Archive for August 2013

A passage to bookmark

    I just finished a remarkably good book.  After concluding, a passage continued to replay in my head.  I went back to find the page, and reread it a second, and then a third time.  Not my habit, I knew the knowledge contained within needed passing on. The wisdom emanates from a 1968 conversation between Henry Kissinger, and then RAND researcher, Daniel Ellsberg.  Kissinger discussed with Ellsberg the trappings of power.  Given his experience as an Under Secretary of Defense during the Vietnam War several years before, Ellsberg had advice to give—and Kissinger got it in spades. Despite Ellsberg's association with the Pentagon Papers later on— a teensy kerfuffle you might have heard of, at the time, he had a friendship with Kissinger and guest lectured in some of his Harvard courses. While the conversation is pure realpolitik, and the advice a bromide to prepare for the political arena,…

#MomInHospital

A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time. Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized mother, and I made the same decision – to tweet from the bedside. (As with Simon’s mom, mine didn’t quite understand what Twitter is, but trusted her son that this was a good thing to do.) Being with my mother during a four-day inpatient stay offered a window into how things actually work at my own hospital, where I’ve practiced for three decades, and into the worlds of hospital care and patient safety, my professional passions. In…

Leave the outpatient regimen untouched

A great commentary out today in JAMA Internal Medicine.  The topic?  Mucking with established ambulatory medication regimens during hospital stays. I find the sins the authors allude to--confusing patients, wasting money, and chasing artificial outcomes, have the least traction with younger hospitalists, trainees, and those without much ambulatory experience.  The temptation to treat the chart or number holds too much sway. An unfortunate consequence--whatever we do on the inpatient side gets exported right back to the caregiver and primary doc.  They must untangle the chaos we create. Treating HM docs should minimize responses  to ethereal measurements and lab readings.  We must also communicate with PCPs to attenuate any potential risks of acting on those findings.   The following passage conveys the sentiment aptly: "The inpatient clinician may not be aware of, or simply ignore, the patient’s long-term success at disease control in the months and years prior to hospitalization. Second,…