Archive for June 2014

Hospital Docs: To round on Only One Floor, or Not to?

A major debate taking place in the hospital medicine community over the last several years concerns the way in which we cohort patients on the medical floors. The traditional way is to have patients belonging to each doctor scattered across the hospital on several different floors. This is in contrast to designing a geographical system where all the patients for any one doctor are located on a single floor. On the surface, it seems like a good idea to have this latter model, which is why some people are advocating for it. Theoretically, rounding in this manner will be more efficient and the amount of pages and calls from nurses should be reduced. As someone who has worked in both extremes as an attending physician, I have had the opportunity to experience the pros and cons of both types of rounding—which I’m going to call geographical versus traditional. I believe…

You Can Observe A Lot by Just Watching.

"You can observe a lot by just watching." -Yogi Berra "You see, but you do not observe." - Sherlock Holmes, A Scandal In Bohemia. Sir Arthur Conan Doyle I walked into the patient's room day after day and heard the same line. "Sorry, Doc…not ready to get home. My breathing is still bad." He was sitting up, resting on the bedside table, looking tiny in the expansive, sterile hospital room. This small man with advanced COPD came in six days earlier with an acute exacerbation. The team rounded on him daily. We filled up his room, piling on the windowsill, filing around his bed. His vital signs improved quickly, and by day three, his numbers were great and his lungs opened up. He barely made it through each syllable on day one; almost a week later he was sounding out sentences, making his way to paragraphs. "It seems you are…

Knowing What We Don’t Know

I thought I would start this month’s blog post with a case. A 36 year-old previously healthy woman presented 5 days into an illness which began with fever, fatigue, severe joint pain, painful mouth sores, and a diffuse skin rash. Her fever lasted 48 hours, and she has been afebrile since. She continues to have severe debilitating joint pain, fatigue, mouth sores, and a diffuse red skin rash. On exam, she was afebrile with normal vital signs. She was quite uncomfortable due to the joint pains and she had aphthous ulcers. There was no frank joint swelling, and the remainder of the exam was normal. Labs revealed normal hemoglobin, a mildly low white blood cell count, and a mildly low platelet count. Electrolytes, inflammatory markers, and the liver panel were normal. What are your thoughts on diagnosis or further work-up? How should we proceed? By the way – the patient…

Women, Leadership & Hospital Medicine: Lean In

by Dr. Rachel George MD, MBA, CPE, SFHM It is time for women in hospital medicine to sit at the table, pursue our ambitions, and change the conversation to what we can do to transform patient care. One year ago Sheryl Sandberg, COO of Facebook, published her best-selling novel Lean In: Women, Work, and the Will to Lead encouraging women to do just that. So, what’s the buzz about? Wasn’t this all sorted out a generation ago and didn’t we get this equal rights thing figured out? We can have it all, right? Unfortunately, that may not be the case. The United States is far behind other countries in helping women stay in the work force; America comes in last place on paid maternity leave (CNN Money), and according to a survey released by the United Nation’s labor agency, only three countries do not provide cash benefits to women during…

Let the Countdown Begin: EMR Re-Launch

The current state of the electronic medical record (EMR) at my organization feels like being in an old hospital complex which has clearly been built up over the course of decades; room numbers are not necessarily logical or in sequence, buildings connect on different floors, and most elevators do not actually go all the way from the bottom to the top of each building. Our current EMR “system” has sprung up over the course of several decades, as each area serially sprung for the system that best met their needs. Interfaces were partial or non-existent, and most single users did not have access to over half of the systems on campus. The result was a dizzying complex of EMRs that few users knew how to fully navigate. So now my organization, like so many others, decided to raise the white flag, spend an enormous sum of cash, and buy a…
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