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Tom Collins is a freelance writer in South Florida who has written about medical topics from nasty infections to ethical dilemmas, runaway tumors to tornado-chasing doctors. He travels the globe gathering conference health news and lives in West Palm Beach.
Speed-mentoring event targets junior hospitalists
When senior physicians and researchers – including hospitalists – talk about their careers, it seems they never fail to mention the mentors who helped shape their professional lives. Mentoring matters – a lot.
Junior hospitalists have a chance to receive mentoring in an area of their choice at HM17.
“This is their opportunity to get ‘rapid-fire’ advice from senior hospitalists from a variety of perspectives,” said event organizer Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta.
The advisers are chosen because of their commitment to supporting career development and because of their reputation and expertise. Many of the speed mentors are returning to the event for the fourth time. It has been held at the SHM annual meeting since 2013.
“This event doesn’t replace traditional mentorship but does give junior hospitalists an opportunity to discuss an aspect of their career with multiple senior hospitalists from across the country,” Dr. Bonsall said.
When senior physicians and researchers – including hospitalists – talk about their careers, it seems they never fail to mention the mentors who helped shape their professional lives. Mentoring matters – a lot.
Junior hospitalists have a chance to receive mentoring in an area of their choice at HM17.
“This is their opportunity to get ‘rapid-fire’ advice from senior hospitalists from a variety of perspectives,” said event organizer Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta.
The advisers are chosen because of their commitment to supporting career development and because of their reputation and expertise. Many of the speed mentors are returning to the event for the fourth time. It has been held at the SHM annual meeting since 2013.
“This event doesn’t replace traditional mentorship but does give junior hospitalists an opportunity to discuss an aspect of their career with multiple senior hospitalists from across the country,” Dr. Bonsall said.
When senior physicians and researchers – including hospitalists – talk about their careers, it seems they never fail to mention the mentors who helped shape their professional lives. Mentoring matters – a lot.
Junior hospitalists have a chance to receive mentoring in an area of their choice at HM17.
“This is their opportunity to get ‘rapid-fire’ advice from senior hospitalists from a variety of perspectives,” said event organizer Joanna Bonsall, MD, PhD, SFHM, assistant professor of medicine at Emory University, Atlanta.
The advisers are chosen because of their commitment to supporting career development and because of their reputation and expertise. Many of the speed mentors are returning to the event for the fourth time. It has been held at the SHM annual meeting since 2013.
“This event doesn’t replace traditional mentorship but does give junior hospitalists an opportunity to discuss an aspect of their career with multiple senior hospitalists from across the country,” Dr. Bonsall said.
Pre-course focuses on perioperative care
Hospitalists packed the room on Monday for a pre-course brimming with information on how to better care for patients undergoing surgery – a category of care that can involve high-stakes and complex decisions before and after a procedure.
Topics covered in the wide-ranging talks included how to assess risk in those with ischemic heart disease, ways to manage anticoagulants in a variety of patients, the basics of anesthesia, and issues particular to patients with neurologic diseases.
“If you keep those things in mind then you will do a good job taking care of patients as long as you use good clinical sense,” said pre-course director Kurt Pfeifer, MD, FHM, professor of internal medicine at the Medical College of Wisconsin, Milwaukee.
Throughout the sessions, presenters posed audience-response questions to keep everyone engaged. In her discussion of perioperative considerations involving neurologic diseases, Rachel Thompson, MD, MPH, SFHM, associate professor of internal medicine at the University of Nebraska Medical Center, Omaha, asked whether it’s true or false that 1 in 10 patients with epilepsy will have a seizure on the day of surgery, even if they maintain their normal medication regimen.
In her talk on using anticoagulants, Barbara Slawski, MD, MS, SFHM, professor of medicine at the Medical College of Wisconsin, said it was important to understand the newest literature when using national guidelines, to consider clotting and bleeding risks when considering bridging anticoagulation therapy, and to make a specific plan for management for each patient.
She emphasized the team approach.
“It’s really important to listen to your surgical colleagues when they’re concerned about bleeding risk,” she said.
Dr. Pfeifer said the hospitalists’ involvement in surgical cases ranges from preoperative assessments, helping handle last-minutes changes in a care plan, managing patients afterward, and postdischarge follow-up.
“When you look at the perioperative continuum, there are a lot of places where we have a role to play – maybe more than anyone else in the equation.”
Hospitalists packed the room on Monday for a pre-course brimming with information on how to better care for patients undergoing surgery – a category of care that can involve high-stakes and complex decisions before and after a procedure.
Topics covered in the wide-ranging talks included how to assess risk in those with ischemic heart disease, ways to manage anticoagulants in a variety of patients, the basics of anesthesia, and issues particular to patients with neurologic diseases.
“If you keep those things in mind then you will do a good job taking care of patients as long as you use good clinical sense,” said pre-course director Kurt Pfeifer, MD, FHM, professor of internal medicine at the Medical College of Wisconsin, Milwaukee.
Throughout the sessions, presenters posed audience-response questions to keep everyone engaged. In her discussion of perioperative considerations involving neurologic diseases, Rachel Thompson, MD, MPH, SFHM, associate professor of internal medicine at the University of Nebraska Medical Center, Omaha, asked whether it’s true or false that 1 in 10 patients with epilepsy will have a seizure on the day of surgery, even if they maintain their normal medication regimen.
In her talk on using anticoagulants, Barbara Slawski, MD, MS, SFHM, professor of medicine at the Medical College of Wisconsin, said it was important to understand the newest literature when using national guidelines, to consider clotting and bleeding risks when considering bridging anticoagulation therapy, and to make a specific plan for management for each patient.
She emphasized the team approach.
“It’s really important to listen to your surgical colleagues when they’re concerned about bleeding risk,” she said.
Dr. Pfeifer said the hospitalists’ involvement in surgical cases ranges from preoperative assessments, helping handle last-minutes changes in a care plan, managing patients afterward, and postdischarge follow-up.
“When you look at the perioperative continuum, there are a lot of places where we have a role to play – maybe more than anyone else in the equation.”
Hospitalists packed the room on Monday for a pre-course brimming with information on how to better care for patients undergoing surgery – a category of care that can involve high-stakes and complex decisions before and after a procedure.
Topics covered in the wide-ranging talks included how to assess risk in those with ischemic heart disease, ways to manage anticoagulants in a variety of patients, the basics of anesthesia, and issues particular to patients with neurologic diseases.
“If you keep those things in mind then you will do a good job taking care of patients as long as you use good clinical sense,” said pre-course director Kurt Pfeifer, MD, FHM, professor of internal medicine at the Medical College of Wisconsin, Milwaukee.
Throughout the sessions, presenters posed audience-response questions to keep everyone engaged. In her discussion of perioperative considerations involving neurologic diseases, Rachel Thompson, MD, MPH, SFHM, associate professor of internal medicine at the University of Nebraska Medical Center, Omaha, asked whether it’s true or false that 1 in 10 patients with epilepsy will have a seizure on the day of surgery, even if they maintain their normal medication regimen.
In her talk on using anticoagulants, Barbara Slawski, MD, MS, SFHM, professor of medicine at the Medical College of Wisconsin, said it was important to understand the newest literature when using national guidelines, to consider clotting and bleeding risks when considering bridging anticoagulation therapy, and to make a specific plan for management for each patient.
She emphasized the team approach.
“It’s really important to listen to your surgical colleagues when they’re concerned about bleeding risk,” she said.
Dr. Pfeifer said the hospitalists’ involvement in surgical cases ranges from preoperative assessments, helping handle last-minutes changes in a care plan, managing patients afterward, and postdischarge follow-up.
“When you look at the perioperative continuum, there are a lot of places where we have a role to play – maybe more than anyone else in the equation.”
Communication expert to explore work-life balance
The hospital medicine field has struggled with the issue of burnout for years. The supply of hospitalists has had trouble keeping up with the demand. Hospitalists, often viewed as agents of change, are also encouraged to take on projects, such as quality improvement initiatives, beyond their clinical duties.
A talk at this year’s meeting will take on the issue of work-life balance, which is often an ideal that hospitalists find difficult to attain.
Dawna Ballard, PhD, will lead the session “Why We Fail at Work-Life Balance,” scheduled for Tuesday, May 2, 3:05–3:45 p.m., as part of the Rapid Fire track.
Dr. Ballard is an associate professor in communication studies at the University of Texas at Austin and is an expert on chronemics, which, as her professional website puts it, is the “study of time as it is bound to human communication.” She does research on why we lead our lives at a certain pace and the effect this pace has on our communication and, ultimately, on the long-term health of organizations.
Recently, she has studied the historical and contemporary problems with the discourse on “work-life balance.” She is also a coauthor of the 2016 book Work Pressures, which explores the ways pressure at work can erode the performance and vitality of people and their organizations.
Dr. Ballard said she has found in her research that the very idea of a “work-life balance” can bring about confusion and frustration.
“Just this morning, someone tweeted me that they don’t really like the notion of balance, and they always feel like they’re being punished,” she said recently. “A big part of the problem is our expectations about ourselves around time.”
[[{"fid":"195467","view_mode":"medstat_image_flush_right","attributes":{"height":"220","width":"147","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":""}},"link_text":false}]]Dr. Ballard said she will focus on promoting a better understanding of the relationship between time and work.
