I sometimes joke that hospitalists are the medicine version of the mullet haircut; you know, all business in “the front” (i.e., the patient care area) and all party in “the back” (i.e., the work room). In “the back,” the usual scenario is to complain and moan about our frequent flyers, our drug seekers, our many unsaveable patients, the incredible situations (“He put a nail where?"), with good-natured but somewhat bitter ...

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Recently, the online version of JAMA published an original investigation entitled "Patient Mortality During Unannounced Accreditation Surveys at US Hospitals." The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was ...

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In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have ...

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I was talking with a colleague in another section today, and she was noting the difference between our hospitalist group and her section.  She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship.  She is a bit frustrated with her new home and its team members because she feels like there are a lot of “B's.”  You know ...

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I read a fascinating article from ProPublica about a nurse practitioner (NP), Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, the payments ...

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My 85-year-old patient was brought in from home. She was cachectic, contracted, minimally responsive to questions, covered in multiple decubitus ulcers on both hips, both knees, both shoulders, and her sacrum. She had polymicrobial sepsis-bacteremic with two different organisms. She was, in fact, dying. Despite her profoundly debilitated condition, her son, who cared for her at home wanted “everything” done. So she was placed on IV fluids, antibiotics, received an ...

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I just finished reading the Journal of Hospital Medicine article called “The highest utilizers of care: individualized care plans to coordinate care, improve health care service utilization, and reduce costs at an academic tertiary care center.” Using a multidisciplinary team of volunteers including members from hospital medicine, ER, psychiatry, ambulatory care, social work, nursing and risk management,  individualized care plans were developed for high utilizer patients.  These patients had multiple ...

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I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I ...

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shutterstock_113875279 Recently I received an elderly patient who had been transferred from another hospital where she had been admitted for two weeks. The pertinent information about this patient is that her son, a doctor, a pathologist, had arranged the transfer. The worst thing to have is a patient with a doctor for a relative. No, the worst thing is to have a patient ...

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shutterstock_226224511 I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical “horror story” with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive ...

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