Physician

Checklists help reduce hospital deaths

Physician
April 15, 2010

by Michael Smith

The use of treatment checklists for 13 common diagnoses was associated with a dramatic reduction in patient deaths at three London hospitals, researchers said.

The year the checklists were introduced, the three facilities in the North West London Hospitals NHS Trust registered 255 fewer deaths than the previous year, according to Brian Jarman, PhD, of Imperial College London, and colleagues.

The targeted diagnoses accounted for 174 fewer deaths than the …

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Primary care and the three year medical student

Physician
April 15, 2010

It’s well documented on this blog that the primary care shortage will only worsen once most of America has access to affordable health insurance.

As I wrote in a recent op-ed. not only will there a shortage of primary care physicians, but nurse practitioners and physician assistants won’t alleviate the problem either, mostly because they are also enticed by the lucrative allure of specialty practice.

Enter the three-year primary care physician.

Texas …

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Primary care doctors are saying farewell

Physician
April 14, 2010

It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.

As the economy faltered, I found my private office practice had simply become unsustainable. With the popularity …

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Rural medicine won’t be helped by health reform

Physician
April 14, 2010

by Rick Bendinger, MD

I am a rural health provider in Abbeville, Alabama and have been here almost 30 years. I originally went to school on a public health scholarship and took the private practice option. This was a program that existed in the 1980s that paid for tuition and a stipend with the obligation to go either to a prison, rural area, or Indian reservation.

Sadly the program no longer exists. …

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Private practice medicine will soon become extinct

Physician
April 14, 2010

I’ve written previously that the days of the private practice physician are numbered.

A detailed piece from the New York Times confirms the exodus.

Young doctors, who are burdened with medical school debt exceeding $150,000 are opting for the financial stability that a salary from a hospital-owned practice, or a large integrative medical center, can bring. Gone are the days where a solo practitioner can hang a shingle and …

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Healthcare workers in the ER hit hard by H1N1

Physician
April 13, 2010

by Michael Smith

Healthcare workers in a New York City emergency department had the highest rate of infection among employees of an urban hospital system during the first wave of the H1N1 pandemic flu, researchers said.

In a single-institution study using medical and administrative records, the adult emergency department had an H1N1 infection rate of 28.8% during April, May, and June of 2009, according to Robert Bristow, MD, and colleagues at New …

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Emergency departments are frequently used by young adults

Physician
April 12, 2010

by Kristina Fiore

Twenty-somethings rely on emergency departments (EDs) for care far more than do other age groups, researchers have found.

In 2006, nearly a quarter of all young adult healthcare visits — 22.1% — took place at an ED, compared with 12.6% for children and adolescents and 8.3% for patients over 30.

That rate has significantly increased over a 10-year period, Robert J. Fortuna, MD, MPH, of the University of Rochester Medical …

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Can house calls be revived under health reform?

Physician
April 11, 2010

Beginning in the 1970s, the house call began a slow death. As the medical-industrial complex (MIC) burgeoned, with bigger hospitals and a surfeit of technology, it became incumbent on patients to come see us rather than us going to see you.

Yet there are pockets of house calls still left in the U.S.

For the geriatric age group, there has been growth in the care-at-home sector, especially for homebound elders. They can …

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Op-ed: Patient satisfaction doesn’t mean the best medical care

Physician
April 10, 2010

A version of this op-ed was published on March 15th, 2010 in the USA Today.

If you recently saw a doctor, you might subsequently receive a survey in the mail asking whether your physician was friendly, spent enough time with you, or showed the appropriate level of concern for your medical issues.

Patient satisfaction surveys are being increasingly used in hospitals nationwide. Press Ganey, a leading organization measuring patient satisfaction, counts more …

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Retail clinics are starting to do more primary care

Physician
April 9, 2010

by Joyce Frieden

Retail clinics aren’t just for strep throats any more; they’ll also be managing diabetes and other chronic diseases.

“It’s a new service strategy,” Sandra Ryan, CPNP, told attendees at a meeting on retail clinics sponsored by the Convenient Care Association and the Jefferson School of Population Health.

“We’re evolving our clinic offerings,” said Ryan, chief nurse practitioner officer for Take Care Health Systems, which operates retail clinics inside Walgreens pharmacies, …

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Preventive medicine may not always help patients

Physician
April 8, 2010

If there’s one thing everyone agrees on, it’s that preventive care is always a good thing. Well, I’m a doctor and I’m afraid of preventive medicine.

The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse …

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Patient attacks on doctors and nurses are more frequent

Physician
April 7, 2010

With the attention focused, rightly, on patient safety, what about health care workers?

It’s somewhat of a hidden phenomenon, but attacks on doctors and nurses are on the rise.

Rahul Parikh writes about this in a recent Slate piece. He cites data from the Bureau of Labor Statistics, which found “health care workers are twice as likely as those in other fields to experience an injury from a violent act at …

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Patient advance directives are critical in the ICU

Physician
April 6, 2010

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’

Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …

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Hospital admissions may require watching and waiting

Physician
April 6, 2010

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.

But her history was concerning to me, and it was concerning to …

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Social work is key to quality patient care

Physician
April 5, 2010

In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”

Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central …

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Aortic dissection symptoms and current treatment options

Physician
April 4, 2010

by Joseph Lombardi, MD

You probably remember the tragic death of actor John Ritter in 2003.

Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.

In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …

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Physicians increase revenue with better appointment analysis

Physician
April 3, 2010

by Nikolaos I. Kakavoulis, MD

Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.

Why is this happening?

Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed …

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Peer review helps doctors improve medical care

Physician
April 2, 2010

While typing words, the advertisement for yet another hospital is overheard from the TV. “Ignore it John,” I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed.

Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care?

At work, …

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Physicians should be involved in health care decisions

Physician
April 2, 2010

As physicians progress through medical training and acquire new knowledge and skills, something interesting happens. They also develop a new and increasing awareness of not only how much they didn’t previously know but also how much they still don’t know. This process sounds paradoxical but has been consistent with my personal experience: The more I learn, the less I think I know.

Any seasoned clinician knows that in order for one …

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A DNR order may not always be best for the patient

Physician
April 2, 2010

Doctors are often encouraged to discuss advance directives with their patients.

But sometimes, when it comes to act on a “Do not resuscitate” (DNR) order, the situation can be far from clear.

In a provocative essay from the Washington Post, emergency physician Boris Veysman discusses a case where he successfully revived a man who, unbeknown to Dr. Veysman, had a DNR order.

Despite the temporary nature of the illness, the family honored …

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