This past week was one of those weeks looming ahead of me that I was already dreading as I entered into it. I was to be working through another holiday and following a string of nights, and I would have a quick turnaround into a mid-shift. As a nocturnist by choice, I rarely work mornings or mid-shifts. I find the nights busy but also less intrusive — i.e., less administrative ...

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When you or a loved one is sick or injured, health care decisions are fundamentally a matter of trust.  You trust your physician will have the answers you need, because you know that, as a highly-trained medical professional, they’re qualified to make the best recommendation for each and every patient under their care. Physicians receive some of the most rigorous education and training of any profession. They spend the better part ...

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The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to her room later in the day to find out more about her history. After rounds ...

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I learn all manner of interesting things from the information sheets posted on the walls of the employee bathrooms at my hospital. I learn, for example, about upcoming CME offerings for advance practice providers, how many seconds one has to scrub the hub of a central line, and what the new process is when nurses need to call in sick. They call a specific phone number and state that they ...

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Being a hospitalized patient is perhaps one of the most disempowering experiences an individual can face (besides being in war, or a prisoner). Patients face constant uncertainty; having no idea what time their physician will visit, when they will be taken for their tests, or who will suddenly interrupt them again with a demand - perhaps an early morning blood draw, or yet another round of interrogation and uncomfortable examination ...

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In 2002, when I began my first hospitalist job, I was a dyed-in-the-wool hospital medicine convert, convinced that the transfer of inpatient care to true specialists in hospital medicine (hospitalists) would dramatically improve the quality and efficiency of inpatient care, increase patient satisfaction and decrease costs. By 2008, I had developed serious doubts, which prompted me to publish an editorial in the Journal of Hospital Medicine, entitled “The Expanding or Shrinking ...

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Alvin is a 42-year-old man who was never really given a chance. His parents both had severe alcohol use disorder. At age 12, his parents encouraged him to skip school to sell marijuana in order to fund their drinking. As his parents began using various illicit drugs, Alvin started selling larger amounts of marijuana to foot their bill. Eventually, marijuana was not ...

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I have a theory. There is a simple thing hospitalists can do that can enhance relationships with our patients, and even, I bet, improve patient satisfaction scores. The catch is it is not something you can do for yourself; you can only “pay it forward” for somebody else. We know patients who trust their physicians are more likely to follow recommendations, and that trust and confidence in physicians ...

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For the last 8 years, I have worked as a locum tenens hospitalist. I began on this path when it was the least popular option upon graduation from residency. I did countless hours of research trying to find accurate information about locum tenens companies, but never found anything written by physicians, only by the companies themselves. So, I stepped into this field blindfolded and learned the hard way. Since then, I have ...

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I am a hospitalist at a safety-net hospital. Through my work, I have come to understand how our daily decisions — filtered through our own biases — influence how health care is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K. He was in his 40s, well-kempt, soft-spoken and had the good habit of looking people ...

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One of the things that can help a physician live a balanced life is finding ways to thrive in the workplace. This is currently a work in progress for me, but I am excited to share what I have learned so far. For some context, I was previously practicing as a nephrologist; and I transitioned to being a hospitalist on an as-needed basis to create flexibility in my schedule. This ...

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It has been a struggle to get out of my own way. I’m sure many of you have the same feeling. My health and well-being have suffered mightily from the stress of taking care of others in my work as a physician. I have not taken care of myself. Period. My career does not make me unique in this situation, as the patients I treat every day suffer from similar ...

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“We are playing the same sport, but a different game,” the wise, thoughtful emergency medicine attending physician once told me. “I am playing speed chess – I need to make a move quickly, or I lose – no matter what. My moves have to be right, but they don’t always necessarily need to be the optimal one. I am not always thinking five moves ahead. You guys [in internal medicine] ...

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It’s been 21 years since Drs. Robert Wachter and Lee Goldman, in an article in the New England Journal of Medicine, first described a new delivery model called “hospitalists” – clinicians whose primary professional focus is the care of hospitalized patients. Since that time the healthcare system has seen rapid growth of hospitalist programs across a variety of specialties. In the OB world, I have had the opportunity to ...

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A study published recently in JAMA Internal Medicine looked at 650,651 Medicare patients hospitalized in 2013. It showed that when patients were cared for by their own outpatient physician, they had a slightly better outcome than when the patients were attended to by full-time hospital-based specialists who had not previously known them. As an internal medicine physician who maintains hospital privileges, as well as caring for patients in ...

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Long continues the debate of what impact hospitalists have on inpatient outcomes. This issue has been playing out in the medical literature for 20 years, since the coining of the term in 1997. In the most recent iteration of the debate, a study was recently published in JAMA Internal Medicine entitled "Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists." The study retrospectively evaluated health care ...

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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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