Tracy Cardin is a nurse practitioner.

Reach out to your colleagues: This can have more impact than you can imagine

Physician
September 18, 2018

I just heard.

A colleague, a man of integrity and warmth, a hard-working physician with ideals, ethics and many valued contributions, has taken his own life. His perspectives may have differed from mine at times, but every interaction was infused with respect. He was a good man.

Much has been written about the rate of suicide of physicians. One million Americans lose their doctors to suicide each year. Normally …

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Reach out to your colleagues: This can have more impact than you can imagine

NP/PA vs. physician: Why is there a productivity gap?

Physician
July 25, 2018

So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …

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NP/PA vs. physician: Why is there a productivity gap?

The 4 types of low-functioning health care team members

Physician
May 29, 2018

There have certainly been numerous articles, periodicals, missives, messages, courses and LinkedIn articles about the importance of strong leadership. I myself have blogged that most “challenges” in hospital medicine could likely be solved with strong leadership and adequate staffing.

But recently I gave a talk with Sarah Apgar from UCSF on differences in supervision and collaboration. During that talk, we investigated what it means to be a functional “member” of a …

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The 4 types of low-functioning health care team members

5 ways to make a connection with previously unreachable patients

Physician
June 1, 2017

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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5 ways to make a connection with previously unreachable patients

The Joint Commission surveys matter more than we think

Policy
May 9, 2017

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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The Joint Commission surveys matter more than we think

When can I follow my intuition?

Physician
December 24, 2016

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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When can I follow my intuition?

You have a dysfunctional hospitalist group. Can it be fixed?

Physician
December 3, 2015

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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You have a dysfunctional hospitalist group. Can it be fixed?

Hold nurse practitioners accountable by including them in the conversation

Policy
August 28, 2015

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, …

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Hold nurse practitioners accountable by including them in the conversation

Powerless in the setting of patient autonomy? Try maternalism.

Physician
May 13, 2015

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 infectious disease …

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Powerless in the setting of patient autonomy? Try maternalism.

The low-hanging fruit of health care costs

Policy
April 30, 2015

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 co-morbidities, …

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The low-hanging fruit of health care costs

Ease the transition to hospital medicine

Physician
March 11, 2015

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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Ease the transition to hospital medicine

The patient’s son is a doctor. But he’s also scared.

Physician
January 26, 2015

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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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The patient’s son is a doctor. But he’s also scared.

5 ways to ease the integration of NPs and PAs

Policy
November 10, 2014

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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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5 ways to ease the integration of NPs and PAs