Archive for August 2014

Hospital Medicine Community: How do we instill some order into the daily chaos? – Part II

Yesterday I highlighted and identified that the daily chaos that has come to characterize hospital medicine needs to be changed. The problem, in a nutshell, as a specialty colleague remarked to me one morning, “I don’t know how on earth you can do this. You are getting called and paged from all directions at the same time about admissions, discharges and urgent floor situations!” We hospitalists need to find order in the chaos, do what we do best, and modify the systems within which we work to improve hospital medicine and patient care. The fact is that you take even the best job in the whole world and instill complete chaos and disorder into it and people will eventually leave that job. So how can we instill and establish some order? I don’t pretend to have all the answers, but here are some ideas: ·Impose stricter limits on the daily patient census.…

Hospital Medicine Community: How do we instill some order into the daily chaos? – Part I

Several years into my career in hospital medicine, I have to say that I still enjoy my job as much as ever and have absolutely no regrets in choosing this profession. I firmly believe that at its best, being a hospital doctor is one of the most rewarding jobs anyone could ever hope to have. You are the “captain of the ship” utilizing your skills to treat patients’ complex illnesses, guiding them through their hospitalization. You get to form very close relationships with patients and their families as you strive to get them better. Having worked in several hospitals up and down the East Coast, I’ve been fortunate enough to work mostly in supportive environments where I’m afforded the opportunity to do this to the best of my abilities. However, I know that many in our specialty across the country work in situations less conducive to optimal patient care. The…

Medicine and surgery in 1900. Should you watch TV’s latest medical drama?

Someone recently stopped you and said, “I can’t believe you are not watching [Breaking Bad, Mad Men, OITNB, Downton Abbey, House of Cards].” You made some reference about the lead character, but know you don’t have the time to watch one episode, let alone 4 seasons on Netflix to catch up.  I did indulge in HBO’s True Detective. Completely worth it. Largely to simply understand these hilarious memes. When the latest buzz surrounded a medical drama during the turn of the 20th century, New York City, and cable television’s ability to hold nothing back, I had to tune in. In the first episode of Cinemax’s new adventure in highbrow cable television, The Knick, the lead surgeon announces, “Let’s give them a show.” Does the show deliver? Before the opening credits, the superstar surgeon of the Knickerbocker Hospital visited a brothel and found the remaining vessel to help propel the cocaine. Added…

Who is the most productive hospitalist in the country? Guess what. It’s not you.

  Some of you might know CMS released our Part B productivity data earlier in 2014.  We have discussed on the policy side of SHM how we might use the data to learn about our field.  Unlike other specialties, we do not have a unique billing identifier.  Without the information, we cannot easily interrogate the database and view the patterns of the more than 40,000 hospital-based practitioners within our healthcare system.  The absence of such a feature creates gaps in our learning.  And as they say, you can't manage what you can't measure. We will acquire a unique code at some point, my conjecture, but until we do, we use inpatient-billing figures to assist in tagging physicians who practice hospital medicine. Most guess ambulatory docs do not bill greater than 25% of their codes on the hospital side, and as the hospitalist majority have their boards in IM or FP…

Apple Health for Patient Engagement

Be on the lookout for Apple Health, a new app that will share multiple inputs of patient information in a cloud platform called “HealthKit.” This HealthKit will allow a user to view a personalized dashboard of health and fitness metrics, which conglomerates information from a myriad of different health and wellness apps, and helps them all “communicate” with one another. Apple may also be collaborating with a number of academic medical centers and electronic health record (EMR) companies (including Epic which controls 40% of the current EMR business), to determine how to innervate this new technology into healthcare systems. The primary purpose of this is to capture and maintain a patient’s engagement in their own health and wellness, a longstanding issue yet to be solved by the medical industry. But this also may be the next major healthcare breakthrough innovation to ease the burden of care continuity, which is the…
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