Archive for July 2014

Hospital Doctors: We should never allow ourselves to become shift workers

Growing up, I had always associated shift work with blue-collar jobs - typically those jobs that didn’t require a degree or graduate education. Not that there’s anything wrong with those jobs (a lot of them are vital public services), but I never expected to one day be working in a job where I would see myself as a “shift worker,” or worse still one where I "clocked in and clocked out" at the start and finish of the day. Graduating from medical school and beginning a career in medicine, I surely had started a noble profession—a calling—where I was as far away from this as possible; in a position where I would receive autonomy and a certain degree of freedom. Now several years into a career in hospital medicine, I sometimes feel surprised at where my chosen specialty has found itself. I'm also surprised by how some of my peers view their own work schedules. Having…

“How do you know the two-midnight rule doesn’t deliver?” We just learned why.

93% of Hospitalist respondents rated observation policy as critical, but close to two-thirds were not confident in determining a patient's status. For several years, hospital-based practitioners have struggled with observation status, the two-midnight rule, and recovery audit mechanisms.  Doubly so because of the evolving regulations CMS continues to proffer.  Expect additional guidance as the workings (and vagaries) of the rule still plague patient admissions. We all toil with “medical necessity” and what the term means.  The linchpin of successfully implementing the rule hinges on deciphering that very term.  We look towards colleagues, administrators, and consultants for aid. However, after countless internal meetings, conference calls, and failed attempts in obtaining an instruction manual, we realized no one had answers.  Moreover, we at SHM did not know if members were coping and applying the rule in a consistent manner. (more…)

Volume, Value, and Thinking outside the Box

Solving the increasing demands within busy hospitalist practices while maintaining high levels of quality will need a touch of creative scheduling. by Dr. Sowmya Kanikkannan MD, FACP, SFHM When I began my job search at the end of residency, I was looking for a career that’s fast-paced, system-oriented focus on a shift schedule. Hospital medicine was at the top of my list because it has all of this, and it also afforded me the opportunity to travel, which is one of my passions. During my weeks on, I was rewarded for working hard with thankful patients and vibrant residents who were eager to learn. During my weeks off, I traveled the world; exploring the Pyramids in Cairo, swimming with sea turtles in the Galapagos Islands and visiting my cousins in Rio de Janeiro. As amazing as these experiences were, I began to notice that during my weeks on, I had…

A Little Friendly Competition Sparks Choosing Wisely

Written by Kelly Rand on July 22, 2014 In every job that must be done, there is an element of fun. You find the fun and – SNAP – the job’s a game! Who knew that Mary Poppins’ advice could apply to reducing waste in health care? Apparently, the Society of Hospital Medicine (SHM) and the Minnesota Medical Association (MMA) did. To get their members fired up about implementing Choosing Wisely , both organizations are inviting their members to engage in a little friendly competition. SHM will award eight prizes totaling $20,000 to the winners of their Choosing Wisely Case Study Competition. The competition provides an opportunity for hospitalists to share projects that have facilitated the successful implementation of one or more recommendations from SHM’s Choosing Wisely list. Submissions will be evaluated on: - Demonstrated  improvement in appropriate utilization - Demonstrated ability to succeed in sustaining efforts - Innovation in…

Rock and Roll Medicine. Jack White brings historic public health mainstream.

[caption id="attachment_10799" align="alignleft" width="300"] www.thirdmanrecords.com[/caption] Jack White, of the White Stripes, the Racounters, and others, introduced a solo album last month called Lazaretto. It's an appropriate name for a rock star trying to maintain a dead musical form - the vinyl record. He made it in the Guinness Book of World records last month while recording and releasing the album in under four hours. (He did the same recently with Neil Young on Jimmy Fallon.) For many, records are alive and well, a lazarus move in the age of digital music. What were lazarettos? The lazarettos were isolation facilities, from plague or leprosy, but really places of death, with no chance of resurrection. White romanticizes the notion of quarantine, and of lazarettos in this NPR interview. He wishes he could have a month of a self-imposed quarantine to achieve some mindfulness, peace. In today's ever connected world, radio silence is…
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