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 I ...

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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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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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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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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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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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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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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, the payments ...

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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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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 ...

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