Proceduralists...

Growing in popularity in many hospitals...BD 

Awaiting both kidney and liver transplants last year, Larry Pritchard suffered from fluid build-up so severe it sometimes leaked from the skin on his stomach. The condition required a procedure known as paracentesis to drain the fluid, but at the first hospital where he was treated, he says, emergency-room doctors didn't even know about the procedure and tried to seal the leaks with medical glue. After switching to Cedars-Sinai Medical Center in Los Angeles, he found something he hadn't heard of before: a dedicated Procedure Center, where doctors were expert at inserting a needle deep into the abdominal wall to drain fluid.

"The doctor knew exactly where to put that needle, and everyone at the procedure center was a pro at what they were doing," says the 62-year-old retired attorney. At Cedars-Sinai's center, experts performed the paracentesis procedure on Mr. Pritchard more than 60 times over six months, as frequently as three times a week, and inserted and removed dialyses catheters before his dual transplant last August. "They literally kept me alive," he says.

Boston's Beth Israel Deaconess Medical Center, affiliated with the Harvard Medical School, also uses a simulation center to train residents on mannequins.

Joseph Li, who runs a group of 24 hospitalists at Beth Israel Deaconess who staff a full-time procedure service, still shudders when he remembers how he was taught to remove fluid from the lungs. "I vividly remember thinking I've never done this, and it's almost like a dirty little secret that this patient doesn't know that," Dr. Li says. "We fumbled our way through it with no issues, but it just highlighted for me what an awful way it was to teach."

The Informed Patient - WSJ.com

Hat Tip:  Kevin, MD