Posts by Suneel Dhand

Thin-slicing Your Next Hospital Medicine Program

As our specialty of hospital medicine continues its exponential expansion, so does the number of established programs to choose from. Without exaggeration, the job market in most areas of the country is pretty hot right now—and all of us know this from the avalanche of offers and job advertisements out there. Speaking as someone who has worked in several different hospitals and interviewed in dozens of programs across the country, I’ve probably seen the best and the worst of them. Fortunately for me, I’ve mostly had the pleasure of working in the better places—with great leaders and strong support for the specialty. But I’d also be lying if I said I hadn’t seen some fairly terrible places too, and certainly interviewed in some that struck me as toxic almost as soon as I walked through the door. I therefore feel I’m in a position to offer a little bit of…

Hospital Medicine and My Airport Parking Experience?

With the festive season upon us, which often includes traveling, I thought I would write about something off the beaten track and share an interesting experience I had recently. A couple of weeks ago I had just returned to Boston after a trip to London. As usual I had taken the latest flight possible and it was night by the time the plane touched down at Logan airport. When I got out of the airport the first thing that struck me was how much colder it was in Massachusetts compared to England (a common misconception is that England is an extremely cold country, but being a small island it’s actually quite mild compared to other countries at the same latitude). I had a short bus shuttle ride with my two large suitcases to where I usually park, and was delighted when I saw my car, knowing that my home and…

Pareto’s Principle in Hospital Medicine

There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s Principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but also your personal life. [caption id="attachment_11495" align="alignleft" width="214"] source: http://commons.wikimedia.org/wiki/File:Vilfredo_Pareto.jpg[/caption] Pareto’s Principle also has become a popular area of focus in the world of business and management. Named after the 19th century Italian economist Vilfredo Pareto, in a nutshell the principle is as follows: 80 percent of effects always come from 20 percent of the causes. Pareto first observed this ratio when he realized that 80 percent of land and wealth in Italy was owned by 20 percent of the…

Hospitalists: Missing Opportunities to Talk about Healthy Habits & Preventive Medicine?

As hospital doctors, we are extremely busy people. Our days whizz by, often without a moment to rest or take a deep breath. We are in "the zone" and rightly completely focused on getting our patients better and in a position where they can hopefully leave the hospital. We have chosen a specialty that is all about secondary level care, one where we know that we are not going to be seeing our patients in the office afterwards. Our encounters and relationships with them may thus seem very brief and to the point. Most of us probably believe in primary prevention too, but feel that it is outside the scope of hospital medicine. For example, apart from the brief spiel our diabetic and heart failure patients may get about the importance of dietary compliance, how much time do we really spend talking about wellness and preventive medicine with our patients?…

The Things We Say to Our Patients That We Should Be More Tactful about

With the increased focus on patient satisfaction and improving the healthcare experience, how we communicate with our patients is becoming more important than ever. And it’s long overdue. From our patients’ perspectives, being sick is bad enough without feeling disrespected or having an inappropriate message communicated by those who are supposed to be caring for them. Yet every day in hospitals across the nation, conversations take place that unintentionally give the wrong impression and add to our patients’ stress levels. Unfortunately many of these incidents occur in the hospital medicine arena. While we’re all well intentioned and generally do communicate excellently, slip-ups still occur, usually as a simple matter of words, tone and perception. Based on my own experience, here are 3 everyday examples where we can improve. To make this more interesting, I’m going to give some analogies from other situations. 1. Discussing code status with younger patients How…
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