Archive for January 2015

What’s on Your Nightstand?

Before going to sleep read for half an hour, and in the morning have a book open on your dressing table. -Osler What is on your nightstand? I'm not asking about the NEJM issue from 2013 that you still haven't gotten to; or the gadgets glowing or dinging through the night; or the accumulating used tissue pile since you and all your patients now have the flu. What books are on your nightstand? As Osler would ask, what are you reading the last 30 minutes of the day? I'll tell you some of my list from 2014, and then a preview of what's ahead for 2015. (Not all of these books were published in this past year. Like that 2013 NEJM article that sits unread, I’m a bit behind on my reading). The Anatomy Lesson, by Nina Siegal I was in Philly this past year, and stopped in the Philadelphia…

Teaching on Today’s Wards: All You Need Is 1 Minute, So SNAPPS to It?

During my eight-year tenure as Associate Program Director for our Internal Medicine Residency, I read countless letters of recommendation for aspiring residents, and many were signed by familiar hospitalist friends from all over the country.  If you think about how many students and residents come into contact with hospitalists, making sure hospitalists are great teachers is more than just a pride issue, it's also critical to training the next generation of physicians, no matter what specialty they go into. Unfortunately, there are many barriers to teaching on the wards today for hospitalists.  First and foremost, time is of the essence.  Less time worked by residents has increased the clinical workload of teaching attend ings…and what has been squeezed out is time for teaching.  Therefore, methods to teach trainees efficiently on the wards are must-have skills for any academic hospitalist. Fortunately, there are two new articles in the Journal of Hospital…

Medical Malpractice & Guideline Use: Do We Need Safe Harbors?

With the endless appearance of medical malpractice solutions in the press, any reader would think we have the answers to the logjam — but no will to implement them.  If you follow the topic, you know every proposal has flaws and limited applications as they relate to individual states or delivery systems. The worst offender seems to be safe harbor protections (i.e., “follow the guidelines and you won’t get sued”). Recently, however, I perused something a bit more refreshing with an uncharacteristic slant. Expecting to read a fluff piece on the subject, I found the writer (a physician attorney) delivered a succinct and well-done overview.  He expands upon why the universe of guidelines looms too large, has too dynamic a foundation, and how the Choosing Wisely campaign and CMS Quality Indicator bundle can work as much for, as against a clinician.  Most important, he illustrates why a guideline will never provide complete refuge: On one hand it may…

Leading Quality Improvement even at a Small Hospital

Hospitals are under increasing pressure to improve clinical quality and adhere to an array of ever-changing measurement and reporting requirements. Many organizations are turning to hospitalists to steer those efforts. Dr. Vercin Ephrem (VE), chief of hospital medicine at LRGHealthcare, in Laconia, NH, spoke with Maureen McKinney (MM), a healthcare journalist and editorial programs manager at Modern Healthcare magazine, about the guiding role hospitalists can play in quality and safety programs. Here is a lightly edited transcript of their discussion. MM: Why do you think hospitalists are well-suited to lead quality-improvement initiatives? VE: Hospitalists are embedded in patient care through the entire care continuum. We work with all departments necessary to ensure that best care practices are met. One of the greatest benefits is that we’re working with the same set of people day in and day out, so we know who to contact in pharmacy, embedded care, nursing, etc.…

Building a Great Hospitalist Team

Ever since we are children, our parents and society teach us how to play together with others. What we don’t realize is that this lays the groundwork for developing important teamwork skills — the same skills that enable success and positive outcomes in the workplace. My own experiences in hospital medicine practice throughout the last decade continue to increase my appreciation for these seemingly simple yet invaluable techniques. Like many young hospital medicine directors, I began my leadership role with only a basic understanding of teamwork concepts. Excited by the new role, I immediately decided that the first task that I would tackle would be to take my new group of disparate physicians and build them into a team that could produce positive results for my hospital and our patients. As you can probably imagine, achieving that goal is not an easy task. I would learn that it requires thought,…
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