Here ’s how and why patients lose in our current system
It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three.
Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner note in the EMR for nearly eighteen hours. The hospitalist eventually deferred on the scan and called for a consult, which was scheduled for the next day because of the late hour.
After a busy day of surgery, the specialist showed up ...
Source: Kevin, M.D. - Medical Weblog - March 7, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jordan-grumet" rel="tag" > Jordan Grumet, MD < /a > Tags: Physician Hospital Source Type: blogs
TeamHealth: Medicine's "Big Short"
Remember Bob Wachter, MD, America's Most Influential Physician Executive in 2015?
Remember how he played Elvis and sang "Your Hospitalist Song" at Mandalay Casino while serving on the board of IPC The Hospitalist Company in 2014?
Remember how Dr Wachter pivoted to "love" as a quality measure in the New York Times after leaving the American Board of Internal Medicine (AB IM) and after he (Source: Dr. Wes)
Source: Dr. Wes - March 4, 2017 Category: Cardiology Authors: Westby G. Fisher, MD Source Type: blogs
TeamHealth: Medicine's "Big Short"
Remember Bob Wachter, MD, America's Most Influential Physician Executive in 2015?
Remember how he played Elvis and sang "Your Hospitalist Song" at Mandalay Casino while serving on the board of IPC The Hospitalist Company in 2014?
Remember how Dr Wachter pivoted to "love" as a quality meas ure in the New York Times after leaving the American Board of Internal Medicine (ABIM) and after he (Source: Dr. Wes)
Source: Dr. Wes - March 3, 2017 Category: American Health Authors: DrWes Source Type: blogs
How the Other Half Lives in Haiti
BY TIM DEPP, MDArriving in Port-au-Prince was like walking into another world. It was hot. The roads were dusty. In spite of reports of aid money being siphoned off and how little progress was being made in rebuilding, the parts of the city we drove through appeared improved since the earthquake. My first impressions of the city were positive, especially considering what I was expecting.Despite Haiti's long and difficult history of slavery, revolution, poverty, violent dictators, overwhelming debt, failed development projects, deforestation, and natural disasters, including the earthquake of 2010 and the cholera epid...
Source: Going Global - March 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
We must remember to humanize our patients
I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it’s too refreshing to pass up. So at 2 a.m. Friday night, I’m zooming (you always “zoom” on a scooter) through the industrial district after a tiring admitting shift. I see some people messing around on bicycles, one pulling a trailer, all laughing and yelling. The road is deserted. “Joyriders,” I think, “out for fun on Friday night.”
I passed them by and was soon ...
Source: Kevin, M.D. - Medical Weblog - March 1, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/kjell-benson" rel="tag" > Kjell Benson, MD < /a > Tags: Physician Emergency Source Type: blogs
A Reset For Physicians?
By PAUL KECKLEY
Last week, the nominee to run the Centers for Medicare and Medicaid Services, Seema Verma testified before the Senate Finance Committee. She conveyed a message akin to that of her new boss, Health and Human Services Secretary Tom Price, a physician and House of Representatives veteran: the federal government has made life miserable for providers adding unnecessary complexity and cost.
She challenged the value of electronic health records especially in small practices and rural settings and likened interoperability to a bridge too far. And she observed that Medicare and Medicaid, that cover 128 million Amer...
Source: The Health Care Blog - February 20, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Things that bug me 3 – vanc and pip/tazo
This study shows clearly that vanc & pip/tazo have a negative synergistic impact on the kidney. The most interesting point in the article (to me) is that vanc trough levels predict AKI in vanc/cefepime but NOT in vanc/pip-tazo.
So in 2017 I fear vanc/pip-tazo. Patients on this combination had a length of stay averaging 2 days longer!
The housestaff with whom I work know my fear, and work hard to avoid the combination. Perhaps they are actually being more thoughtful about antibiotic choices. That would be good for our patients. (Source: DB's Medical Rants)
Source: DB's Medical Rants - February 16, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
We need to start talking about what comes after physician burnout
I burned out, big and bad. I can see that now. My practice environment had become gradually untenable and every attempt I made to change it was blocked. My call schedule was inflexible and a lot more frequent than when I started my job. The hospitalists and ED kept sending me cases I didn’t feel qualified to manage, but as it was usually the middle of the night and I was the general surgeon on call, I had no choice.
