At a quality and patient safety meeting recently, one of the departments was presenting their annual report on all they have done, reviewing progress that has been made around several quality and patient safety initiatives. One of their project centered on efforts to decrease an incredibly high no-show rate. Coupled with their desire to avoid overbooking appointments, the problem has compromised patient access, both for their own established patients and for new ...

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Nearly a quarter of a century ago (good heavens, I can hardly believe I have to say that!), when I was just starting out as a junior faculty attending, I remember one of my mentors taking me to the hospital with him on morning rounds to see all of his patients who were admitted to the hospital. He was an eminent cardiologist, incredibly gifted and well-respected, and we walked the wards ...

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Sometimes things go just the way you want them to, and sometimes they don't. Compare and contrast the case of two different patients, and how things went trying to get them the care they needed. The first patient, let's call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment. After ...

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Earlier this week, I was pleased to learn that my practice had achieved a statistically significant increase in box clicking. In reviewing data from our accountable care organization, graphs were shown to us demonstrating improved compliance with several of the measures that they've instituted institution-wide for the purpose of reporting back to Medicare on how well we are taking care of our patients. One of these measures is the ever popular "falls ...

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So many moving parts. Just last week, a patient I've cared for over 20 years came to see me, and she was despondent over a number of issues. First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all ...

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This was the end-of-the-hallway conversation with an elderly patient after wrapping up a recent office visit, as we walked away from the exam room toward the front desk to schedule her follow-up appointment, and she realized that we were "celebrating" 20 years together. I met her when she was admitted as an inpatient when I was on service as a junior attending just starting out, and after going home she came ...

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It's that time of year again. The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training. Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn. Now it's our job to make sure they stay this way. (Have I written this column before? Every year ...) We need to make sure we have a world where ...

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As we all know, the time around discharge from the hospital is a tricky one. In more ways than one can imagine, patients are in a delicate state, judged by those caring for them to no longer be sick enough to need to remain in the hospital, but possibly not quite completely ready to be fully back in the community, on their own at home. Over the past few years, there have ...

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How smart do we want our electronic health record to be? Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good. Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders with those bendy metal bars that allowed you to insert new pages, separated into multiple ...

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Repercussions. Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave. Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is "something else that we have to do," we often see it open up a ...

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