Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with ...

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The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use. There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them ...

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My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined. At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams ...

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Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but ...

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There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live,” but rather on the “right to die.” These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost ...

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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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STAT_LogoA good relationship between a patient and his or her physician is the cornerstone of superb medical care. That relationship is important when you know the doctor well. It may be even more important when you don’t, say when you are in the hospital.

Growing competition for new customers is inspiring American hospitals to focus on providing ...

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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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I am working hospitalist right now. On Friday, a man in his 80s was admitted with difficulty breathing. He had a complicated history, including a heart attack at age 35 with all the subsequent sequela of heart disease. He had an abnormal heart rhythm and was taking a blood thinner for stroke prevention. In addition, he had scarring of his lungs (cause unknown). He was transferred to us from another hospital. ...

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Recently, I wrote a letter to hospital executives, urging them to deliberately invest their own personal time and effort in fostering hospitalist well-being. I suggested several actions that leaders can take to enhance hospitalist job satisfaction and reduce the risk of burnout and turnover. Following the publication of that post, I heard from several hospital executives and was pleasantly surprised that they all responded positively to my ...

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