“I will identify a few common themes (in everyday talk and popular culture) about the role of time in being effective at work,” she said. “I will then discuss what the research and data suggest is actually true about these relationships between time and work.”
Struggles with balancing personal time and time in the workplace seem to be linked with job satisfaction in hospital medicine, the literature suggests. In survey results published in 2012, 63% of hospitalists reported high job satisfaction, but personal time was one area in which they reported being least satisfied. Satisfaction or dissatisfaction with personal time was also one of the areas that predicted satisfaction or dissatisfaction with their specialty.1
Dr. Ballard said that she hopes to debunk some misconceptions. “The goal of this talk is to identify problems with commonly held assumptions that actually lead to reduced effectiveness at work and increased stress,” she said. “Given the centrality of time to our experience as professional and personal selves, working with a clear (evidence-based) understanding of the sociocultural and historical underpinnings of common assumptions is critical.”
One problem, she said, is that there is “a mythology that this is something that has ever existed or ever could exist, and so it disciplines people and it makes people feel like they’re failing.”
“Work is uneven – especially for doctors, it’s really uneven,” she said. “It can be really intense sometimes and then there can be times where we can pull back. ... Intensity doesn’t have to be bad and not good. It just is descriptive.”
She added, “We love work that can be intense at times.”
Reference
1. Hinami K, Whelan CT, Wolosin RJ, et al. “Worklife and satisfaction of hospitalists: Toward flourishing careers.” J Gen Intern Med. 2012;27(1):28-36.
“Why We Fail at Work-Life Balance”
Tuesday, May 2, 3:05–3:45 p.m.
The hospital medicine field has struggled with the issue of burnout for years. The supply of hospitalists has had trouble keeping up with the demand. Hospitalists, often viewed as agents of change, are also encouraged to take on projects, such as quality improvement initiatives, beyond their clinical duties.
A talk at this year’s meeting will take on the issue of work-life balance, which is often an ideal that hospitalists find difficult to attain.
Dawna Ballard, PhD, will lead the session “Why We Fail at Work-Life Balance,” scheduled for Tuesday, May 2, 3:05–3:45 p.m., as part of the Rapid Fire track.
Dr. Ballard is an associate professor in communication studies at the University of Texas at Austin and is an expert on chronemics, which, as her professional website puts it, is the “study of time as it is bound to human communication.” She does research on why we lead our lives at a certain pace and the effect this pace has on our communication and, ultimately, on the long-term health of organizations.
Recently, she has studied the historical and contemporary problems with the discourse on “work-life balance.” She is also a coauthor of the 2016 book Work Pressures, which explores the ways pressure at work can erode the performance and vitality of people and their organizations.
Dr. Ballard said she has found in her research that the very idea of a “work-life balance” can bring about confusion and frustration.
“Just this morning, someone tweeted me that they don’t really like the notion of balance, and they always feel like they’re being punished,” she said recently. “A big part of the problem is our expectations about ourselves around time.”
[[{"fid":"195467","view_mode":"medstat_image_flush_right","attributes":{"height":"220","width":"147","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":""}},"link_text":false}]]Dr. Ballard said she will focus on promoting a better understanding of the relationship between time and work.
“I will identify a few common themes (in everyday talk and popular culture) about the role of time in being effective at work,” she said. “I will then discuss what the research and data suggest is actually true about these relationships between time and work.”
Struggles with balancing personal time and time in the workplace seem to be linked with job satisfaction in hospital medicine, the literature suggests. In survey results published in 2012, 63% of hospitalists reported high job satisfaction, but personal time was one area in which they reported being least satisfied. Satisfaction or dissatisfaction with personal time was also one of the areas that predicted satisfaction or dissatisfaction with their specialty.1
Dr. Ballard said that she hopes to debunk some misconceptions. “The goal of this talk is to identify problems with commonly held assumptions that actually lead to reduced effectiveness at work and increased stress,” she said. “Given the centrality of time to our experience as professional and personal selves, working with a clear (evidence-based) understanding of the sociocultural and historical underpinnings of common assumptions is critical.”
One problem, she said, is that there is “a mythology that this is something that has ever existed or ever could exist, and so it disciplines people and it makes people feel like they’re failing.”
“Work is uneven – especially for doctors, it’s really uneven,” she said. “It can be really intense sometimes and then there can be times where we can pull back. ... Intensity doesn’t have to be bad and not good. It just is descriptive.”
She added, “We love work that can be intense at times.”
Reference
1. Hinami K, Whelan CT, Wolosin RJ, et al. “Worklife and satisfaction of hospitalists: Toward flourishing careers.” J Gen Intern Med. 2012;27(1):28-36.
“Why We Fail at Work-Life Balance”
Tuesday, May 2, 3:05–3:45 p.m.
The hospital medicine field has struggled with the issue of burnout for years. The supply of hospitalists has had trouble keeping up with the demand. Hospitalists, often viewed as agents of change, are also encouraged to take on projects, such as quality improvement initiatives, beyond their clinical duties.
A talk at this year’s meeting will take on the issue of work-life balance, which is often an ideal that hospitalists find difficult to attain.
Dawna Ballard, PhD, will lead the session “Why We Fail at Work-Life Balance,” scheduled for Tuesday, May 2, 3:05–3:45 p.m., as part of the Rapid Fire track.
Dr. Ballard is an associate professor in communication studies at the University of Texas at Austin and is an expert on chronemics, which, as her professional website puts it, is the “study of time as it is bound to human communication.” She does research on why we lead our lives at a certain pace and the effect this pace has on our communication and, ultimately, on the long-term health of organizations.
Recently, she has studied the historical and contemporary problems with the discourse on “work-life balance.” She is also a coauthor of the 2016 book Work Pressures, which explores the ways pressure at work can erode the performance and vitality of people and their organizations.
Dr. Ballard said she has found in her research that the very idea of a “work-life balance” can bring about confusion and frustration.
“Just this morning, someone tweeted me that they don’t really like the notion of balance, and they always feel like they’re being punished,” she said recently. “A big part of the problem is our expectations about ourselves around time.”
[[{"fid":"195467","view_mode":"medstat_image_flush_right","attributes":{"height":"220","width":"147","class":"media-element file-medstat-image-flush-right","data-delta":"1"},"fields":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":"","field_file_image_caption[und][0][format]":"plain_text","field_file_image_credit[und][0][format]":"plain_text"},"type":"media","field_deltas":{"1":{"format":"medstat_image_flush_right","field_file_image_caption[und][0][value]":"Dr. Dawna Ballard","field_file_image_credit[und][0][value]":""}},"link_text":false}]]Dr. Ballard said she will focus on promoting a better understanding of the relationship between time and work.
“I will identify a few common themes (in everyday talk and popular culture) about the role of time in being effective at work,” she said. “I will then discuss what the research and data suggest is actually true about these relationships between time and work.”
Struggles with balancing personal time and time in the workplace seem to be linked with job satisfaction in hospital medicine, the literature suggests. In survey results published in 2012, 63% of hospitalists reported high job satisfaction, but personal time was one area in which they reported being least satisfied. Satisfaction or dissatisfaction with personal time was also one of the areas that predicted satisfaction or dissatisfaction with their specialty.1
Dr. Ballard said that she hopes to debunk some misconceptions. “The goal of this talk is to identify problems with commonly held assumptions that actually lead to reduced effectiveness at work and increased stress,” she said. “Given the centrality of time to our experience as professional and personal selves, working with a clear (evidence-based) understanding of the sociocultural and historical underpinnings of common assumptions is critical.”
One problem, she said, is that there is “a mythology that this is something that has ever existed or ever could exist, and so it disciplines people and it makes people feel like they’re failing.”
“Work is uneven – especially for doctors, it’s really uneven,” she said. “It can be really intense sometimes and then there can be times where we can pull back. ... Intensity doesn’t have to be bad and not good. It just is descriptive.”
She added, “We love work that can be intense at times.”
Reference
1. Hinami K, Whelan CT, Wolosin RJ, et al. “Worklife and satisfaction of hospitalists: Toward flourishing careers.” J Gen Intern Med. 2012;27(1):28-36.
“Why We Fail at Work-Life Balance”
Tuesday, May 2, 3:05–3:45 p.m.
Hospitalists get hands-on training at POC ultrasound pre-course
Hospitalists participated in a double-header of hands-on point-of-care ultrasound training here on Monday, looking to gain an edge in expertise in a role that’s becoming more and more common.
Nearly 100 hospitalists and other health care professionals heard talks on the fundamental principles of ultrasound and cardiac, lung and vascular, and abdominal ultrasound. The highlights of the sessions were two 80-minute hands-on segments using the probes.
“This course has grown and grown – this is the largest we’ve ever done,” said pre-course director Nilam Soni, MD, MS, FHM, associate professor of medicine at the University of Texas Health Science Center San Antonio.
A morning and afternoon session were held, each attended by 48 registrants. Because of high demand, the society added 12 spots to each session – and there was still a wait list, said Ricardo Franco-Sadud, MD, the other director of the course and associate professor of medicine at the Medical College of Wisconsin, Milwaukee.
“The idea is to give you the most amount of time with the probe in their hand,” Dr. Franco said.
In one of the hands-on sessions, Adam Merando, MD, a hospitalist and associate program director of the internal medicine residency program at Saint Louis University, slid and rocked the probe on the stomach of a volunteer as the picture came into view.
