Patient Experience

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

Is Patient-Centered Care Bad for Resident Education? #JHMChat Explores #meded & #ptexp

The term “patient-centered” has become a healthcare buzzword and was certainly popularized by the creation of the patient-centered medical home in ambulatory care. In the inpatient world, patient-centered rounds symbolizes this effort to improve patient experience and is the subject of a new study in this month’s Journal of Hospital Medicine, which we'll discuss on next Monday's #JHMChat at 9 p.m. EST on Twitter. In a randomized trial, Brad Monash and UCSF colleagues explored the impact of patient-centered rounds on patient experience. Patient-centered rounds was a bundle of 5 evidence-based practices: 1) pre-rounds huddle; 2) bedside rounds; 3) nurse integration; 4) real-time order entry; and 5) whiteboard updates. The control group continued with routine practice of attending rounds. The study was impressive for several reasons, but one in particular caught my attention – an army of 30 pre-med students volunteered to be observers (and also get shadowing experience?) to monitor…

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

Fake News! Get Your Fake News Here!

One of the top stories of 2016 is fake news. Chances are, in 2017, we will continue to fall for these fairy tales. When people think Obamacare and the Affordable Care Act are two completely different entities, we know facts can dissipate quickly. Why are we duped so easily? These stories fit into a narrative we want to believe in, reinforcing our often insular views, where the echo chamber reverberates at high frequency. We digest only headlines and forward those along, not having time to fully read the stories. Lack of faith in the "media" causes us to trust any headline from any source over the mainstream media. Facebook is recognizing the large role it plays in dissemination of fake stories to the extent that it plans to roll out a new filter in Germany to begin to fight this epidemic. Here's how you and others can combat fake news…

The Best Way to Die?

by David Brabeck, MD, FACP
By David Brabeck, MD, FACP Medicine can be a strange business. Trainees are often thrust into situations involving life and death in which there is often little formal education for end of life experiences. Moreover, relatively few have personally experienced family members or loved ones dying. The population of the United States is aging and palliative care is a growing field. Despite this, formal medical school education regarding palliative care and hospice is quite varied and often inadequate. A recent review in the journal Medical Education reported that medical schools’ curriculums include between two hours and several weeks of training for end-of-life issues. With limited training in this area, residents and supervising attendings are often left to experiential education to guide them in their communication and medical decision making when a patient is close to dying. These can be difficult waters to navigate when futility of care and patient’s wishes…
David Brabeck, MD, FACP is Associate Program Director, Internal Medicine Residency, in the Departments of Hospital Medicine/General Internal Medicine at Lahey Hospital and Medical Center in Burlington, MA. He can be reached at [email protected]