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Doctors, Hospitals, And The Yankees

Joe Boyd hated the Yankees. “Those damn Yankees. Why can’t we beat ‘em?” Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil — giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series.

Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True — Joe Boyd made out in the end, but that will only happen if someone from Hollywood writes our script.

Here’s the problem: At the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, procedures, hospitalizations, even surgeries are done without communication to other doctors who would benefit from this information. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Does It Matter What The Hospitalist Thinks?

I read this article about a young child with heterotaxy syndrome with great interest. Not because I find heterotaxy syndrome something of great fascination, but because of the lack of communication — on both ends of the spectrum:

Even though 5 other Dr. all came in and listened to his lungs and said that he didn’t sound like he was wheezing and that his lungs sounded really good. But because this hospital is overly political, process driven, bureaucratic, and in a constant state of litigious fear they are unable to make any conclusions based on actual medicine and patient care. Common sense is blown out the window when you  have a system were a hospitalist one year out of medical school has an opinion that is as valuable as a cardiologist with 25+ years experience.

But in fairness, they all had to “really consider her opinion.”

So they went and got a pulmonologist to evaluate him, which Scott and I were very happy about because there was nothing in the world that would’ve made me more happy in that moment than to have her proven wrong. Which she was.

The whole article is a case study in stress, distrust, and legalism. Read more »

*This blog post was originally published at The Happy Hospitalist*

Doctor-Patient Communication: Much Room For Improvement

In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.

If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap.

Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 percent of patients thought they did. Read more »

*This blog post was originally published at ACP Internist*

When Doctors And Nurses Don’t Get Along

What do you do when doctors and nurses don’t get along? A reader asks for my advice:

Hi Happy,

I have this problem and wanted some advice from someone with more experience dealing with this.

I have been bashed by nurses because they expect me to know all the bureaucratic issues, when you don’t have more than a month in the hospital. I have noticed that nurses get mad, when you give them an instruction  they don’t understand, or they aren’t used to, not because you are wrong, but instead, their lack of ignorance, or their narrow process of thought. One example of this is when they laugh at me cause i prescribed a generic medication of a common drug that they weren’t familiar with the generic name.

Days ago, a first-year family doctor was yelled at badly by some nurse because she filled in the prescription chart where she shouldn’t – she didn’t know because no one told her. I have seen that attitude several times from different nurses – they yell in a very unproper manner. Read more »

*This blog post was originally published at The Happy Hospitalist*

Pay Patients To Take Their Medicine?

The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication.

There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. Read more »

*This blog post was originally published at Mind The Gap*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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