“Now we’re getting an image,” his bedside instructor, Brandon Boesch, DO, a hospitalist at Highland Hospital in Oakland, Calif., told him. Dr. Merando had found the liver.
He eventually found the main target, the inferior vena cava, and assessed its diameter in relation to the breathing of the “patient.” This information is used to gauge how responsive acute circulatory failure patients are to fluid therapy.
At one point, with another learner, the image shifted.
“You see how it feels like your hand is not moving, but the image is changing?” Dr. Boesch said. “That’s part of the fine motor skill.”
Kirk Spencer, MD, professor of medicine and a cardiologist at the University of Chicago and perennial participant in the course, said it’s a great way for hospitalists who were hesitant about learning ultrasound to get over the hump.
Benji Mathews, MD, assistant professor of medicine at the University of Minnesota, Minneapolis, another bedside instructor, said the enthusiasm about the course is well founded.
“This is one of the few technologies that brings you back to the bedside.”
Hospitalists participated in a double-header of hands-on point-of-care ultrasound training here on Monday, looking to gain an edge in expertise in a role that’s becoming more and more common.
Nearly 100 hospitalists and other health care professionals heard talks on the fundamental principles of ultrasound and cardiac, lung and vascular, and abdominal ultrasound. The highlights of the sessions were two 80-minute hands-on segments using the probes.
“This course has grown and grown – this is the largest we’ve ever done,” said pre-course director Nilam Soni, MD, MS, FHM, associate professor of medicine at the University of Texas Health Science Center San Antonio.
A morning and afternoon session were held, each attended by 48 registrants. Because of high demand, the society added 12 spots to each session – and there was still a wait list, said Ricardo Franco-Sadud, MD, the other director of the course and associate professor of medicine at the Medical College of Wisconsin, Milwaukee.
“The idea is to give you the most amount of time with the probe in their hand,” Dr. Franco said.
In one of the hands-on sessions, Adam Merando, MD, a hospitalist and associate program director of the internal medicine residency program at Saint Louis University, slid and rocked the probe on the stomach of a volunteer as the picture came into view.
“Now we’re getting an image,” his bedside instructor, Brandon Boesch, DO, a hospitalist at Highland Hospital in Oakland, Calif., told him. Dr. Merando had found the liver.
He eventually found the main target, the inferior vena cava, and assessed its diameter in relation to the breathing of the “patient.” This information is used to gauge how responsive acute circulatory failure patients are to fluid therapy.
At one point, with another learner, the image shifted.
“You see how it feels like your hand is not moving, but the image is changing?” Dr. Boesch said. “That’s part of the fine motor skill.”
Kirk Spencer, MD, professor of medicine and a cardiologist at the University of Chicago and perennial participant in the course, said it’s a great way for hospitalists who were hesitant about learning ultrasound to get over the hump.
Benji Mathews, MD, assistant professor of medicine at the University of Minnesota, Minneapolis, another bedside instructor, said the enthusiasm about the course is well founded.
“This is one of the few technologies that brings you back to the bedside.”
Hospitalists participated in a double-header of hands-on point-of-care ultrasound training here on Monday, looking to gain an edge in expertise in a role that’s becoming more and more common.
Nearly 100 hospitalists and other health care professionals heard talks on the fundamental principles of ultrasound and cardiac, lung and vascular, and abdominal ultrasound. The highlights of the sessions were two 80-minute hands-on segments using the probes.
“This course has grown and grown – this is the largest we’ve ever done,” said pre-course director Nilam Soni, MD, MS, FHM, associate professor of medicine at the University of Texas Health Science Center San Antonio.
A morning and afternoon session were held, each attended by 48 registrants. Because of high demand, the society added 12 spots to each session – and there was still a wait list, said Ricardo Franco-Sadud, MD, the other director of the course and associate professor of medicine at the Medical College of Wisconsin, Milwaukee.
“The idea is to give you the most amount of time with the probe in their hand,” Dr. Franco said.
In one of the hands-on sessions, Adam Merando, MD, a hospitalist and associate program director of the internal medicine residency program at Saint Louis University, slid and rocked the probe on the stomach of a volunteer as the picture came into view.
“Now we’re getting an image,” his bedside instructor, Brandon Boesch, DO, a hospitalist at Highland Hospital in Oakland, Calif., told him. Dr. Merando had found the liver.
He eventually found the main target, the inferior vena cava, and assessed its diameter in relation to the breathing of the “patient.” This information is used to gauge how responsive acute circulatory failure patients are to fluid therapy.
At one point, with another learner, the image shifted.
“You see how it feels like your hand is not moving, but the image is changing?” Dr. Boesch said. “That’s part of the fine motor skill.”
Kirk Spencer, MD, professor of medicine and a cardiologist at the University of Chicago and perennial participant in the course, said it’s a great way for hospitalists who were hesitant about learning ultrasound to get over the hump.
Benji Mathews, MD, assistant professor of medicine at the University of Minnesota, Minneapolis, another bedside instructor, said the enthusiasm about the course is well founded.
“This is one of the few technologies that brings you back to the bedside.”
Experienced HM clinicians tackle opioid issues
Societal trends – and ills – don’t stop at the hospital door, and opioid use is no exception. Hospitalists are frequently presented with difficult cases involving patients who have been using opioids for long periods of time, including some who show signs of opioid addiction. These cases present challenges for treatment and sometimes tense situations in which patients request delivery of pain medication that a hospitalist might consider excessive or potentially harmful.
Two experienced hospitalists will guide HM17 attendees through this dicey terrain in “The Hospitalist’s Role in the Opioid Epidemic” session, scheduled for Tuesday, May 2, 1:35–2:35 p.m., as part of the Quality Track.
“We will be discussing how hospitalists have contributed to the opioid epidemic, and how we can be part of the solution,” she said. “We hope hospitalists will leave the talk with a better understanding of how their prescribing practices contribute to opioid-related adverse events, and how to prescribe more safely and appropriately, to minimize risks and maximize benefits.”
“Both chronic pain and long-term opioid therapy are high-prevalence conditions,” she said. “While hospitalists are often comfortable with their knowledge and skills in treating acute pain, many of us find that our patients have multiple or complex pain conditions that include chronic pain components.”
Despite the best of intentions, hospitalists are increasingly concerned that they might take steps in treatment that could actually contribute to opioid abuse. This session will, in part, be geared toward avoiding those pitfalls.
“Treatment of pain during hospitalization is more challenging in patients who regularly take opioid medications,” Dr. Mosher said. “The growing concern that hospitalists might inadvertently contribute to risky or excessive opioid use though well-intentioned, inpatient and discharge prescribing makes it even more essential that we increase our knowledge, skills, and confidence in this area.”
The Hospitalist’s Role in the Opioid Epidemic
Tuesday, May 2, 1:35–2:35 p.m.
Societal trends – and ills – don’t stop at the hospital door, and opioid use is no exception. Hospitalists are frequently presented with difficult cases involving patients who have been using opioids for long periods of time, including some who show signs of opioid addiction. These cases present challenges for treatment and sometimes tense situations in which patients request delivery of pain medication that a hospitalist might consider excessive or potentially harmful.
Two experienced hospitalists will guide HM17 attendees through this dicey terrain in “The Hospitalist’s Role in the Opioid Epidemic” session, scheduled for Tuesday, May 2, 1:35–2:35 p.m., as part of the Quality Track.
“We will be discussing how hospitalists have contributed to the opioid epidemic, and how we can be part of the solution,” she said. “We hope hospitalists will leave the talk with a better understanding of how their prescribing practices contribute to opioid-related adverse events, and how to prescribe more safely and appropriately, to minimize risks and maximize benefits.”
“Both chronic pain and long-term opioid therapy are high-prevalence conditions,” she said. “While hospitalists are often comfortable with their knowledge and skills in treating acute pain, many of us find that our patients have multiple or complex pain conditions that include chronic pain components.”
Despite the best of intentions, hospitalists are increasingly concerned that they might take steps in treatment that could actually contribute to opioid abuse. This session will, in part, be geared toward avoiding those pitfalls.
“Treatment of pain during hospitalization is more challenging in patients who regularly take opioid medications,” Dr. Mosher said. “The growing concern that hospitalists might inadvertently contribute to risky or excessive opioid use though well-intentioned, inpatient and discharge prescribing makes it even more essential that we increase our knowledge, skills, and confidence in this area.”
The Hospitalist’s Role in the Opioid Epidemic
Tuesday, May 2, 1:35–2:35 p.m.
Societal trends – and ills – don’t stop at the hospital door, and opioid use is no exception. Hospitalists are frequently presented with difficult cases involving patients who have been using opioids for long periods of time, including some who show signs of opioid addiction. These cases present challenges for treatment and sometimes tense situations in which patients request delivery of pain medication that a hospitalist might consider excessive or potentially harmful.
Two experienced hospitalists will guide HM17 attendees through this dicey terrain in “The Hospitalist’s Role in the Opioid Epidemic” session, scheduled for Tuesday, May 2, 1:35–2:35 p.m., as part of the Quality Track.
“We will be discussing how hospitalists have contributed to the opioid epidemic, and how we can be part of the solution,” she said. “We hope hospitalists will leave the talk with a better understanding of how their prescribing practices contribute to opioid-related adverse events, and how to prescribe more safely and appropriately, to minimize risks and maximize benefits.”
