The inhumanity of medical residency programs
My mother-in-law died last week.
She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now isolated by a sticky divorce at age 3 and 5.
Her second set of grandkids were born into career parents. She was there to help again, babysitting at a moment’s notice. And when she died, the eldest grandson from her son’s third m...
Source: Kevin, M.D. - Medical Weblog - September 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/natasha-deonarain" rel="tag" > Natasha Deonarain, MD, MBA < /a > Tags: Physician Hospitalist Residency Source Type: blogs
Faculty Procedural Supervision and Expertise: An Endangered Species
Editor’s Note: This post is one of two pieces on the topic of procedural competency. Check back next week for the other piece.
A few days ago I was working with a new resident and she came to me for help with a procedure. She had a patient with a severe headache and fever and she wanted to do a spinal tap. We had previously discussed the differential diagnosis and the possibility of meningitis. Now it was clear the resident was not at all confident in her ability to do the procedure and that I might have to do it. I took a deep breath. Although there had been a time when I was confident about doing a spinal tap, that was...
Source: Academic Medicine Blog - September 6, 2016 Category: Universities & Medical Training Authors: David P. Sklar, M.D. Tags: Featured From the Editor Editor in Chief faculty procedural competency resident Source Type: blogs
Worst day, or worst day ever?
So we have this new thing at Sunnydale: the nurses from the neurocritical care unit charge for both the NCCU and an overflow surgical/med-surg/ortho unit on a different floor.Right now we have our usual nine beds in NCCU and eleven beds on the other floor. (I ' ll call it " ortho, " because it ' s mostly post-op and pre-op orthopedic cases, but there are important exceptions, one detailed below.) Once the NCCU expands to include epilepsy patients and an epilepsy monitoring unit, we ' ll have a total of twenty-six rooms to charge: thirteen on each floor, with the possibility of two of those rooms on each floor being double-...
Source: Head Nurse - August 30, 2016 Category: Nursing Authors: Jo Source Type: blogs
Expanding Choice Through Change
During these last days of summer, we here at Disruptive Women are reflecting on posts from when we first launched—it’s fascinating to see how far we’ve come and where we still have to go—to push—to Disrupt. After all, a woman’s work is never done. We originally published this post on September 25, 2008.
Remember Harry and Louise? Sitting at their kitchen table, the nondescript couple burst onto the national stage in a 1993 television commercial that deftly attacked Bill Clinton’s proposed health care plan and made even those of us committed to universal health insurance afraid of its consequences.
I ca...
Source: Disruptive Women in Health Care - August 30, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Choice Source Type: blogs
When too many cooks … the problem of too many consultants
Recently I communicated with a patient’s mother in another state. She had great angst when a series of subspecialists gave her different opinions on the ongoing plan for her grown son.
This problem happens too often in 2016. Each subspecialist seems to see the patient solely through the prism of their expertise. We have seen one consultant call 3 or 4 other consultants.
Many hospitalists will tell you this story. At many community hospitals the consultants do not just provide an opinion, but rather they write orders. This practice leads to confusion and sometimes conflict amongst the subspecialties.
Several...
Source: DB's Medical Rants - August 24, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Emergency physicians: You are not alone
Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them. Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are addicted, and a few are just lonely. They’re inescapable. And nurses. They’re all around also. The ones who carry out your orders, tend to your patients, sometimes ignore what you say and con...
Source: Kevin, M.D. - Medical Weblog - August 15, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/edwin-leap" rel="tag" > Edwin Leap, MD < /a > Tags: Physician Emergency Source Type: blogs
On the Worst Healthcare Experience of My Life
By JESS JACOBS
This has been a very sad weekend for me personally, the wider health care community and for anyone who knew Jess Jacobs, who died on Saturday. She was only 29 years old, and was smart, funny, enthusiastic, and brave well beyond her years. She suffered from two very rare diseases, but was also working to push health policy forward at ONC, FDA and Aetna, and she really knew her stuff. Jess was a marvel and a rarity in more ways than one. She was #UnicornJess. (That link will take you to the twitter memorial on Sunday night, but also check out remembrances from Ted Eytan & Carly Medosch). I’m as...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: Matthew Holt Tags: THCB #UnicornJess Hospital Care Jess Jacobs Source Type: blogs
Absolution
By ANISH KOKA, MD
Like many cities, Philadelphia is a city defined by its neighborhoods. I practice in two neighborhoods separated by a few miles but leagues apart in every other way. One of the hospitals is a tertiary care facility in the heart of Center City – a well to do upcoming part of town – and the other is a small community hospital a few miles South. The patients at the two locations are quite different, and the mechanism of health care delivery is also starkly different. Medical care at the Center City campus is provided mostly by employed physicians, and care at the community hospital is provide...
