As hospitals everywhere have been using every health care provider available to them in response to COVID-19, the specialty of hospital medicine has shown itself to be uniquely suited for coordinating the effort, to be the front of the frontline responders. I suspect that many people don't understand what "hospital medicine" is, even though it's larger than almost any other ...

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It was a Thursday. It was supposed to be one of those “regular” evening shifts. Then, at 6:15 p.m., my first page went off: Bed 11, Mrs. R., Dr. H. needs to talk to you. The page came from the COVID section of the emergency department. I immediately called back. It saddened me when I learned that our patient was a young woman health care worker in her early 50s. She ...

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I am an internal medicine doctor on the frontline of the COVID-19 pandemic in Oakland, California. Before the first confirmed case at my hospital, I could sense the fear and anxiety of the impending disaster with every interaction I had with colleagues and my patients. This was largely due to the uncertainty of what was to come, and we were mainly looking towards the overwhelmed health ...

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Multiple times a week, I get messages asking some variation of, "How are you holding up?" I am neither an anesthesiologist, critical care, or ER physician, so I’m not three inches away from exposure while intubating patients with coronavirus. I am also not a nurse or respiratory therapist in a room dozen of times a day administering life-saving medications, performing vital assessments, or carefully managing the oxygen lifeline. I’m certainly ...

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As I drove into work this week, I felt the elephant standing on my chest with its heavy foot in the pit of my stomach.  Amidst this current global pandemic due to COVID-19, I reminded myself to breathe. The idea of getting closer to the hospital made the adrenaline surge through my anxiety-ridden heart. I think back to a time many years ago, when I was a pediatric resident, preparing to ...

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About a year ago, I had an interesting encounter on my way back home to Texas after visiting my parents. I was casually chatting with an older female acquaintance as I got situated on the plane. She asked me what kind of medicine I practice. This woman is in medicine, not a physician, but knowledgeable about the varying specialties. I told her that I was an internist working as a ...

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Just to give you my background, I manage a large hospitalist program for a busy downtown community hospital that is part of a large health system consisting of a total of 29 acute care hospitals in the same geographical area. One of the reasons why our team was hired recently to manage this hospitalist program was to change the existing work culture, which had resulted in poor team performance, low physician ...

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What About Recovery” is a provocative essay by Yale professor Lenore Buckley, MD, in JAMA. She writes in detail about the death of her 68-year-old brother in a hospital. She felt his doctors did not do enough to help him recover because his nutritional and physical therapy needs were not met. However, there’s more to it. She calls out the system existing in every hospital I’m aware of writing, ...

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STAT_LogoWhat if I told you that, as your doctor, I’d rather listen to your memoir than to your lungs? Or that while I find the sound of a beating heart a marvel to behold, I’m more interested in hearing the jazz song that you wrote or talking about the words tattooed on your left wrist. What if ...

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“Happiness is when what you think, what you say and what you do are in harmony.” - Mahatma Gandhi Burnout among physicians is at an epidemic proportion. National data suggests that more than 50 percent of our workforce is burned out, and this trend has been across the board from physicians in training to practicing physicians. Some of the specialties are more affected than others. Repercussions of provider burnout on health care ...

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I previously suggested that transitioning from the traditional inpatient care model to the hospitalist model inadvertently motivated providers to hospitalize more patients, specifically borderline sick patients.  Our example was a 74-year-old woman with pneumonia whose path to admission met less resistance with a hospitalist at the helm. The question I posed at the end was this: model aside, should we admit that patient or not?  What’s best ...

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Why is your hospital always full? Actually, it’s more than full.  You have twenty boarders in the ED. You turned your postop recovery unit into an overnight surge center.  Every day administrators beg you to please, please discharge patients, if possible before 11 a.m.  You’ve hired an army of case managers, dissected the discharge process, and held countless capacity management meetings, but you’re still bursting at the seams. It wasn’t always ...

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As a hospitalist, like most in health care, I am afflicted by the slow march of thousands of mouse clicks on the electronic health record (EHR) every day I work.  But after starting a new job and learning a new EHR, I have become painfully aware of the volume of alerts that pop up when I place orders.  Don’t get me wrong: I appreciate being informed that a patient has ...

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A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance ...

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I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the ...

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First impressions are critical. We are taught early in our careers that first impressions truly matter. Whether interviewing for medical school or a residency program, our goal is to make a positive first impression in hopes of making the cut at each checkpoint in our early careers. These processes in our academic lives and careers are exhausting. As residencies and medical schools are becoming more competitive, the importance of first impressions ...

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I am considered a “xennial” physician. Not quite a millennial — but also not fitting into the generation of the respected preceptors I had in medical school and residency. I took my MCAT via paper and pencil. My mini boards during my clinical rotations were on paper and pencil. All of my licensing and board exams were computerized. It was not an option to sit at home and log on to ...

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On the outside, most American hospitals appear completely modernized. If resources are utilized correctly, they appear equipped for any disaster, any CMS audit and any surprise joint commission inspection that may come. The procedural appearance of hospitals seems robust and reflective to medicine in the 21st century. However, the framework for the daily function of many American hospitals is architecturally weak and weathered (metaphorically speaking). With the progression of times ...

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Two years ago, when I was still in residency I happened to be on overnight call the day prior to election day. An associate program director of my residency program asked me if I wouldn't mind being a doctor of record who evaluates whether I agree a patient is too sick to go to the polls. They forwarded to me names of patients who expressed interest in voting and were already ...

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Not knowing what else to do after finishing my pediatric residency 15 years ago, I became a general pediatrician. Not knowing how to find a job halfway across the country and closer to home, I relied on a recruiter from a smallish town in South Dakota to woo me into private practice. Not knowing how to choose my future partners, I let them choose me. Despite my unbelievably naive approach to ...

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