“Both chronic pain and long-term opioid therapy are high-prevalence conditions,” she said. “While hospitalists are often comfortable with their knowledge and skills in treating acute pain, many of us find that our patients have multiple or complex pain conditions that include chronic pain components.”
Despite the best of intentions, hospitalists are increasingly concerned that they might take steps in treatment that could actually contribute to opioid abuse. This session will, in part, be geared toward avoiding those pitfalls.
“Treatment of pain during hospitalization is more challenging in patients who regularly take opioid medications,” Dr. Mosher said. “The growing concern that hospitalists might inadvertently contribute to risky or excessive opioid use though well-intentioned, inpatient and discharge prescribing makes it even more essential that we increase our knowledge, skills, and confidence in this area.”
The Hospitalist’s Role in the Opioid Epidemic
Tuesday, May 2, 1:35–2:35 p.m.
Are you getting the most out of your EHR?
Sparrow Health System in Lansing, Mich., went live with its electronic health record (EHR) system at its main hospital on Dec. 1, 2012. For a year and a half, the system was untapped, innovation-wise. Very few features were turned on, and it sat relatively idle with regard to quality improvement. Hospitalists and others used the EHR, but not ambitiously. Everyone, essentially, used the post-launch period to catch their breath. Some even decided it would be the perfect time to retire, rather than confront the new reality of the EHR.
“It took a good 6 months, probably longer for some, for people to feel comfortable, to start smiling again and really feel like, ‘This isn’t so bad and actually might be working for us,’ ” said Carol Nwelue, MD, medical director of Sparrow’s adult hospitalist service.
Although Sparrow is now probably ahead of the curve when it comes to maximizing its EHR use, its story carries themes that are familiar to hospitalists and to the medical field: The beginning is scary and bumpy; there typically is a long getting-used-to period; and then some hospitalists get ansty and try to get more out of the system, but only gradually – and not without pain.
The bottom line is that most hospitals have a long way to go, said Venkataraman Palabindala, MD, a hospitalist and assistant professor of medicine at the University of Mississippi Medical Center in Jackson.
“We are nowhere close to using the technology to maximum benefit,” said Dr. Palabindala, also a member of the Society of Hospital Medicine’s information technology committee.
How well hospitalists are maximizing their use of EHRs varies from center to center and doctor to doctor. But, for those that are more advanced, Dr. Palabindala and other advocates of better EHR use mention these characteristics that drive the change:
- They have hospitalist leaders with a strong interest in IT who like to tinker and refine – and then share the tricks that work with others at their center.
- They belong to EHR-related committees or work at centers with hospitalists with a big presence in those committees.
- They keep their eyes on what other centers are doing with EHRs and use those projects as models for projects at their own centers.
- They are willing to make changes in their own processes, when feasible, so that they can better dovetail with the EHR.
- They keep their lines of communication open with their EHR vendors.
- They attend user meetings to get questions answered and share information and experiences.
At Sparrow, two committees – one nurse-led and one physician-led – guide EHR enhancement. The committees are a place where, yes, doctors can vent about the EHR (the phrase they use is “pain points”), but also a place where they can get constructive feedback. The committees also keep an eye out for EHR projects elsewhere that they might be able to do themselves.
EHR: a CAUTI example
In 2014, Sparrow doctors and nurses wanted to lower their number of catheter-associated urinary tract infections (CAUTI). With the EHR that had gone live 2 years before, they had the data that they needed. They just had to figure out how to turn the data into a workable plan. Ah, if only things were so simple with EHRs. As any health center that has gone through the great transition from paper to digital can attest, having the data only puts you at the foot of the mountain.
But using a program that Texas Health System had developed as a model, Sparrow got its CAUTI program up and running. The new system included not just a placement order, but the discontinuation order, too. Advisories on best practice were built into the work flow, including alerts on when catheters had been in for 48 hours, and metrics were created to track how well the whole thing worked.
“Once the data [were] obtained and validated, it was quickly shown that more needed to be done within this clinical program to impact our CAUTI numbers,” she said. “With collaboration from end users, the system was tweaked more and BPAs (best practice advisories) were added and removed in certain areas and shifted the focus from physician-facing to nursing-facing in most areas.”
It appears to be working: CAUTI incidence at 836-bed Sparrow Hospital has dropped from a total of 52 in 2014 to 11 over the first 3 quarters of 2016.
Sparrow has also built programs to better use its EHR for sepsis, medical reconciliation, and methicillin-resistant Staphylococcus aureus screening, and one is being developed for heart failure.
Vendor engagement = QI opportunity
Sparrow and many other health systems are motivated to use more of Epic’s features and to innovate through an Epic rewards program that gives rebates for advanced use that can total hundreds of thousands of dollars. That innovation helps Epic problem solve and it can then point to that innovation in its marketing.
Almost all hospitals, and their hospitalists, are using the EHR for such basics as reducing unnecessary testing, medical reconciliation, and to document more accurately, said Eric Helsher, vice president of client success at Epic, whose job is to foster the spread of new and better ways to use the EHR. Most hospitals use the EHR, to at least some degree, for targeted quality improvement (QI) and patient safety programs, he said.
Dr. Palabindala pointed to record-sharing features as a way clinicians can share records within minutes without having to bother with faxing or emailing. Integrating smart-paging into the EHR is another way for doctors to communicate – it may not be as good as a phone call, but it’s less disruptive during a workday, he notes.
Epic is just now rolling out a secure text-messaging system hospitalists and others can use to communicate with one another – the header of the text thread clearly shows the patient it is referencing, Mr. Helsher said. Other EHR uses, such as telemedicine, are being used around the country but are far less widespread. But users are generally becoming more ambitious, he said.
“For the last 5-10 years, we’ve been in such an implementation rush,” Mr. Helsher explained. “ Now, at much more of a macro scale, the mentality has changed to ‘OK, we have these systems, let’s go from the implementation era to the value era.’ ”
Corinne Boudreau, senior marketing manager of physician experience at Meditech, said their sepsis tool has been very popular, while messaging features and shortcut commands for simpler charting are gradually coming into wider use. Meditech also expects their Web-based EHR – designed to give patients access on their mobile devices – will give doctors the mobility they want.
Still, there’s a wide range in how much hospitalists and other doctors are using even the fundamental tools that are available to them.
“I think that between implementation and maximization there is a period of adoption, and I think that that’s where a lot of folks are these days,” she said.
As “physician engagement” has become a buzzword in the industry, Meditech has worked with physician leaders on how to get doctors to absorb the message that the EHR really can help them do their jobs better.
“If you get [doctors] at the right time, you show them how it can make things easier or take time off their workload,” Ms. Boudreau said. “For some physicians that time to get them might be first thing in the morning before they see patients. Another physician might want to do it in the evening. If you hit that evening physician in the morning, you’ve missed that window of opportunity.”
Given the demands on doctors’ time and either an inability or unwillingness to put the time in that’s needed to learn about all functions the EHR can offer, there’s a growing acknowledgment that doctors often can’t simply do this on their own.
“There’s more recognition that this is a project that needs to be resourced,” Ms. Boudreau said. “They’re already strapped for time; to put something additional on top of it needs to be accommodated for. It needs to be resourced in terms of time, it needs to be resourced in terms of compensation. There need to be governance and support of that.”
Early adopters vs. late bloomers
Many hospitalists and HM groups have advanced, but some places have lagged behind, said John Nelson, MD, MHM, a veteran hospitalist, practice management consultant, and longtime columnist with The Hospitalist.
“We find it’s reasonably common to go to a place where they’re still keeping their census in an Excel spreadsheet,” he said. “Last year, we found people who do billing on paper and index cards.”
He said that often, a failure to adopt new EHR functionality isn’t because hospitals and HM groups are avoiding it. He said he sees IT shortcomings as a major blocker.
“They want to use it,” he said. “Inertia might be part of the reason people are failing to fully capture the benefit the EHR could offer, [but] the bigger reason is local IT configurations and support.”
As an example, Dr. Nelson explained that at some of the centers he has worked with the name of the attending physician is not always reflected in the EHR. That’s a big no-no, he said. The problem, he’s sometimes found, isn’t really the EHR, but quirks in the hospital system: The EHR is locked down for that information and can be changed only by a person in the admitting department.
“It would require the hospitalist to call down [to admissions] and get someone else to make that change – and that’s tedious a big headache. They give up and don’t do it anymore,” he said. “Ideally, you’d want to make it so the hospitalists can make the change themselves.”
At his center, Overlake Hospital Medical Center in Bellevue, Wash., a go-to hospitalist is David Chu, MD, who has gone through Epic training and shares tips with colleagues. He is one of a relatively few physicians there who has taken the time to use the drop-down menu feature for putting information into a chart.
That might sound like a fairly basic use for a multimillion-dollar EHR system. But it still can take hours and hours to get it right.
“The way to do it is a little bit of a programmer’s way of looking at things,” Dr. Chu said, noting it involves programming-style language with double colons, commas, and quotations marks.
“For me, I think it took a good 10, 12, 15 hours on my part to get things going,” he said. “It was a good time investment up front to help me on that end, but it’s just hard getting people to want to commit that time, especially if they’re not that savvy with computers.”
His hospitalist colleague, Ryan Chew, MD, is more advanced – he has a taxonomy-like shorthand he uses to give him the right set of basic fields for a given type of case. For someone admitted with pneumonia, he’d want to know certain things all the time. Were they short of breath? Did they have chest pain? What were their vital signs? What about inflammatory markers?
