hospitals


Keeping Frail Elderly out of the Hospital

When I was a medical resident at Boston City Hospital, a large, public, inner city hospital, I began wondering whether hospitals sometimes caused as many problems as they cured. Over and over, I saw older patients admitted with one disease such as pneumonia or a heart attack, who ended up falling and breaking a bone […]

Treating Older People in the Emergency Department

In my 16 years in Emergency Medicine in England it has become increasingly common to see people over 85 years of age. This is an experience shared with ED colleagues from several other countries. Even the proud near-centurion awaiting a “letter from the Queen” is a not infrequent visitor to my department. EDs are increasingly […]

Two Common Sources of Overtreatment

Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is “waste.” At the very least, “waste” is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well. I recently saw a friend at a party. Since […]

How Hospital Care Should Work

This is a corny essay by a man who, having recently undergone surgery, was reminded of those people who, in tending to our health, urge us to focus on what issues properly define life.  First it was the emergency room where I observed the palpable concern on the face of a woman whose only job […]

Do Not Transfer

They finally signed a “Do Not Transfer” order. The patient’s family had been reasonable enough, but they lacked medical expertise, and no one at the nursing home ever mentioned that an acceptable option could be to let a 92-year-old man live out his days, unencumbered by transfers to the emergency room for every attack of […]

Trying to Practice What I Preached: Helping my Parents at the End of Their Lives

Once again, the challenge of how to constrain rising health care expenditures has caught the public interest, stimulated by concerns over rising federal debt and limited ability to generate tax revenues. I recently chronicled my unsuccessful efforts at stimulating medical cost containment from both academic and foundation positions (1971–2002) in the April 23, 2011 issue […]