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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Going into my final few months of residency, I am somewhat puzzled knowing that so many of my colleagues are signing contracts with hospital-owned outpatient practices or are going into subspecialist fellowship training or have plans to work as a hospitalist. As someone who plans to go into solo private practice, I feel like an outlier. Yes, I know what you might be thinking. Who goes into solo practice these days ...

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Our specialty of hospital medicine has grown exponentially over the last decade and now finds itself at the forefront of American medicine. I’m proud to be part of such a growing movement and must say that I find the job just as rewarding as when I first became an attending physician when the specialty was still in its fledgling stage. As the number of us soars towards the 50,000 mark, the ...

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 I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes.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

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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 ...

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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 ...

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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 ...

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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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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 ...

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