Dr. Chew can get all of those fields to pop up by typing “.rchppneumonia.” The “.” means that a special code is to follow. The “rc” is for Ryan Chew, the “hp” is for history and physical, and “pneumonia,” is the type of case. For cases that require other information to be entered, he can add that as needed.
Hospitalists might try to write shortcut phrases, but unless they have a well-defined system, it won’t be helpful over the long run, he said.
“If you don’t have a good organization system … you’ll never remember it,” Dr. Chew said.
But even he hasn’t created the drop-down menus. He said he just hasn’t been willing to take the time, especially since he feels his own way of doing things seems to be working just fine.
Effort is essential
Expanding the functionalities of the EHR takes effort, no doubt. As a result, some physicians and hospitalist groups have not been open-minded to the idea – and opportunities – of the EHR as a database.
“I think for some people, even still, working with the EHR, it’s become more something they’ve learned to get used to rather than something that they sought to take advantage of, in terms of helping things,” Dr. Chew said. “They’re still working against the EHR a little bit.”
Dr. Palabindala agreed, and said that regardless of resistance or complaint, EHRs work.
“No matter how much we argue, it is proven in multiple studies that EHRs showed increased patient safety and better documentation and better transfer of the data,” he said.
He suggests hospitalists make more of an effort.
“I strongly encourage hospitalists to be part of the every EHR-related committee, including CPOE [computerized physician order entry], analytics, and utilization-review committees,” he said. “Learning about the upgrades and learning about all the possible options, exploring clinical informatics on a regular basis is important. I also encourage [hospitalists] to participate in online, EHR-related surveys to learn more about the EHR utility and what is missing in their home institution.”
He acknowledges that it’s “hard to develop a passion.” Then he put it in terms he thought might resonate: “Think of it like a new version of smart phone. Show the enthusiasm as if you are ready for next version of iPhone or Pixel.” TH
Is hospitalists’ EHR efficiency taken advantage of?
Even though their level of EHR use can be hit or miss, hospitalists tend to be ahead of the game, many agree. But that can come with some drawbacks. They’re often the go-to people everyone else in the hospital relies on to handle the system that some think is too unwieldy to bother with.
“One thing that really distinguishes hospitalists from many other providers, particularly on the inpatient side, is just the frequency with which they use the EHR,” said Eric Helsher of Epic. Many hospitalists are chosen by administrators to test pilot projects for that reason, he adds. “They want to get it out there with a group who they know will have a lot of exposure to the system and may be more willing to make those changes for long-term gain.”
Sometimes that expertise leads to situations that go beyond the hospitalist simply being leaders of change – they’re doing work they were never really intended to do.
John Nelson, MD, MHM, a hospitalist consultant based in Seattle, said hospitalists tell him that a subspecialist might handle a case but will not want to be the attending physician specifically so they don’t have to deal with the EHR. He said the specialist in such cases will say something along the lines of, “You can call me, I’ll help you, and I’ll come by and say hello to the patient and make the care decisions, but I need you to be the attending so you can document in the chart and you can do the med rec because ‘I can’t figure out how to do those buttons right.’ ”
Some will ask hospitalists “for a hand” with a case when really all they want is for the hospitalist to enter information into the system. It’s a tricky situation for the hospitalist, Dr. Nelson said.
“Some will be transparent and say I don’t really have a medical question – I just can’t figure out how to do the med rec and the discharge, so would you do it?” he said, adding the systems issues are largely because of new rounding patterns sparked by HM’s expanding role in-hospital. “I think it meaningfully contributes to what I perceive to be a decline in hospitalist morale in the last 2 or 3 years.”
Tom Collins is a freelance writer in South Florida.
Sparrow Health System in Lansing, Mich., went live with its electronic health record (EHR) system at its main hospital on Dec. 1, 2012. For a year and a half, the system was untapped, innovation-wise. Very few features were turned on, and it sat relatively idle with regard to quality improvement. Hospitalists and others used the EHR, but not ambitiously. Everyone, essentially, used the post-launch period to catch their breath. Some even decided it would be the perfect time to retire, rather than confront the new reality of the EHR.
“It took a good 6 months, probably longer for some, for people to feel comfortable, to start smiling again and really feel like, ‘This isn’t so bad and actually might be working for us,’ ” said Carol Nwelue, MD, medical director of Sparrow’s adult hospitalist service.
Although Sparrow is now probably ahead of the curve when it comes to maximizing its EHR use, its story carries themes that are familiar to hospitalists and to the medical field: The beginning is scary and bumpy; there typically is a long getting-used-to period; and then some hospitalists get ansty and try to get more out of the system, but only gradually – and not without pain.
The bottom line is that most hospitals have a long way to go, said Venkataraman Palabindala, MD, a hospitalist and assistant professor of medicine at the University of Mississippi Medical Center in Jackson.
“We are nowhere close to using the technology to maximum benefit,” said Dr. Palabindala, also a member of the Society of Hospital Medicine’s information technology committee.
How well hospitalists are maximizing their use of EHRs varies from center to center and doctor to doctor. But, for those that are more advanced, Dr. Palabindala and other advocates of better EHR use mention these characteristics that drive the change:
- They have hospitalist leaders with a strong interest in IT who like to tinker and refine – and then share the tricks that work with others at their center.
- They belong to EHR-related committees or work at centers with hospitalists with a big presence in those committees.
- They keep their eyes on what other centers are doing with EHRs and use those projects as models for projects at their own centers.
- They are willing to make changes in their own processes, when feasible, so that they can better dovetail with the EHR.
- They keep their lines of communication open with their EHR vendors.
- They attend user meetings to get questions answered and share information and experiences.
At Sparrow, two committees – one nurse-led and one physician-led – guide EHR enhancement. The committees are a place where, yes, doctors can vent about the EHR (the phrase they use is “pain points”), but also a place where they can get constructive feedback. The committees also keep an eye out for EHR projects elsewhere that they might be able to do themselves.
EHR: a CAUTI example
In 2014, Sparrow doctors and nurses wanted to lower their number of catheter-associated urinary tract infections (CAUTI). With the EHR that had gone live 2 years before, they had the data that they needed. They just had to figure out how to turn the data into a workable plan. Ah, if only things were so simple with EHRs. As any health center that has gone through the great transition from paper to digital can attest, having the data only puts you at the foot of the mountain.
But using a program that Texas Health System had developed as a model, Sparrow got its CAUTI program up and running. The new system included not just a placement order, but the discontinuation order, too. Advisories on best practice were built into the work flow, including alerts on when catheters had been in for 48 hours, and metrics were created to track how well the whole thing worked.
“Once the data [were] obtained and validated, it was quickly shown that more needed to be done within this clinical program to impact our CAUTI numbers,” she said. “With collaboration from end users, the system was tweaked more and BPAs (best practice advisories) were added and removed in certain areas and shifted the focus from physician-facing to nursing-facing in most areas.”
It appears to be working: CAUTI incidence at 836-bed Sparrow Hospital has dropped from a total of 52 in 2014 to 11 over the first 3 quarters of 2016.
Sparrow has also built programs to better use its EHR for sepsis, medical reconciliation, and methicillin-resistant Staphylococcus aureus screening, and one is being developed for heart failure.
Vendor engagement = QI opportunity
Sparrow and many other health systems are motivated to use more of Epic’s features and to innovate through an Epic rewards program that gives rebates for advanced use that can total hundreds of thousands of dollars. That innovation helps Epic problem solve and it can then point to that innovation in its marketing.
Almost all hospitals, and their hospitalists, are using the EHR for such basics as reducing unnecessary testing, medical reconciliation, and to document more accurately, said Eric Helsher, vice president of client success at Epic, whose job is to foster the spread of new and better ways to use the EHR. Most hospitals use the EHR, to at least some degree, for targeted quality improvement (QI) and patient safety programs, he said.
Dr. Palabindala pointed to record-sharing features as a way clinicians can share records within minutes without having to bother with faxing or emailing. Integrating smart-paging into the EHR is another way for doctors to communicate – it may not be as good as a phone call, but it’s less disruptive during a workday, he notes.
Epic is just now rolling out a secure text-messaging system hospitalists and others can use to communicate with one another – the header of the text thread clearly shows the patient it is referencing, Mr. Helsher said. Other EHR uses, such as telemedicine, are being used around the country but are far less widespread. But users are generally becoming more ambitious, he said.
“For the last 5-10 years, we’ve been in such an implementation rush,” Mr. Helsher explained. “ Now, at much more of a macro scale, the mentality has changed to ‘OK, we have these systems, let’s go from the implementation era to the value era.’ ”
Corinne Boudreau, senior marketing manager of physician experience at Meditech, said their sepsis tool has been very popular, while messaging features and shortcut commands for simpler charting are gradually coming into wider use. Meditech also expects their Web-based EHR – designed to give patients access on their mobile devices – will give doctors the mobility they want.
Still, there’s a wide range in how much hospitalists and other doctors are using even the fundamental tools that are available to them.
“I think that between implementation and maximization there is a period of adoption, and I think that that’s where a lot of folks are these days,” she said.
As “physician engagement” has become a buzzword in the industry, Meditech has worked with physician leaders on how to get doctors to absorb the message that the EHR really can help them do their jobs better.
