During intern orientation a few months ago, they promised we would never be alone in the hospital. And they were right. Until they weren’t. It’s hard to see colors in the dark — that’s why he looks blue. That’s strange; it almost seems like his chest is not moving. I must be overreacting. Everything is fine. My right hand began flicking his foot. Yell for help. This baby is a healthy newborn. Call a code. Interns ...

Read more...

Duty hours have been the focus of a lot of research recently. If you are just joining this discussion, the iCOMPARE trial randomized 63 internal medicine residency programs to either flexible (interns could work more than 16 hours) or standard (interns had to work within the 16-hour limit) work hours. The results so far have shown no significant difference in the time interns spend on patient care ...

Read more...

Lying in a hospital bed while awaiting heart surgery, I looked at my teen daughter and my parents, then smugly pointed out the irregular slashes on the cardiac monitor. "See these?" I said. "They're called PVCs. My doctor is going to fix them. Make them all go away." The asymmetrical rhythm, a frequent and annoying pattern of multiple skipped heartbeats, had plagued me for the last three years, despite my swearing off ...

Read more...

I’m being sarcastic, of course, but that’s often how it seems some days. Those are days when I’ve been busy at patients’ bedsides all day and then struggle to get my documentation done later, typically many hours later. I jot notes to myself as I go along, but it can be hard to recall at 5 p.m. just what I did and why at 8 a.m. It used to be very much the ...

Read more...

About once or twice a day, everyone on our hospital's computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning. They include things like a notification that a particular data system is down and that a backup on paper will have to be used for documentation, or the hospital ...

Read more...

Dear Alex, As you realize your destiny, I want to share the lessons I have learned in my 45 years on the front lines of health care. I am hoping they will serve you well on your journey. First and foremost, love what you do. Have fun with the people who surround you. Know that in medicine, as in life, you will have the chance to make a difference in others’ lives, ...

Read more...

Take a stroll through any emergency department or hospital break room, and what do you see? Chips, pop, candy bars, and different flavors of junk food. Working in the trenches of medicine requires stamina and mental fortitude. Fueling the body and mind is critical for optimal performance and patient care. Unfortunately, many health care professionals are killing themselves by what they put into their mouths. A few years ago, I began to ...

Read more...

My anger rises when I see the TV "nurse" with her short white dress and her breasts spilling over her pronounced cleavage and her submissive voice speaking to this muscular male MD. Her quick giggle and pretentious demeanor is a stereotype portrayed across the land. And the reality of what we really do goes unnoticed. We have people shouting: "Bring me a coke!" "A blanket, hurry up!" "The food is too cold ... the food ...

Read more...

The use of health care information technology has increased exponentially over the last five years, and as a frontline physician, I have seen this change at close quarters. In most of the hospitals I’ve worked in up and down the East Coast, it’s been interesting to observe this transformation. The process has usually started with nurses and then moved on to encompass doctors. It’s overall a good thing, as I 
Read more...

A little background before I set off:  I study in a medical school in India whose attached public hospital is as busy as it can get. It serves its people absolutely free of cost and is often a refuge for the poor of the society. We often run out of resources, and patients outnumbering the beds is a common sight. And yet, like everything else, life and medicine must go ...

Read more...

How do you react when presented with your quality data? In my experience, physicians generally respond by:

  1. Ignoring the metrics
  2. Arguing about why the metrics are wrong
  3. Saying the metrics are stupid
A lot of doctors refuse to participate in the process of developing, reviewing and refining quality metrics. Although this has the definite advantage of feeling like you’re sticking it to “the man,” it feeds an unhelpful cycle that eventually hurts ...

Read more...

I was recently working in clinic on a Friday afternoon. I was on my last patient of the day, and it had been a particularly long clinic. I had big plans for the weekend and should have already finished. The gentleman entered the room, sat down, and we began the consultation. Because I was so behind, I went through everything a little quicker than I usually would, but still covering ...

Read more...

As voters fume about the high cost of health care, politicians have been targeting two well-deserved villains: pharmaceutical companies, whose prices have risen more than inflation, and insurers, who pay their executives millions in salaries while raising premiums and deductibles. Although the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass ...

Read more...

What if each new feature of your medical record came with a description of how it would improve patient value, not just how to use it? Could a simple checklist help to achieve Annals' vision of putting patients first by helping to ensure that health care innovators release only those features that help us improve patient value? Could a simple checklist help organizations reduce ...

Read more...

Growing up, any opportunity to eat out was truly a luxury. We just didn't have the money for it. Occasionally on birthdays or a special trip, we would be treated with a big fish sandwich from Burger King, or my personal favorite, a $20 party tray of shrimp fried rice from the local Hong Kong Express takeout spot. As trivial as these fast food places were, they were special because of how ...

Read more...

As media coverage of the 50th anniversary of Woodstock shifted into high gear earlier this month, two articles in the "Arts and Medicine" section of JAMA called attention to another anniversary that transported me back in time. It has been 40 years since the publication of The House of God -- an unabashedly irreverent (some would say "borderline pathological") fictionalized account of author Stephen Bergman's ...

Read more...

Personal journal entry, September 11, 2017: Sometimes we wear womanhood like a yoke — burdensome on our shoulders, as we carry the torch for younger women coming behind. Sometimes, we swing womanhood as a sword, slicing, and jousting for survival in a world that started without us, and in some cases, would be more than happy to continue that way. Sometimes, womanhood surrounds us thick as a fog, wrapping us in ...

Read more...

We all expect hospitals to be open and operating when we need them, but extreme weather events like hurricanes are a strain on resources and pose significant challenges for hospitals. Closing a hospital is an extreme action, but several hospitals in Florida, Georgia and South Carolina did just that before the arrival of Hurricane Irma in 2017. With more than 300 hospitals and a higher share of older adults than ...

Read more...

The attending physician looked concerned. My fellow medical student’s face was wet with tears. I knew the next words out of the attending’s mouth would be “Are you OK?” and indeed they were. I have encountered this phrase many times, almost exclusively in psychologically traumatic situations.  It’s a reflex response to an uncomfortable social situation, the “right” thing to say to a student in distress. As medical students, we learn and practice the ...

Read more...

When I walked into my first shift on labor and delivery as a brand new OB/GYN intern, complete with a freshly starched white coat, I was 33 weeks pregnant. As I listened to my chief resident effortlessly sign out the labor board, I was terrified. As the words pre-eclampsia, chorioamnionitis, and postpartum hemorrhage swirled around the room, I couldn’t get my heart rate under control. “They already hate ...

Read more...

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.