In the morning, when I asked again if we could find another way to manage these patients, I was told to suck it up, and usually something about bootstraps. I was also trying to handle this without app...
Source: Kevin, M.D. - Medical Weblog - February 12, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Physician Hospital Surgery Source Type: blogs
Family visits: No one ever regrets coming too soon
Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on.
I dial the call-back number.
“Pod A,” a caffeinated voice chirps. It’s Candice, one of the nurses.
“Hi. Amy here, returning a page,” I murmur.
“Oh hi, Dr. Cowan,” she says. “I just wanted to let you know that the family is all here. They’re ready for the meeting.” Her voice is sweet. At sixty-three, Candice is st...
Source: Kevin, M.D. - Medical Weblog - February 9, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/amy-cowan" rel="tag" > Amy Cowan, MD < /a > Tags: Physician Hospital Hospitalist Source Type: blogs
How the patient ends up on the wrong end of the stick
It would never have gone down this way ten years ago whenlength of stay was all the buzz. The Cat Scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a a quick observation stay. Bing, bang, boom. One, two three.Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner note in the EMR for nearly eighteen hours. The hospitalist eventually deferred on the scan and called for a consult, which was scheduled for the next day because of the late hour.After a busy day of surgery, the sp...
Source: In My Humble Opinion - February 6, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
How the patient ends up on the wrong end of the stick
It would never have gone down this way ten years ago whenlength of stay was all the buzz. The Cat Scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a a quick observation stay. Bing, bang, boom. One, two three.Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner note in the EMR for nearly eighteen hours. The hospitalist eventually deferred on the scan and called for a consult, which was scheduled for the next day because of the late hour. After a busy day of surgery, ...
Source: In My Humble Opinion - February 5, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
What Is The ‘Relative Value’ Of An Infectious Disease Physician?
Infectious diseases (ID) physicians may be disappearing. In the 2016 internal medicine fellowship match, in which residents were matched with sub-specialty training programs, 35 percent of available ID training positions nationwide were left unfilled. By comparison, just 0.9 percent of gastroenterology and cardiology positions were not filled that year (Figure 1). Although trainees’ career choices are influenced by many complex factors, the driving force behind residents’ aversion to ID is likely quite simple: money.
ID specialists are among the lowest paid physicians in the United States. According to the 2016 Medscap...
Source: Health Affairs Blog - February 3, 2017 Category: Health Management Authors: Timothy Sullivan Tags: Costs and Spending Featured Health Professionals Payment Policy Quality Alternative Payment Models infectious disease Physicians RVU targets Source Type: blogs
Why this physician can ’t be her family’s doctor
The day I got into medical school, my uncle said to me, “You are going to be a doctor! We finally have a doctor in the family. You are going to take care of your uncle in his old age.” Other family members echoed the same sentiment. First doctor in the family. Now, we will all have free medical advice.
As I progressed through medical school, then internship and residency, then finally to being an adult hospitalist, I often received questions from my family.
What’s this rash? Why does it hurt when I urinate? Is it bad to have blood in my stool? Even one night after my mom finished watching a medical dr...
Source: Kevin, M.D. - Medical Weblog - January 27, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/karen-yeter" rel="tag" > Karen Yeter, MD < /a > Tags: Physician Primary care Source Type: blogs
7 ways hospital executives can support their staff
Dear hospital executive,
If you are like many of the hospital leaders with whom I regularly talk, you’re probably concerned that your hospitalist program isn’t delivering the value you need in this metrics-driven and cost-constrained environment. You may see your hospitalists as disengaged free agents who either don’t know or care too little about contributing to the success of your organization beyond seeing the patients on their list. They may repeatedly complain about being overworked, underappreciated or dumped on, and you worry they will leave soon for greener pastures.
As a former hospital executive myself, I s...
Source: Kevin, M.D. - Medical Weblog - January 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/leslie-flores" rel="tag" > Leslie Flores < /a > Tags: Physician Hospital Hospitalist Source Type: blogs