“If you get [doctors] at the right time, you show them how it can make things easier or take time off their workload,” Ms. Boudreau said. “For some physicians that time to get them might be first thing in the morning before they see patients. Another physician might want to do it in the evening. If you hit that evening physician in the morning, you’ve missed that window of opportunity.”
Given the demands on doctors’ time and either an inability or unwillingness to put the time in that’s needed to learn about all functions the EHR can offer, there’s a growing acknowledgment that doctors often can’t simply do this on their own.
“There’s more recognition that this is a project that needs to be resourced,” Ms. Boudreau said. “They’re already strapped for time; to put something additional on top of it needs to be accommodated for. It needs to be resourced in terms of time, it needs to be resourced in terms of compensation. There need to be governance and support of that.”
Early adopters vs. late bloomers
Many hospitalists and HM groups have advanced, but some places have lagged behind, said John Nelson, MD, MHM, a veteran hospitalist, practice management consultant, and longtime columnist with The Hospitalist.
“We find it’s reasonably common to go to a place where they’re still keeping their census in an Excel spreadsheet,” he said. “Last year, we found people who do billing on paper and index cards.”
He said that often, a failure to adopt new EHR functionality isn’t because hospitals and HM groups are avoiding it. He said he sees IT shortcomings as a major blocker.
“They want to use it,” he said. “Inertia might be part of the reason people are failing to fully capture the benefit the EHR could offer, [but] the bigger reason is local IT configurations and support.”
As an example, Dr. Nelson explained that at some of the centers he has worked with the name of the attending physician is not always reflected in the EHR. That’s a big no-no, he said. The problem, he’s sometimes found, isn’t really the EHR, but quirks in the hospital system: The EHR is locked down for that information and can be changed only by a person in the admitting department.
“It would require the hospitalist to call down [to admissions] and get someone else to make that change – and that’s tedious a big headache. They give up and don’t do it anymore,” he said. “Ideally, you’d want to make it so the hospitalists can make the change themselves.”
At his center, Overlake Hospital Medical Center in Bellevue, Wash., a go-to hospitalist is David Chu, MD, who has gone through Epic training and shares tips with colleagues. He is one of a relatively few physicians there who has taken the time to use the drop-down menu feature for putting information into a chart.
That might sound like a fairly basic use for a multimillion-dollar EHR system. But it still can take hours and hours to get it right.
“The way to do it is a little bit of a programmer’s way of looking at things,” Dr. Chu said, noting it involves programming-style language with double colons, commas, and quotations marks.
“For me, I think it took a good 10, 12, 15 hours on my part to get things going,” he said. “It was a good time investment up front to help me on that end, but it’s just hard getting people to want to commit that time, especially if they’re not that savvy with computers.”
His hospitalist colleague, Ryan Chew, MD, is more advanced – he has a taxonomy-like shorthand he uses to give him the right set of basic fields for a given type of case. For someone admitted with pneumonia, he’d want to know certain things all the time. Were they short of breath? Did they have chest pain? What were their vital signs? What about inflammatory markers?
Dr. Chew can get all of those fields to pop up by typing “.rchppneumonia.” The “.” means that a special code is to follow. The “rc” is for Ryan Chew, the “hp” is for history and physical, and “pneumonia,” is the type of case. For cases that require other information to be entered, he can add that as needed.
Hospitalists might try to write shortcut phrases, but unless they have a well-defined system, it won’t be helpful over the long run, he said.
“If you don’t have a good organization system … you’ll never remember it,” Dr. Chew said.
But even he hasn’t created the drop-down menus. He said he just hasn’t been willing to take the time, especially since he feels his own way of doing things seems to be working just fine.
Effort is essential
Expanding the functionalities of the EHR takes effort, no doubt. As a result, some physicians and hospitalist groups have not been open-minded to the idea – and opportunities – of the EHR as a database.
“I think for some people, even still, working with the EHR, it’s become more something they’ve learned to get used to rather than something that they sought to take advantage of, in terms of helping things,” Dr. Chew said. “They’re still working against the EHR a little bit.”
Dr. Palabindala agreed, and said that regardless of resistance or complaint, EHRs work.
“No matter how much we argue, it is proven in multiple studies that EHRs showed increased patient safety and better documentation and better transfer of the data,” he said.
He suggests hospitalists make more of an effort.
“I strongly encourage hospitalists to be part of the every EHR-related committee, including CPOE [computerized physician order entry], analytics, and utilization-review committees,” he said. “Learning about the upgrades and learning about all the possible options, exploring clinical informatics on a regular basis is important. I also encourage [hospitalists] to participate in online, EHR-related surveys to learn more about the EHR utility and what is missing in their home institution.”
He acknowledges that it’s “hard to develop a passion.” Then he put it in terms he thought might resonate: “Think of it like a new version of smart phone. Show the enthusiasm as if you are ready for next version of iPhone or Pixel.” TH
Is hospitalists’ EHR efficiency taken advantage of?
Even though their level of EHR use can be hit or miss, hospitalists tend to be ahead of the game, many agree. But that can come with some drawbacks. They’re often the go-to people everyone else in the hospital relies on to handle the system that some think is too unwieldy to bother with.
“One thing that really distinguishes hospitalists from many other providers, particularly on the inpatient side, is just the frequency with which they use the EHR,” said Eric Helsher of Epic. Many hospitalists are chosen by administrators to test pilot projects for that reason, he adds. “They want to get it out there with a group who they know will have a lot of exposure to the system and may be more willing to make those changes for long-term gain.”
Sometimes that expertise leads to situations that go beyond the hospitalist simply being leaders of change – they’re doing work they were never really intended to do.
John Nelson, MD, MHM, a hospitalist consultant based in Seattle, said hospitalists tell him that a subspecialist might handle a case but will not want to be the attending physician specifically so they don’t have to deal with the EHR. He said the specialist in such cases will say something along the lines of, “You can call me, I’ll help you, and I’ll come by and say hello to the patient and make the care decisions, but I need you to be the attending so you can document in the chart and you can do the med rec because ‘I can’t figure out how to do those buttons right.’ ”
Some will ask hospitalists “for a hand” with a case when really all they want is for the hospitalist to enter information into the system. It’s a tricky situation for the hospitalist, Dr. Nelson said.
“Some will be transparent and say I don’t really have a medical question – I just can’t figure out how to do the med rec and the discharge, so would you do it?” he said, adding the systems issues are largely because of new rounding patterns sparked by HM’s expanding role in-hospital. “I think it meaningfully contributes to what I perceive to be a decline in hospitalist morale in the last 2 or 3 years.”
Tom Collins is a freelance writer in South Florida.
Sparrow Health System in Lansing, Mich., went live with its electronic health record (EHR) system at its main hospital on Dec. 1, 2012. For a year and a half, the system was untapped, innovation-wise. Very few features were turned on, and it sat relatively idle with regard to quality improvement. Hospitalists and others used the EHR, but not ambitiously. Everyone, essentially, used the post-launch period to catch their breath. Some even decided it would be the perfect time to retire, rather than confront the new reality of the EHR.
“It took a good 6 months, probably longer for some, for people to feel comfortable, to start smiling again and really feel like, ‘This isn’t so bad and actually might be working for us,’ ” said Carol Nwelue, MD, medical director of Sparrow’s adult hospitalist service.
Although Sparrow is now probably ahead of the curve when it comes to maximizing its EHR use, its story carries themes that are familiar to hospitalists and to the medical field: The beginning is scary and bumpy; there typically is a long getting-used-to period; and then some hospitalists get ansty and try to get more out of the system, but only gradually – and not without pain.
The bottom line is that most hospitals have a long way to go, said Venkataraman Palabindala, MD, a hospitalist and assistant professor of medicine at the University of Mississippi Medical Center in Jackson.
“We are nowhere close to using the technology to maximum benefit,” said Dr. Palabindala, also a member of the Society of Hospital Medicine’s information technology committee.
How well hospitalists are maximizing their use of EHRs varies from center to center and doctor to doctor. But, for those that are more advanced, Dr. Palabindala and other advocates of better EHR use mention these characteristics that drive the change:
- They have hospitalist leaders with a strong interest in IT who like to tinker and refine – and then share the tricks that work with others at their center.
- They belong to EHR-related committees or work at centers with hospitalists with a big presence in those committees.
- They keep their eyes on what other centers are doing with EHRs and use those projects as models for projects at their own centers.
- They are willing to make changes in their own processes, when feasible, so that they can better dovetail with the EHR.
- They keep their lines of communication open with their EHR vendors.
- They attend user meetings to get questions answered and share information and experiences.
At Sparrow, two committees – one nurse-led and one physician-led – guide EHR enhancement. The committees are a place where, yes, doctors can vent about the EHR (the phrase they use is “pain points”), but also a place where they can get constructive feedback. The committees also keep an eye out for EHR projects elsewhere that they might be able to do themselves.
EHR: a CAUTI example
In 2014, Sparrow doctors and nurses wanted to lower their number of catheter-associated urinary tract infections (CAUTI). With the EHR that had gone live 2 years before, they had the data that they needed. They just had to figure out how to turn the data into a workable plan. Ah, if only things were so simple with EHRs. As any health center that has gone through the great transition from paper to digital can attest, having the data only puts you at the foot of the mountain.
But using a program that Texas Health System had developed as a model, Sparrow got its CAUTI program up and running. The new system included not just a placement order, but the discontinuation order, too. Advisories on best practice were built into the work flow, including alerts on when catheters had been in for 48 hours, and metrics were created to track how well the whole thing worked.
