Archive for June 2016

Gotta Ticket to Hamilton?

A question searching for answers... “How does a bastard, orphan, son of a whore and a Scotsman, dropped in the middle of a Forgotten spot in the Caribbean by providence Impoverished, in squalor Grow up to be a hero and scholar?” I wish I heard those lines rapped in person, but getting Hamilton tickets is as impossible as getting appropriate ER admissions. It’s hard to escape a story about our 10 dollar founding father these days; everyone knows it (though few have seen it), cite lines, rap patriotic tunes... Hamilton reinvigorated theater and energized many to reflect on the history of our country, diversity in the arts, and the importance of theater. Theater, one of the oldest arts, was developed as entertainment, but also as a laboratory for ideas, a search for discovery of what is like to be human. A place to try out new ideas while asking tough…

Hospitalist Union Update, Patient Obs. Status Notice Top Hospital Medicine News

SHM & Hospital Medicine in the News: June 9 – June 23, 2016 This issue of SHM & Hospital Medicine in the News features: An update on the Oregon hospitalist union, which recently reached a tentative agreement with the hospital at which its members work, causing them to cancel their informational picket Medicare’s draft proposal for a written patient observation status notice to inform them of what it is and its financial implications regarding Medicare coverage. (SHM’s Advocacy team and Public Policy Committee submitted comments in response last week, on which SHM’s Communications team issued a press release.) The continued growth of sub-specialty hospitalists, the cause of which is often cited to be work-life balance One team of doctors in Vermont that has found ways to reduce the number of unnecessary blood tests performed, guided by recommendations originally developed by SHM Analysis of how bundled payments have been a driver…

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…

R-E-S-P-E-C-T

A lot has been written about physician (or provider) burnout. Some of the highest burnout rates include internists and ER doctors, both of which live in our wheelhouse, and some factors that impact the burnout rate have included too many bureaucratic tasks, insufficient income, the computerization of medicine, the ACA, (thanks Obama), insufficient income in relation to hours of work, lack of work-life balance, hyper-responsible personality types as well as a lack of individual control within an organization. But in my practice, one of the greatest negative impacts I see on provider attitude and compassion fatigue is the erosion of the respectful relationship between provider and patient. Let me demonstrate. Just last week on our hospital medicine service, we had a patient call a provider "bitch," had a patient who refused to take any medicine or comply with any phlebotomy without multiple 45-minute debates about the relative merits of each…

Hospitalists & Unionization: Part II

by David Schwartz, MD
By: Dr. David Schwartz Senator Elizabeth Warren once said, “If you don’t have a seat at the table, you are probably on the menu.” While somewhat amusing on the surface, Warren’s comment cuts to the core of why my colleagues and I decided to form the first hospitalist specialty union. The Outsourcing: In 2014, a consulting firm was hired to review our hospitalist program. We were a 38-member group serving a 382 bed referral hospital - one of only two in our community of 200,000. We care for 50-60% of inpatients at any given time and average 35-40 admissions - and sometimes over 50 - in a 24-hour period. Our census had been growing significantly for some time without a comparable increase in staffing.  The occupancy rate of the hospital consistently reaches 90-100%.  The only other hospital is a 115 bed community medical center. We were told that the purpose…
Dr. Schwartz is the president of the Pacific Northwest Hospital Medicine Association, AFT local 6552, and is a hospitalist at Sacred Heart Medical Center in Springfield, Oregon. He graduated from the University of Maryland School of Medicine and completed residency in Internal Medicine at New York Medical College.
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