Archive for February 2017

The Upside of Anger

Recently, I heard from a number of NP/PA providers in response to Dr. John Nelson’s editorial published in the January edition of The Hospitalist. In the editorial, Dr. Nelson refers to an article in the Journal of Clinical Outcomes. The single-site study compared routine versus expanded PA care in a community hospital, and the intervention group delivered a three percent reduction in costs with similar measures in quality. In discussing the results, Dr. Nelson concluded that this article showed that, with proper planning and infrastructure, care delivered primarily by PAs can go "OK". Many of you took offense at the lack of enthusiasm or support for the model studied and felt that it demonstrated poor understanding for the migration of roles for NP/PA providers in hospital medicine. So who is right? Was it merely one tiny study that showed “OK” results? Or was it an impactful article that demonstrates the…

My Top Five Drugs I Want Now

This is a serious list.  We get conditioned on what we have and accept the untoward effects or inconveniences of the drugs in our armamentarium. These five tweaks would make our lives a helluva lot easier: A non-opiate pain reliever without the nasty side effects of an NSAID.  By far and away, this is my number one. An oral insulin.  Can you imagine how much easier life would be? A rapid-acting antidepressant that works.  We (adult providers) neglect the limited functional abilities from cardiovascular or musculoskeletal disorders our patients live with.  The problem is only getting worse. Imagine an accelerated resolution to mental health issues which invariably magnify and worsen the physical ones we have a hard enough time dealing with in the first place. A systemic anti-inflammatory that is not prednisone.  We use that train wreck of a drug so often we forget what a horror show it is.  Its list…

Clinicians to Follow on Twitter, Opioid Management & Int’l HM in the News

SHM & Hospital Medicine in the News: February 2 – February 16, 2017 Check out the latest hospital medicine and SHM-related stories in mainstream and healthcare-centric news. For the full stories, click on the links below: JHM deputy editor, Vineet Arora, MD, MPP, FHM, was listed as 1 of 13 clinicians to follow on Twitter and was quoted in an article discussing mortality rates among U.S. vs. foreign trained doctors. Brad Flansbaum, DO, MPH, MHM reviewed this story in a recent blog post. Thomas W. Frederickson, MD, SFHM wrote an article for the pharma letter highlighting SHM’s Reducing Adverse Drug Events related to Opioids (RADEO) guide, for which he was the lead author Former SHM president Mark V. Williams, MD, MHM spoke about the evolution of hospital medicine at the first International Conference of Hospital Medicine in Taiwan. Journal of Hospital Medicine research from 2012 was cited in an article…

Does Your Onboarding Process Really Get Folks On Board?

Not long ago, I had a conversation with a good friend who is the hospitalist medical director for a five-hospital health system in the northeast. We were commiserating about how hard it is to recruit new hospitalists to rural and small-town settings and the high risk of rapid turnover despite all the energy invested in recruiting and onboarding them. As we discussed how new hospitalists are oriented into his organization, I learned that like most hospitalist groups, my friend’s group focuses onboarding efforts on making sure that new providers know how to find their way around the hospital and use the EHR, complete required training modules, are credentialed with payors, and are aware of applicable policies and procedures. They also see this time as a probationary period to ensure the new group member has adequate clinical skills and behavioral competencies. This conversation got me thinking about the crucial relationship between…

A GIF Is Worth 3000 Words: Introducing #VisualAbstract for #JHMChat

by Charlie M. Wray, DO, MS
If you’re like most hospitalists, your day usually starts around dawn (or dusk, for our nocturnal colleagues). After arriving at the hospital and quickly receiving sign out on your patients, you down the last bit of coffee and rush off to spend a morning on the wards. As you’re getting into a rhythm, the charge nurse on 3C grabs you as you walk by and lets you know that Mr. Sanchez’s son arrived and would like an update. BEEP. BEEP. BEEP: “Mrs. Jones wants to know when she can eat.” Just as you head her way, the cardiology fellow sees you and wants to discuss the follow-up plan on Mr. Aldridge… By 3PM, you’ve grabbed a quick bite to eat, and you’re likely leading the Patient Safety Committee meeting (while still fielding intermittent pages, of course). By early evening, you’re placing a few last minute orders and putting out small…
Charlie M. Wray, DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.
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