“Once the data [were] obtained and validated, it was quickly shown that more needed to be done within this clinical program to impact our CAUTI numbers,” she said. “With collaboration from end users, the system was tweaked more and BPAs (best practice advisories) were added and removed in certain areas and shifted the focus from physician-facing to nursing-facing in most areas.”
It appears to be working: CAUTI incidence at 836-bed Sparrow Hospital has dropped from a total of 52 in 2014 to 11 over the first 3 quarters of 2016.
Sparrow has also built programs to better use its EHR for sepsis, medical reconciliation, and methicillin-resistant Staphylococcus aureus screening, and one is being developed for heart failure.
Vendor engagement = QI opportunity
Sparrow and many other health systems are motivated to use more of Epic’s features and to innovate through an Epic rewards program that gives rebates for advanced use that can total hundreds of thousands of dollars. That innovation helps Epic problem solve and it can then point to that innovation in its marketing.
Almost all hospitals, and their hospitalists, are using the EHR for such basics as reducing unnecessary testing, medical reconciliation, and to document more accurately, said Eric Helsher, vice president of client success at Epic, whose job is to foster the spread of new and better ways to use the EHR. Most hospitals use the EHR, to at least some degree, for targeted quality improvement (QI) and patient safety programs, he said.
Dr. Palabindala pointed to record-sharing features as a way clinicians can share records within minutes without having to bother with faxing or emailing. Integrating smart-paging into the EHR is another way for doctors to communicate – it may not be as good as a phone call, but it’s less disruptive during a workday, he notes.
Epic is just now rolling out a secure text-messaging system hospitalists and others can use to communicate with one another – the header of the text thread clearly shows the patient it is referencing, Mr. Helsher said. Other EHR uses, such as telemedicine, are being used around the country but are far less widespread. But users are generally becoming more ambitious, he said.
“For the last 5-10 years, we’ve been in such an implementation rush,” Mr. Helsher explained. “ Now, at much more of a macro scale, the mentality has changed to ‘OK, we have these systems, let’s go from the implementation era to the value era.’ ”
Corinne Boudreau, senior marketing manager of physician experience at Meditech, said their sepsis tool has been very popular, while messaging features and shortcut commands for simpler charting are gradually coming into wider use. Meditech also expects their Web-based EHR – designed to give patients access on their mobile devices – will give doctors the mobility they want.
Still, there’s a wide range in how much hospitalists and other doctors are using even the fundamental tools that are available to them.
“I think that between implementation and maximization there is a period of adoption, and I think that that’s where a lot of folks are these days,” she said.
As “physician engagement” has become a buzzword in the industry, Meditech has worked with physician leaders on how to get doctors to absorb the message that the EHR really can help them do their jobs better.
“If you get [doctors] at the right time, you show them how it can make things easier or take time off their workload,” Ms. Boudreau said. “For some physicians that time to get them might be first thing in the morning before they see patients. Another physician might want to do it in the evening. If you hit that evening physician in the morning, you’ve missed that window of opportunity.”
Given the demands on doctors’ time and either an inability or unwillingness to put the time in that’s needed to learn about all functions the EHR can offer, there’s a growing acknowledgment that doctors often can’t simply do this on their own.
“There’s more recognition that this is a project that needs to be resourced,” Ms. Boudreau said. “They’re already strapped for time; to put something additional on top of it needs to be accommodated for. It needs to be resourced in terms of time, it needs to be resourced in terms of compensation. There need to be governance and support of that.”
Early adopters vs. late bloomers
Many hospitalists and HM groups have advanced, but some places have lagged behind, said John Nelson, MD, MHM, a veteran hospitalist, practice management consultant, and longtime columnist with The Hospitalist.
“We find it’s reasonably common to go to a place where they’re still keeping their census in an Excel spreadsheet,” he said. “Last year, we found people who do billing on paper and index cards.”
He said that often, a failure to adopt new EHR functionality isn’t because hospitals and HM groups are avoiding it. He said he sees IT shortcomings as a major blocker.
“They want to use it,” he said. “Inertia might be part of the reason people are failing to fully capture the benefit the EHR could offer, [but] the bigger reason is local IT configurations and support.”
As an example, Dr. Nelson explained that at some of the centers he has worked with the name of the attending physician is not always reflected in the EHR. That’s a big no-no, he said. The problem, he’s sometimes found, isn’t really the EHR, but quirks in the hospital system: The EHR is locked down for that information and can be changed only by a person in the admitting department.
“It would require the hospitalist to call down [to admissions] and get someone else to make that change – and that’s tedious a big headache. They give up and don’t do it anymore,” he said. “Ideally, you’d want to make it so the hospitalists can make the change themselves.”
At his center, Overlake Hospital Medical Center in Bellevue, Wash., a go-to hospitalist is David Chu, MD, who has gone through Epic training and shares tips with colleagues. He is one of a relatively few physicians there who has taken the time to use the drop-down menu feature for putting information into a chart.
That might sound like a fairly basic use for a multimillion-dollar EHR system. But it still can take hours and hours to get it right.
“The way to do it is a little bit of a programmer’s way of looking at things,” Dr. Chu said, noting it involves programming-style language with double colons, commas, and quotations marks.
“For me, I think it took a good 10, 12, 15 hours on my part to get things going,” he said. “It was a good time investment up front to help me on that end, but it’s just hard getting people to want to commit that time, especially if they’re not that savvy with computers.”
His hospitalist colleague, Ryan Chew, MD, is more advanced – he has a taxonomy-like shorthand he uses to give him the right set of basic fields for a given type of case. For someone admitted with pneumonia, he’d want to know certain things all the time. Were they short of breath? Did they have chest pain? What were their vital signs? What about inflammatory markers?
Dr. Chew can get all of those fields to pop up by typing “.rchppneumonia.” The “.” means that a special code is to follow. The “rc” is for Ryan Chew, the “hp” is for history and physical, and “pneumonia,” is the type of case. For cases that require other information to be entered, he can add that as needed.
Hospitalists might try to write shortcut phrases, but unless they have a well-defined system, it won’t be helpful over the long run, he said.
“If you don’t have a good organization system … you’ll never remember it,” Dr. Chew said.
But even he hasn’t created the drop-down menus. He said he just hasn’t been willing to take the time, especially since he feels his own way of doing things seems to be working just fine.
Effort is essential
Expanding the functionalities of the EHR takes effort, no doubt. As a result, some physicians and hospitalist groups have not been open-minded to the idea – and opportunities – of the EHR as a database.
“I think for some people, even still, working with the EHR, it’s become more something they’ve learned to get used to rather than something that they sought to take advantage of, in terms of helping things,” Dr. Chew said. “They’re still working against the EHR a little bit.”
Dr. Palabindala agreed, and said that regardless of resistance or complaint, EHRs work.
“No matter how much we argue, it is proven in multiple studies that EHRs showed increased patient safety and better documentation and better transfer of the data,” he said.
He suggests hospitalists make more of an effort.
“I strongly encourage hospitalists to be part of the every EHR-related committee, including CPOE [computerized physician order entry], analytics, and utilization-review committees,” he said. “Learning about the upgrades and learning about all the possible options, exploring clinical informatics on a regular basis is important. I also encourage [hospitalists] to participate in online, EHR-related surveys to learn more about the EHR utility and what is missing in their home institution.”
He acknowledges that it’s “hard to develop a passion.” Then he put it in terms he thought might resonate: “Think of it like a new version of smart phone. Show the enthusiasm as if you are ready for next version of iPhone or Pixel.” TH
Is hospitalists’ EHR efficiency taken advantage of?
Even though their level of EHR use can be hit or miss, hospitalists tend to be ahead of the game, many agree. But that can come with some drawbacks. They’re often the go-to people everyone else in the hospital relies on to handle the system that some think is too unwieldy to bother with.
“One thing that really distinguishes hospitalists from many other providers, particularly on the inpatient side, is just the frequency with which they use the EHR,” said Eric Helsher of Epic. Many hospitalists are chosen by administrators to test pilot projects for that reason, he adds. “They want to get it out there with a group who they know will have a lot of exposure to the system and may be more willing to make those changes for long-term gain.”
Sometimes that expertise leads to situations that go beyond the hospitalist simply being leaders of change – they’re doing work they were never really intended to do.
John Nelson, MD, MHM, a hospitalist consultant based in Seattle, said hospitalists tell him that a subspecialist might handle a case but will not want to be the attending physician specifically so they don’t have to deal with the EHR. He said the specialist in such cases will say something along the lines of, “You can call me, I’ll help you, and I’ll come by and say hello to the patient and make the care decisions, but I need you to be the attending so you can document in the chart and you can do the med rec because ‘I can’t figure out how to do those buttons right.’ ”
Some will ask hospitalists “for a hand” with a case when really all they want is for the hospitalist to enter information into the system. It’s a tricky situation for the hospitalist, Dr. Nelson said.
“Some will be transparent and say I don’t really have a medical question – I just can’t figure out how to do the med rec and the discharge, so would you do it?” he said, adding the systems issues are largely because of new rounding patterns sparked by HM’s expanding role in-hospital. “I think it meaningfully contributes to what I perceive to be a decline in hospitalist morale in the last 2 or 3 years.”
Tom Collins is a freelance writer in South Florida.