Source: The Health Care Blog - August 2, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Palliative Chemotherapy: An Oxymoron
By Rebecca Gagne HendersonI was inspired to write this after reading the series of posts on Pallimed titled “Against Euphemisms” by Drew Rosielle. At its very best, the term “Palliative Chemotherapy” is an oxymoron. At its worst, it is a treatment that robs the patient and family of quality of life and valuable time may have been spent doing the things that are important to them.As a palliative consultant on a campus which does not house a cancer center my referrals typically come from hospitalist attending physicians rather than oncologists. I cannot begin to tell you the number of conversations I have had through...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 1, 2016 Category: Palliative Care Tags: cancer chemotherapy euphamisms gagne henderson palliative rebecca Source Type: blogs
Healing at the hospital begins with peace and quiet
The space can make a difference. I had already spent over two years working as a hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges. Fast forward to the end of May 2016 to one of my first shifts working in the new building, a.k.a “The Zuck”: Zuckerberg San Francisco General (ZSFG). Change had never felt so good.
I walked across the bridge connecting our old building to the new ZSFG, which consisted of expansive windows and white beams that outlined the hall. It was a sunny day in San Francisco, and I was able to witness it for a few secon...
Source: Kevin, M.D. - Medical Weblog - July 31, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/pallabi-sanyal-dey" rel="tag" > Pallabi Sanyal-Dey, MD < /a > Tags: Physician Hospital Source Type: blogs
The hospital with a high episiotomy rate
I have been an OB/GYN hospitalist at a busy suburban community hospital for almost one year. I truly love my job. However, I’ve noticed something unexpected that’s prompted me to pause. There are several physicians — good, clinically competent, kind physicians — who frequently perform episiotomies. Routine episiotomy is not recommended. In my training and eight years of practice prior to becoming a hospitalist I rarely saw it used. So this experience has been surprising. There are a number of reasons physicians with high episiotomy rates is bothersome, and it brings to mind issues we all face in med...
Source: Kevin, M.D. - Medical Weblog - July 31, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/nicole-calloway-rankins" rel="tag" > Nicole Calloway Rankins, MD < /a > Tags: Conditions OB/GYN Source Type: blogs
Nurse Creates The Mother Lode of All Advance Directives.
Albany, NY -- Adrian Fleming knew all about the horrors that went on at her hospital everyday. As a seasoned floor nurse at SunnyView Hospital for over 20 years, she had a front seat view of the face palms that threatened patient safety everyday. She also knew someday she would be a patient in her own hospital and with that fear in mind, set out to create the mother lode of all advance directives.An advance directive is a written statement of a person's wishes regarding medical treatment created to ensure those wishes are carried out should the person be unable to communicate them to a doctor.Her advance directi...
Source: The Happy Hospitalist - July 20, 2016 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
Against Euphemisms - Part 3 - Palliative Sedation
"Palliative Sedation."Golly I hate this one. Frankly 'terminal sedation' was better, because it was at least less confusing, but neither of them are clear or transparent, and particularly 'palliative sedation' is just so confusing and potentially laden with too many meanings to be ever useful. There are so many clinical scenarios out there in which someone is sedated (deliberately, or as an aftereffect of trying to control pain/anxiety/dyspnea/etc; deeply or lightly; continuously until death vs temporarily as respite) in circumstances that the average person would agree would be 'palliative' or 'of-palliative-intent'...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 20, 2016 Category: Palliative Care Tags: euphemisms palliative sedation rosielle The profession Source Type: blogs
Top 10 Causes of DKA Hospitalization (ICD-10 Codes)
Most internists are taught the three most common causes of hospitalization for diabetic ketoacidosis (DKA) are infection, infection, infection. In clinical reality, the three most likely causes of hospitalization for DKA are didn't take insulin, didn't take insulin and didn't take insulin. With ICD-9, E15.1 could be used to code DKA Hospitalization Due to Noncompliance. With ICD-10 coding rules, didn't take insulin is not specific enough to code the cause of DKA hospitalization. The new ICD-10 codes provide a much more detailed look at the causes of DKA leading to hospitalization and will hopef...
Source: The Happy Hospitalist - July 19, 2016 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
The Doctors Club
By ANISH KOKA, MD
Vatsal Thakkar, a psychiatrist, recently wrote of the perks doctors are afforded in everyone’s favorite instrument of social justice – the New York Times. Dr. Thakkar speaks effectively and correctly about a broken health care system navigated best by pulling the ‘doctor’ card. Some on the progressive left have seized on this blatant disregard for egalitarianism as yet another example of a broken healthcare system, despite the fact that a two tiered system is exactly what they have been building over the last eight years.
To be clear, there has always been special treatment accorded fellow doc...
Source: The Health Care Blog - July 19, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
