He was not conscious or communicative, but he ...

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Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm.  Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results. Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these ...

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For years, I have been progressively beating a louder and louder drum -- one where my colleagues know that I liken radiology to McDonald's. Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren't enough doctors or hours in ...

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The hospital is never a quiet place. Walk through the wards on a typical day, and you'll hear a cacophony of alarms, bells, and other tones coming from both computers and medical equipment. American Medical News recently discussed so-called "alarm fatigue."  They cite a study showing find that "16,934 alarms sounded in [a medical] unit during an 18-day period." That's astounding, and for those who are wondering, that's about 40 alarms an hour. It's ...

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At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along. Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety.  As one speaker highlighted, how can we really start to address this ...

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A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq. His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news -- a loved one going into a war zone. But, to me, 8-months ...

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I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: "Language Matters: Women-centered talk during pelvic exams." Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs ...

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by Nancy Walsh Patients admitted to an intensive care unit (ICU) over the weekend face a greater likelihood of dying compared with those admitted on a weekday, a meta-analysis suggested. The meta-analysis, encompassing more than 180,000 weekend and weekday ICU admissions, found that even after adjusting for disease severity, the odds ratio for death among those admitted to an ICU over a weekend was 1.08 (95% CI 1.04 to 1.13, P<0.001), according ...

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by Brian Forrest, MD When I started a cash-only, direct-pay practice nine years ago, my reasons were simple: spend more time with my patients, provide better care, and live a better life. I was uncomfortable signing insurance contracts that limited my ability to care for my patients. I was unwilling to sign an employment contract that required me to see a patient every 7.5 minutes, or lose ...

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In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks.  That is, the re-admission of recently discharged hospitalized patients. They bring up good some good points, and point out that, until recently, hospitals really didn't have any incentive to reduce bouncebacks:

... hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum ...

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