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Permission denied: Snippets from the front line

I received a phone call from a hospital case manager that my patient did not meet criteria for further admission and should be discharged. Unfortunately, the patient was just removed from a breathing machine, and was still in the ICU for sepsis. There are several criteria used by hospitals guiding whether a patient should be admitted or discharged. Who establishes …

“Overutilization” monicker: Snippets from the front line

I am a geriatric doctor caring for elderly and bedridden patients. Keeping them out of the hospital is a challenge as they face problems different from the general population. Diminished mobility at home comes with skin breakdown and ulceration, muscle and joint atrophy, less ability to expand the lungs and exercise the heart, pain management, and psychologic support requiring family …

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Crime scene: Snippets from the frontline

Hospitals should do no harm. But when administrators intentionally and maliciously create a dangerous environment, the hospital is a crime scene. I’ve been on the frontline for almost 40 years and seen this evolve. Around the country in the 1990s, some hospitals and their legal teams jointly developed a game plan of self-serving greed affecting patients sometimes resulting in death. …

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An American right: Snippets from the frontline

Hospitals compete against each other for your healthcare. Full page ads tout their newest, cleanest, safest facility with the best doctors, latest technology, and quality statistics. Some larger institutes do outshine others technologically, but basically they’re all the same mounting public relations campaigns to gain your confidence and claim your insurance dollar. It is the American way to make money …

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Losing sleep…and experience (Snippets from the front line)

Several years ago, I realized getting up in the middle of the night to answer phone calls or going into the hospital to admit a patient was finally taking a toll. After doing it for 40 years, I thought age was finally getting to me. Luckily six months ago, the hospital hired ICU physician intensivists, covering us at night for …