Posts by Brad Flansbaum

The course seems obvious

A compelling clinical vignette always gets me. Those written for lay eyes grip me even more. The exceptional writer strips away the medical nuance and expresses the case in the starkest of terms. The stakes feel germane, the emotions conveyed hit close to home. We have been there we say and ask if a similar patient might occupy our bed tomorrow.  Alternatively and as applicable, we imagine if the profiled provider could be us. We also engage these accounts for comfort and solidarity. We take solace in sharing similar front line experiences with others, as atypical as they sometimes might be. Apiece with that spirit, I recently read an illuminating article in The Atlantic. The account profiles a physician and the difficult dilemma he faced caring for an acutely ill man with a tenuous, but hopeful prognosis. He had no advanced directives and the family, going against convention, wished to cease…

Observation units and who $aves

This week, JAMA IM released a nice study profiling patients on observation status for the years 2010-11.  While only involving one site, the large sample and thorough accounting of data enhances our knowledge of the growing obs trend. (more…)

Readmissions on PBS Newshour

  A nice long form feature on the Medicare Readmissions Program on the NewsHour this evening:                                         Click here to watch the video, and here to read an excellent extended PBS interview with Jordan Rau from Kaiser Health News.  The PACT program at Beth Israel Deaconess gets a nod. The money quote: "Sometimes people are like cars.  At 200K miles, nothing you do will keep them out of the shop."

Feed Me Good!

  A story in Kaiser Health News Caught my eye this AM:                                             I could not resist citing a quote like this: Behind the scenes, UNC has installed a sous-vide cooking system, often used in fine restaurants, which cooks food in airtight plastic submerged in water baths to ensure food are cooked to the exact temperature. The system speeds delivery service since food is partly cooked and chefs can finish it on a grill after an order is placed.   Or this: "It’s been a game changer for us," said Angelo Mojica, director of food and nutrition services at UNC. He said patient satisfaction scores, which he tracks every day on a television monitor in the kitchen, have soared to 99 percentile. He parses those ratings by hospital floor and…

Trends come in threes

All things come in threes, or so they say. In my time in practice, I have cared for many undocumented adults. Usually Latino, young, and male, their issues reduce into two categories: injuries related to work (construction and food service) and uncontrolled flares of chronic conditions (diabetes and asthma). Occasionally, I also care for desperate folks in need of dialysis, transplants, or continued mechanical ventilation. Difficulty understates the latter category. (more…)