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 I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes.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 ...

Read more...

Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free. But when I started my first job as an attending physician in central Massachusetts, I was in for a big shock. I had ...

Read more...

With the endless appearance of medical malpractice solutions in the press, any reader would think we have the answers to the logjam -- but no will to implement them.  If you follow the topic, you know every proposal has flaws and limited applications as they relate to individual states or delivery systems. The worst offender seems to be safe harbor protections (i.e., “follow the guidelines and you won’t get sued”). Recently, however, I ...

Read more...

shutterstock_223878937 gomerblog The Rübler-Koss model or 7 stages of grief is a series of emotional stages an admitting provider experiences when faced with an impending admission. The 7 stages are best remembered by the acronym DABDDAH, which stands for denial, anger, bargaining (or blocking), deflection (or delaying), depression, acceptance, and ...

Read more...

Ever since we are children, our parents and society teach us how to play together with others. What we don’t realize is that this lays the groundwork for developing important teamwork skills -- the same skills that enable success and positive outcomes in the workplace. My own experiences in hospital medicine practice throughout the last decade continue to increase my appreciation for these seemingly simple yet invaluable techniques. Like many young ...

Read more...

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 ...

Read more...

Welcome to Friday night as a hospitalist in the ultimate Green State, Colorado: Time to gear up for some marijuana-facilitated paranoia, memory loss, nausea and vomiting, and memory loss. I’m not a teetotaler, but I do find the new surge in cases of preventable disease a bit disheartening if not occasionally humorous. Prior to this past year, it wasn’t uncommon for me to encounter an occasional marijuana medical problem, but ...

Read more...

One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn't shocking. The patient hadn't been doing well lately, and I wasn't surprised when I got the message that they were on the way to the emergency room. Due to our ...

Read more...

One of the things that I love about my job as a hospitalist is the ease with which we can develop friendships with colleagues from other disciplines. Since I am an inpatient physician, it’s not surprising that some of my good friends are cardiologists, nurses, endocrinologists, physical therapists and, of course, other hospitalists. In fact, I met my neurosurgeon husband while co-managing his patients at the hospital. While thinking about ...

Read more...

The enormous push continues to reduce readmissions, due in no small part to stiff financial penalties from CMS for the worst performing hospitals. The most commonly cited statistic is that about 1 in 5, or 20 percent, of Medicare patients are readmitted within 30 days. A staggeringly high number when you think about it. Having discharged thousands of patients and seen the characteristics of those patients that are frequently readmitted ...

Read more...

38 Pages

Most Popular