Archive for May 2015

Have we hit peak hospitalist?

I have detected something unusual.  Take a look at the cited quotes below and see if you can spot what I am referring to.  Both come from a national newspaper.  Here's the first: On arrival, Larson was put in a room and examined by a physician assistant. He didn’t stop at the admissions office because his information and treatment orders already had been placed into the hospital computer system. Larson was subsequently seen by an internal medicine hospitalist, an infectious-disease doctor and an orthopedic surgeon, who conferred regularly about his care over the next four days. He required 12 days of intravenous antibiotics after discharge; medical supplies were delivered within an hour of his arrival home. A nurse followed shortly to teach him how to administer the medication and give him a 24-hour phone number for a nurse and pharmacist. And here is the second: The hospitalist treating Albright told her that…

Improving Patient Satisfaction through Education, Feedback & Incentives

[caption id="attachment_12537" align="alignright" width="221"] Chart couresty of Kaiser Health News.[/caption] Patient satisfaction survey performance is becoming increasingly important for hospitals, as the ratings are being used by payers in pay-for-performance programs more and more (including the CMS Value Based Purchasing program). CMS also recently released their “Five-Star Quality Rating System” for hospitals, which publicly grades hospitals on 1-5 stars based on their patient satisfaction scores. Unfortunately, there is little literature to guide physicians on exactly HOW to improve patient satisfaction scores for themselves or their groups. A recent publication in the Journal of Hospital Medicine (JHM) found a feasible and effective intervention to improve patient satisfaction scores among trainees, the methodology of which could easily be applied to hospitalists. Dr. Gaurav Banka, a former internal medicine resident (and current cardiology fellow) at UCLA Hospital, was interviewed about his team’s recent publication in the Journal of Hospital Medicine, “Improving patient satisfaction…

Could you be just a little sicker?

I take a deep breath as I get ready to go see Mrs. H. I can predict after sign-out from the ER doc where this is likely to go. Mrs. H. is an 87 year-old woman who comes to the emergency room with weakness. She stumbled and fell to the floor but could not get up to reach the phone to call for help. She laid there on the floor for an hour until her son stopped by to visit and brought her to the ER. Through diligent testing, she is found to have a urinary tract infection and dehydration. She has a few bruises, but nothing is broken. Her son is with her in the emergency department, and he is relieved that she will be admitted to the hospital (admitted – as far as he is concerned). He has been afraid something like this would happen to her for…

Keeping up with the ABIM

You can recall some of the famous apologies and non-apologies of the recent past. Bill—“Even presidents have private lives.”  Kanye—“It starts with this… I’m sorry, Taylor.”  And in early February, we added this one.  Rich- “We got it wrong. We are sorry.” Now don’t get me wrong, apologies are good and a necessary first step toward healing and returning to normalcy. Dr. Baron’s American Board of Internal Medicine (ABIM) apology seemed sincere even if it was only accompanied by minor changes in the Maintenance of Certification (MOC) process. That apology was of course in response to the groundswell of defiance that had been growing for the last year, mostly focusing on the increased requirements and fees that came about with the early 2014 changes to the ABIM MOC process that upped the number of “points” required, upped the fees, and dropped the reporting period to every two years from every…

Ten 2-Letter Words to Live by

One of my favorite residency attendings recently passed away. A life cut too short. Dr. Leeper, an Emory pulmonologist, was a prime example of the academic triumvirate: an incredible researcher, clinician and educator. Although I spent only a few weeks with him as an intern, I frequently find myself sharing and using his words of wisdom. As the intern, resident and students were scrambling around all day gathering bits of data, doing procedures, adjusting dials, or questioning what was happening, in would walk the Dr. Leeper, the attending who had all the answers. He acted with grace and equanimity. His actions and mantras held us accountable while letting us see the bar we could achieve. In those first days with him, while presenting a case, I would stumble with some lab tests, or relate that the outside records weren’t available, or discuss some imaging that was missing or delayed. He…
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