Physician | https://xitter.cf/t.co/ymdHK4O5hQ | The Podcast by KevinMD

Nashua, NH, north of Boston
Joined December 2007
Two nurses, one of them still in training, were responsible for 16 emergency room patients, including a baby with RSV who needed to be transferred. Molly Murray, a physician assistant in emergency medicine, says that was her last shift. She says the baby, in all likelihood, should have been one-to-one, and that administration said, “Well, technically there are two of you, so this seems like a fair staffing ratio.” She says it wasn’t, because one of the two was still in training. What else she says the nurses were juggling on the same shift: Patients asking for medications, water, and discharge paperwork, some of them yelling at the nurses. Two ICU holds, one of them a GI bleed. Consultants to talk to, orders to carry out, and blood products to pick up. Hours of documentation after the shift was over. What does your unit get when the nurses call administration for help? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #EmergencyMedicine #ThePodcastbyKevinMD
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Her water broke at 14 weeks, and she was pregnant with twins. Every week after that, the nurses printed a certificate and all of them signed it. Vince Baiera, a nurse and health care executive, says his wife was on bed rest for five months, three of them in the hospital. He describes the small things the nurses did. The certificate said, “Congrats, you made it to 24 weeks.” They hung them on the door. The nurses wore sweaters that said, “We grow miracle babies.” When the fluid leaked again and they were scared, the nurses stayed calm: “We see this all the time. Don’t worry, we got you.” They pointed to what they had seen before, like no blood in the fluid. They kept a board of the weeks and days, and the nurses cheered the count: “31 and three!” He also says one question mattered more than they knew. The team asked if she was having contractions, she said yes, and what they meant was painful contractions. He says that miss was shared, and they learned it in the last month. What does your unit do when a hospital stay is long and the outcome is uncertain? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #PatientExperience #ThePodcastbyKevinMD
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She asked her care team whether her first breast biopsy would hurt, and was told it was really simple. Bianca Haines, a patient advocate, says no one told her she would be in excruciating pain, or that she would be able to see the whole procedure on a flat-screen TV above her head. The bed had no grips. She says she kept saying, “I need a grip.” Her list of what care teams could do differently is short and specific: Tell the patient what to expect during a biopsy before it starts. Put the information in layman’s terms, with bullet points, instead of a pointer to a website. Make sure every specialist knows the patient before she walks in the door. She says her second team did, and that the communication between them was essential. She had three more biopsies after that first one, and she says she knew what to expect each time. What do you tell a patient before a first biopsy? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #PatientExperience #ThePodcastbyKevinMD
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The two physicians she had brought in and trained gave her three months’ notice, because she was not, in their words, “feeding the mid-levels.” Sarah A. Vlach, a physiatrist and sports medicine physician, says she built her practice from scratch. She says she worked about nine months without a medical assistant before the notice came. A former partner once offered to take her last two procedures so she could make her daughter’s soccer game. She says he added, “Of course, you wouldn’t want to miss out on those RVUs.” Has a metric ever told you what your work is worth? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #PhysicianCareers #ThePodcastbyKevinMD
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On the day her insurance ran out, a woman with wounds on both feet was told to go home from a skilled nursing facility. 34 home health agencies refused her. Gary Rothenberg, a podiatrist who had treated her for years, says there was no plan for home care and she lived alone. He says it was around Thanksgiving, the agencies were short staffed, and no one was in her home to teach the wound care she needed. He says she ended up back in the emergency room with infected ulcers and a prolonged hospital stay. What should be in place before a patient’s coverage for a facility stay ends? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #CareTransitions #ThePodcastbyKevinMD
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At her first prenatal visit, 3 of a patient’s 4 sonograms were thrown in the trash at checkout, in front of the whole waiting room. The 1 the office kept for its records showed what appeared to be a single embryo. Nichole Cubbage, a biorepository technician, says she demanded the other 3 back and was told the images of her own uterus were incorrect and nothing she should look into. Of course, she looked. She had come in at 6 weeks and 1 day and says she was scoffed at for coming in so early. After that, she says, her repeated questions met a huge lack of answers, with physicians referring her to other physicians within the same practice. She did not have an ultrasound after 24 weeks because her provider said it was not medically necessary. What should an office do before it throws away a patient’s own images? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #PatientAdvocacy #ThePodcastbyKevinMD
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A cardiologist’s friend, a musician on Medicaid, called to say his coverage had changed and he could no longer afford the medication he needed. Payman Sattar (@md_payman), a cardiologist, says the medication was now over $300 a month. Then the pandemic dried up all of his friend’s gigs. Sattar tried a few things to get him the medication, but he just stopped taking it. About a couple months later, he had a big stroke and passed away. How many patients stop a medication without ever telling their doctor? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #Medicaid #ThePodcastbyKevinMD
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A perfusionist holds up an iPad so a family can say their final goodbyes, holds the patient’s hand while they die, and clamps the line on their life support. Julie Collins, a cardiovascular perfusionist, says the patients she was taking care of were the same age she was, and they were dying. She says health care workers took their clothes off in the backyard, followed themselves through the house with a can of Lysol, and showered in the basement so they would not touch anything. Her 7-year-old son, probably every month for two years, came to her with one question: “Mommy, you’re not going to die, are you?” She told him no, everything was going to be OK. In the back of her head, she says, she was wondering. When you remove support from one patient, she says, there is usually another patient who needs the machine. At the end of the night you cry a little bit, and you realize the next patient needs you as much as the one who just died. What did the people taking care of your family carry home that you never saw? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #HealthcareWorkers #ThePodcastbyKevinMD
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In the final year of her physical therapy program, the professors split the class into “the white guys” and “the janitors.” The janitors were all the students of color. Jerenda Bond (@JerendaBond), DPT, a physical therapist, says it was a competitive learning game in a joint mobilization class. The students of color ended up not doing as great in the class as they could have, because they felt intimidated and pushed aside to the margins. The students took it to the provost. Leadership let the professor continue so the class could finish. In the meetings, she says, he maintained his innocence, that it was just a game. If the only way to finish a course is to keep the professor, what should a school do? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #HealthEquity #ThePodcastbyKevinMD
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A mother arrived at her daughter’s first cystic fibrosis consultation with highlighted protocols and all her questions. Her doctor saw that her hands were shaking. Laura Spiegel, a patient advocate and the mother of a child with cystic fibrosis, had printed the evidence-based protocols and highlighted them. She says she looked like a very informed and activated caregiver. Within the first 5 or 10 minutes, the pulmonologist saw past that. The doctor sat in a chair right next to her, took her hands and, Laura recalls, told her that her daughter would lead a long and full life. That is what let Laura hear the rest of the visit. Her tip for families: write down your number-one goal for the appointment and say it first. What would you want a doctor to say in the first five minutes? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #CysticFibrosis #ThePodcastbyKevinMD
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