An intracranial bleed? You couldn’t do much worse than miss an intracranial bleed. How had I let my craze to decrease my patient load overtake proper medical care? I had failed to check the head CT! I was appalled at myself, mortified by my negligence. I stumbled through the rest of the day, an acrid mix of shame and guilt churning inside me.
It’s been nearly 23 years since the Americans With Disabilities Act, a federal law prohibiting discrimination against people with disabilities, went into effect. Despite its unequivocal language, studies in recent years have revealed that disabled patients tend not only to be in poorer health, but also to receive inadequate preventive care and to experience worse outcomes.
Transitional care programs are ripe for innovation for forward-thinking providers who are willing to do the difficult work of making these programs a success. For hospitals, even seemingly modest success, such as preventing a few dozen readmissions, can yield a financial benefit – and preventing more than that could save a hospital millions of dollars.
Doctors hate pain. Let me count the ways. We hate it because we are (mostly) kindhearted and hate to see people suffer. We hate it because it is invisible, cannot be measured or monitored, and varies wildly and unpredictably from person to person. We hate it because it can drag us closer to the perilous zones of illegal practice than any other complaint.
Simply acquiring technology is not enough; it is essential to implement the technology effectively to achieve those types of results. Here, then, are the top 10 mistakes practices make in implementing information technology — and how to avoid making them.
I was not aware how common these errors are until I became a patient myself after being diagnosed with hypopharyngeal carcinoma. I am sharing my personal experiences about the medical and surgical errors that occurred during my hospitalizations at three different hospitals. My inability to speak after surgery made it difficult for me to prevent all of these mistakes. Fortunately, I was able to abort many of them.
While it may seem that the financial problem created by expensive, proprietary health IT is simple and straightforward—health IT expenses push the budget into the red, doctors see fewer patients, revenue falls, and creditors come calling—healthcare economics are unique and apparently beamed from some other dimension where up is down and black is white, so linear explanations don’t really hold.
I hope that the FDA’s efforts investigate robotic surgery will not slow or dissuade brilliant individuals and forward-thinking companies from developing more useful solutions for the operating room. I have no desire to see hospitals, surgeons, and OR staff members balk at these solutions in favor of re-embracing traditional or old-fashioned practices and attitudes.
“Innovation in medicine is driven by need, but also by the market,” said Dr. Michael R. Harrison, the director emeritus of the Fetal Treatment Center and the director of the Pediatric Device Consortium, both at the University of California, San Francisco. “Big markets have lots of folks developing devices, but small markets like the pediatrics market don’t.”
One obvious question: is the robot another “laser”? There is a more fundamental and important question. Granting that the pace of traditional development and evaluation of products may not excite investors, are we going to cede that vital function to those for whom scientific probity may not match their interest in the equity market?
Most clinical providers are aware of the more common capacities of EHRs. However, there are many capacities that are being underused that can be of great assistance in providing safe care that avoids waste and identifies best practices. Electronic communication with providers outside of one’s clinical setting, clinical decision support, and improving the body of knowledge of best practices are three capacities of modern EHRs.
It is almost 7:00 a.m. and I carry my briefcase and lunch bag from the car to my office. I nod to some of the night shift employees heading home. Another day has begun. I type my password and check the computer, reminding myself of the twenty patients I am scheduled to see today in the cancer clinic. A few new consults with untreated or recurrent cancers occupy the longer appointment slots.
No recent internet headline or cleverly-worded web teaser caused me to click my computer mouse on it faster than one that linked to a video discussing a Consumer Reports study on hospital safety. Strangely enough, it wasn’t the subject matter that grabbed my attention. It was the tone of the headline: “Hospitals Get Low Safety Scores In New Study.”
Am I safe surgeon, or merely a board certified one? I usually spend Tuesdays fixing elective hernias. But the other day I was asked to clear a c-spine, handle an unexpected gynecologic finding, manage a pediatric trauma, resuscitate a septic ICU patient, and opine on a neck dissection. No, I wasn’t in Africa or 1985; I was sitting in front of a computer monitor.
Medical schools have traditionally relied on undergraduate science grades and the MCAT to decide which applicants to interview. They based this approach in part on numerous studies that found good correlations between science G.P.A. and MCAT scores and subsequent medical school performance. But more recent studies have also revealed that MCAT scores are significantly influenced by a student’s race, gender, and socioeconomic background.