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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by John Gever Surgery for torn knee ligaments and meniscal cartilage may have improved patients' short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said. A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have ...

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Year: 1994 Setting: Port Moresby General Hospital, Papua New Guinea Position: Chief medical officer for Chevron Oil Co. The wife of an expatriate employee has injured her arm and, suspecting that she has fractured her left elbow, I accompany her to the Port Moresby hospital for further evaluation. The building looks good and new. In fact, it was recently donated to Papua New Guinea by the Japanese government. While waiting for the X-rays, I ...

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What is the purpose of the note in the patient chart? Depends who you’re asking. The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything. Instead, he urged us to write, as concisely ...

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