Advertisement
Shocker: Hospitalists’ “Unprofessional” Behavior Is Normal

Shocker: Hospitalists’ “Unprofessional” Behavior Is Normal

By their own admission, medical hospitalists are guilty of many types of unprofessional behavior, says a paper published a in the Journal of Hospital Medicine. A group of researchers from the University of Chicago surveyed medical hospitalists from three major Chicago area teaching institutions. The respondents themselves rated each listed behavior on a professionalism scale. There were 77 responses from a pool of 101 hospitalists who were sent the questionnaires. The study asked respondents to state whether they had either engaged in and/or observed unprofessional conduct. The key findings were as follows: Most of the respondents had engaged in at least one unprofessional behavior. The most common unprofessional behavior was (I hope you are sitting down) having non-medical/personal conversations, such as discussing plans for the evening, in hospital corridors. [Gasp!] Over 60% of these doctors admitted that they ordered a routine test as “urgent” as a way of obtaining results more quickly. (Can you believe it?) My favorite is that 40% confessed that they had made fun of or disparaged the emergency department team for missing findings. (Unreported but very likely true is that 60% of those questioned committed another unprofessional act, which was lying by claiming they had never made fun of or disparaged any ED MDs. The only physicians I know who do not routinely make fun of the ED staff are pathologists because they never deal directly with the ED. Before all you ED docs get your panties in a knot, I am certain all of you disparage all of us too.) Other alleged unprofessional behaviors were celebrating a blocked admission, going to work when ill,...
Patient Dies 90 Min After Live Broadcast Surgery

Patient Dies 90 Min After Live Broadcast Surgery

“In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.” As I predicted last year, it had to happen sooner or later. In that post, I wrote “A major complication will inevitably occur during a live broadcast. No matter the reason, it will be blamed on the live video surgery.” Of the many stories in the Indian media about this tragic case, most brought up the debate about the ethics of showing surgery to an audience in real time. One article featured the response of a senior physician at the All India Institute of Medical Sciences (AIIMS) in Delhi, where the tragic event took place, who said, “Live surgery has nothing to do with the death; the whole world is moving from open to laparoscopic procedure for its safety rate. He succumbed because of his disease, and there were several experts present who did whatever was possible to save his life.” Right. I’m not so sure about that. Here’s what happened. A 62-year-old man who was having a laparoscopic resection for a liver cancer began bleeding during the procedure, which was being televised live to surgeons at a seminar. A Japanese liver surgeon was performing the operation assisted by a surgeon from the AIIMS, India’s most prestigious medical school. Reports say members of the audience encouraged the surgeons to switch to an open operation after bleeding could not be controlled laparoscopically, but the conversion did not occur until several hours had elapsed. The patient died in an intensive care unit about 90...
The Opioid Epidemic: What Was the Joint Commission’s Role?

The Opioid Epidemic: What Was the Joint Commission’s Role?

Last month the Joint Commission issued a statement written by its Executive VP for Healthcare Quality Evaluation Dr. David W. Baker explaining why it was not to blame for the opioid epidemic. If you haven’t already read it, you should. Here is the first paragraph of that document: “In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, The Joint Commission’s pain standards take that blame. We are encouraging our critics to look at our exact standards, along with the historical context of our standards, to fully understand what our accredited organizations are required to do with regard to pain.” With the help of an anonymous colleague, I looked at some of the historical context. In December 2001, the Joint Commission and the National Pharmaceutical Council (founded in 1953 and supported by the nation’s major research-based biopharmaceutical companies) combined to issue a 101-page monograph entitled “Pain: Current understanding of assessment, management, and treatments.” Here in italics are some excerpts from it. My emphasis is added in bold. Page 4: In 1968, McCaffery defined pain as “whatever the experiencing person says it is, existing whenever s/he says it does. This definition emphasizes that pain is a subjective experience with no objective measures. It also stresses that the patient, not clinician, is the authority on the pain and that his or her self-report is the most reliable indicator of pain. This set the tone for clinicians—i.e., patients are always to be trusted to report pain accurately. Page 16: For example, some clinicians incorrectly assume that exposure to an addictive drug usually results in addiction. Table...
Should Doctors Wear White Coats? The Debate Continues

Should Doctors Wear White Coats? The Debate Continues

An infectious disease fellow at the Harvard Medical School is convinced that white coats are covered in bacteria and cause infections. But in a post on a website called The Conversation, he admits that there is no conclusive evidence proving the latter. Evidence—who needs evidence? In the piece, Dr. Philip Lederer quotes ID epidemiologists Drs. Eli Perencevich and Mike Edmond, who said, “we don’t need a randomized trial to prove that parachutes save lives, we also don’t need a trial of white coats.” The parachute reference is to a 2003 paper in the annual humorous Christmas edition of the BMJ, which pointed out that parachutes have never been subjected to a randomized trial. It concluded, “We think that everyone might benefit if the most radical protagonists of evidence-based medicine organized and participated in a double-blind, randomized, placebo controlled, crossover trial of the parachute.” The parachute paper has been cited 145 times in the peer-reviewed literature and is constantly brought up to rebuff those calling for evidence. It happens so often that the deputy editor-in-chief of the Canadian Journal of Anesthesiology, Dr. Greg Bryson recently tweeted, “The parachute argument. A signpost indicating that bull[*!@] lies ahead.” Lederer goes on to recommend that physicians in the US adopt the 2008 UK rule called “bare below the elbows” which mandates all physicians must wear shirts with sleeves above the elbows, no ties, and no watches or rings. If this policy has decreased the rate of hospital-acquired infections in the UK, wouldn’t someone have done a before-and-after study documenting this breakthrough by now? A recent post by Dr. John Henning Schumann echoed what...
Caribbean invasion: Medical school turf wars

Caribbean invasion: Medical school turf wars

Last week, the Wall Street Journal reported on an interesting situation occurring in New York City’s teaching hospitals. Old established US medical schools are upset because offshore schools were paying to have their students do third- and fourth-year clinical clerkships at hospitals that were formerly the exclusive domain of the US schools. The New York schools are complaining that they are having trouble finding enough clerkship slots for their students. The mostly Caribbean-based schools were paying hospitals upwards of $400 per week for each student doing rotations. One Caribbean school, St. George’s, has paid close to $38 million for clerkships to the New York City Health + Hospitals system, which consists of 11 city-owned hospitals, for clerkships over the last nine years. The money was welcomed by the system, which expects to lose $600 million in operational expenses for fiscal year 2016. Another interesting fact mentioned in the story was that St. George’s says that this year “831 of its students obtained first-year residency posts at US institutions on their first attempt through the national matching program.” That accounts for about 3% of residency slots offered in the 2016 match. They are really cranking out the graduates. This clinical clerkships thing has bothered me for many years. In about 1992 when I was chairman of surgery and program director of a university-affiliated community hospital surgery residency, I began to wonder why my department taught three or four medical students at a time, did all their paperwork and evaluations, dealt with occasional crises, and more for free. The US schools not only didn’t pay their affiliated hospitals to teach their...
Page 1 of 1712345...Last »
[ HIDE/SHOW ]