Day in the Life of a Hospitalist

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

Wow! A Two-fer

First I hear the American Board of Pediatrics ordains hospital medicine as a bonafide subspecialty. Then, for the adults among us, CMS issues a hospitalist specialty code.  No joke.  A specialty code--go live on April 3, 2017. This has been a laborious task and years in the making. Have a lookie: If you are scratching your head and wondering about the fuss, let me tell you the insights we will draw from the new knowledge and why it will advance our specialty.  For years, hospitalists got lumped with "generalists" when CMS, researchers, or insurance companies ventured to look at physician utilization patterns and service to the healthcare system. What was our individual and collective cost or contribution to a case?  Who understood.  Any interested party trying to untangle what a doc was producing during a hospital stay had only billing patterns, i.e., the percentage of inpatient codes one charged, to determine if…

Purge this Word Your Vocabulary. It’s Likely Harming Patients and Wasting Real Money.

  A little something I sent to my residents--and I post it here as the issue has relevance to every clinician.  Also, a wise professor offered me something to contemplate.  As you read, consider whether this is a professionalism OR systems issue.  If the latter, are the behaviors in accord with the signals we give our trainees, nocturnists and shift workers. Further, do we then have a system designed to provide us with the results we are asking for?  Scenario One: You walk into a bar, and you see a hot girl or guy. You think, "Hmm, I want to meet this person. Let me consider what to do next." Scenario Two: You have a car with a sluggish engine. Something is not right. Once again, you think, "I need to consider how to get the motor purring again." In both cases, everyone would agree you have some decisions to…

Recidivism

  You might wonder why “recidivism” in the subject line. In the context of readmissions, the word comes up often—and in particular, those who cycle from shelters to the street to the ER. Rinse. Repeat.  I focus on the Northeast, but my guess is your regional experience is like mine. You have noticed over the last two to three years, big cities, and NYC in particular, have seen a marked uptick in the number of people sleeping on the sidewalks. The causes of the increase stem from budget cuts, the economy and myriad other factors you can probably surmise. (more…)

Maintaining Balance

I’m not much for New Year’s resolutions. They seem to be too easy to break and lead to disappointment. But my birthday and New Year’s are close together, and they do provide convenient markers to reflect on life, health, and balance. Every day I round in the hospital I find myself discussing healthy lifestyle habits with my patients. Take time to exercise. Eat healthier and eat fewer processed foods. Drink more water. Cut back on the caffeine, alcohol, and soda. Try to control portion size on your plate.   Slow down. Reduce stress. Do as I say, not as I do. When working on the wards, nearly every one of these recommendations go out the window.   Busy days go like this: I get to the hospital too early to do a morning work-out (at least, I don’t pull myself out of bed early enough). Once I’m off and running, I have…
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