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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Sometimes it feels like the great unspoken secret between doctors and nurses. The words that we dare not utter to patients and families. Perhaps it is our hope that we're wrong. Perhaps, we dread providing unwanted news. Perhaps, we don't want to face reality or extinguish our patients' hope. As a daughter, I felt that sense of sadness and dread, waiting to hear the news that would not be told. It was September ...

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Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on. I dial the call-back number. "Pod A," a caffeinated voice chirps. It's Candice, one of the nurses. "Hi. Amy here, returning a page," I murmur. "Oh hi, ...

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Dear hospital executive, If you are like many of the hospital leaders with whom I regularly talk, you’re probably concerned that your hospitalist program isn’t delivering the value you need in this metrics-driven and cost-constrained environment. You may see your hospitalists as disengaged free agents who either don’t know or care too little about contributing to the success of your organization beyond seeing the patients on their list. They may repeatedly ...

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About three years ago, our hospital was abuzz about patient satisfaction. Our HCAHPS scores were lower than expected, and there was a push by the administration to improve them. As a hospitalist, I wondered to myself, what could I possibly do to improve them?  I already believed I was doing a very good job communicating effectively with patients. Many years ago, I developed the habit at the end of each encounter ...

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How can a doctor resist an essay entitled, "The Sickness Unto Death?" Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence? It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on. “In despairing over ...

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Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of ...

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It turns out that South Carolina is having a busy hurricane season. Recently, Charleston County was under a mandatory evacuation in anticipation of Hurricane Matthew. All I-26 lanes were converted into westbound traffic, gas stations were running low on fuel, and the local Wal-Mart was out of bottled water. It was T-minus 3 days to the landfall of Hurricane Matthew, with very variable predictions on the trajectory, speed, and strength. ...

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My mother-in-law died last week. She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now ...

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