Hospitalists See Benefit from Working with ‘Surgicalists’
Time was critical. He needed surgery right away to remove his gallbladder. But for that, he needed a surgeon.
“There was a surgeon on call, but the surgeon was not picking up the phone,” Dr. Singh says. “I’m scratching my head. Why is the surgeon not calling back? Where is the surgeon? Did the pager get lost? What if the patient has a bad outcome?”
Eventually, Dr. Singh had to give up on the on-call surgeon, and the patient was flown to a hospital 45 miles away in downtown Sacramento. His surgery had been delayed for almost 12 hours.
The man lived largely due to good luck, Dr. Singh says. The unresponsive surgeon had disciplinary proceedings started against his license but retired rather than face the consequences.
Today, hospitalists at Sutter Amador no longer have to anxiously wait for those responses to emergency pages. It’s one of many hospitals that have turned to a “surgicalist” model, with a surgeon always on hand at the hospital. Surgicalists perform both emergency procedures and procedures that are tied to a hospital admission, without which a patient can’t be discharged. Although it is growing in popularity, the model is still only seen in a small fraction of hospitals.
The model is widely supported by hospitalists because it brings several advantages, mainly a greater availability of the surgeon for consult.
“We don’t have to hunt them down, trying to call their office, trying to see if they’re available to call back,” says Dr. Singh, who is now also the chair of medical staff performance at Sutter Amador and adds that the change has helped with his job satisfaction.
A Clear Delineation
Arrangements between hospitalists and surgicalists vary depending on the hospital, but there typically are clearly delineated criteria on who cares for whom, with the more urgent surgical cases tending to fall under the surgicalists’ care and those with less urgent problems, even though surgery might be involved, tending to go to hospitalists.
When a surgery-related question or the need for actual surgery arises, the model calls for a quick response time from the surgicalist. Hospitalists and surgicalists collaborate on ways to reduce length of stay and prevent readmissions since they share the same institutional goals. Hospitalists are also more in tune with the needs of the surgeons, for instance, not feeding a patient who is going to need quick surgery and not administering blood thinners when a surgery is imminent unless there’s an overriding reason not to do so.
One advantage of this collaboration is that a hospitalist working alongside a surgicalist can get extra surgery-related guidance even when surgery probably isn’t needed, says John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM.
“Maybe the opinion of a general surgeon could be useful, but maybe I can get along without it because the general surgeons are busy. It’s going to be hard for them to find time to see this patient, and they’re not going to be very interested in it,” he says. “But if instead I have a surgical hospitalist who’s there all day, it’s much less of a bother for them to come by and take a look at my patient.”
Remaining Challenges
The model is not without its hurdles. When surgicalists are on a 24-hour shift, the patients will see a new one each day, sometimes prompting them to ask, “Who’s my doctor?” Also, complex cases can pose a challenge as they move from one surgicalist to another day to day.
John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,1 says he is now concerned that the principles he helped make popular—the absorption of surgeons into a system as they work hand in hand with other hospital staff all the time—might be eroding. Some small staffing companies are calling themselves surgicalists, promising fast response times, but are actually locum tenens surgeons under a surgicalist guise, he says.
Properly rolled out, surgicalist programs mean a much better working relationship between hospitalists and surgeons, says Lynette Scherer, MD, FACS, chief medical officer at Surgical Affiliates Management Group in Sacramento. The company, founded in 1996, employs about 200 surgeons, twice as many as three years ago, Dr. Scherer says, but the company declined to share what that amounts to in full-time equivalent positions.
“The hospitalists know all of our algorithms, and they know when to call us,” Dr. Scherer says. “We share the patients on the inpatient side as we need to. We keep the ones that are appropriate for us, and they keep the ones that are appropriate for them.”
The details depend on the hospital, she says.
“Whenever we go to a new site, we sit down with the hospitalist team and say, ‘What do you need here?’ And our admitting grids are different based on what the different needs of the hospitals are.”
To stay on top of complex cases with very sick patients, the medical director rounds with the team nearly every day to help guide that care, Dr. Scherer says.
At Sutter Amador, the arrival of the surgicalist model has helped shorten the length of stay by almost one day for surgery admissions, Dr. Singh says.
Reported outcomes, however, seem to be mixed.
In 2008, Sutter Medical Center in Sacramento switched from a nine-surgeon call panel to four surgeons who covered the acute-care surgery service in 24-hour shifts. Researchers looked at outcomes from 2007, before the new model was adopted, and from the four subsequent years. The results were published in 2014 in the Journal of the American College of Surgeons.2
The total number of operations rose significantly, with 497 performed in 2007 and 640 in 2011. The percentage of cases with complications also fell significantly, from 21% in 2007 to 12% in 2011, with a low of 11% in 2010.
But the mortality rate rose significantly, from 1.4% in 2007 to 2.2% in 2011, with a high of 4.1% in 2008. The study authors note that the mortality rate ultimately fell back to levels not statistically significantly higher than the rate before the service. They suggested the spike could have been due to a greater willingness by the service to treat severely ill patients and due to the “immaturity” of the service in its earlier years. The percentage of cases with a readmission fell from 6.4% in 2007 to 4.7% in 2011, with a low of 3% in 2009, but that change wasn’t quite statistically significant.
“The data’s really bearing out that emergency patients are different in terms of the care they demand,” Dr. Scherer says. “So the patient with alcoholic cirrhosis who presents with a hole in his colon is very different than somebody who presents for an elective colon resection. And you can really reduce complications when you have a team of educated people taking care of these patients.”
Dr. Nelson says adopting the model “just means you’re a smoother operator and you can provide better service to people.” He adds that for any hospital that is getting poor surgical coverage and is paying for it, “it might make sense to consider it.”
Thomas R. Collins is a freelance medical writer based in Florida.
References
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007;205(5):704-711.
- O’Mara MS, Scherer L, Wisner D, Owens LJ. Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg. 2014;219(1):90-98.
For a Model That Many Say Makes Sense, Why Not More Growth?
So why hasn’t the surgicalist field exploded? About 10 years ago, that’s what was predicted. In 2007, John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM, wrote an article saying the field could be close to a “surge” similar to the medical hospitalist explosion.1
It’s not known how many of the nation’s roughly 5,600 hospitals use a surgicalist model. There is no association for surgicalists, who are also sometimes called “surgical hospitalists.”
But according to Dr. Nelson’s anecdotal impressions, the number could range from 300 to 800 hospitals, he says. That would mean it is in place only in roughly 10% of U.S. hospitals.
Expansion of the field has been slowed by cost and politics.
Most hospitals don’t have enough surgeons to pull off a surgicalist program, and adding the right number of surgeons costs money, Dr. Nelson says.
And at smaller community hospitals that have used on-call surgeons for years, it’s a thorny issue. Those surgeons often get a call stipend for being on call. If surgeons don’t have a full slate of elective surgeries, they could rely on that on-call pay and resist the adoption of the surgicalist model, which would mean losing that pay, Dr. Nelson says.
“Some of the surgeons in the community might say, ‘I don’t really like ED call, but I have to keep doing it because of the stipend. I depend on it for my income,’” he says.
Even those who wouldn’t mind losing that on-call pay might not be enthusiastic about a move to a surgicalist model because it would bring more general surgeons into the region.
Some, Dr. Nelson says, might say, “How do I know that in two years they aren’t stealing my referrals? The new surgical hospitalist is also a potential competitor for referrals I depend on.”
And other surgeons might resist simply because they like the professional gratification of emergency surgery work, he says.
According to John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,2 “In a lot of academic centers that didn’t pay call stipend, this was just very simple for them to implement some model of this. … Once you try to send someone to an established group where there was already someone taking call, that became very controversial, and I’ve seen litigation result from that.”
Trauma surgeons resisted the model, at least in part, because of semantics: The term “surgical hospitalist” was too similar to “medical hospitalist,” and they worried it might imply a lack of surgical training, says Dr. Maa.
For now, the typical assessment of the model that Dr. Nelson hears is: “They’ve thought about it, they may in the future, but no, they don’t have one.”
“It’s not growing as fast as the medical hospitalist idea did,” he says. “But it is growing. It’s not going to go away, but it’s still relatively small.”
—Thomas R. Collins
References
- Nelson J. The surgical surge. The Hospitalist website. Accessed October 25, 2016.
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007 ;205(5):704-711.
Time was critical. He needed surgery right away to remove his gallbladder. But for that, he needed a surgeon.
“There was a surgeon on call, but the surgeon was not picking up the phone,” Dr. Singh says. “I’m scratching my head. Why is the surgeon not calling back? Where is the surgeon? Did the pager get lost? What if the patient has a bad outcome?”
Eventually, Dr. Singh had to give up on the on-call surgeon, and the patient was flown to a hospital 45 miles away in downtown Sacramento. His surgery had been delayed for almost 12 hours.
The man lived largely due to good luck, Dr. Singh says. The unresponsive surgeon had disciplinary proceedings started against his license but retired rather than face the consequences.
Today, hospitalists at Sutter Amador no longer have to anxiously wait for those responses to emergency pages. It’s one of many hospitals that have turned to a “surgicalist” model, with a surgeon always on hand at the hospital. Surgicalists perform both emergency procedures and procedures that are tied to a hospital admission, without which a patient can’t be discharged. Although it is growing in popularity, the model is still only seen in a small fraction of hospitals.
The model is widely supported by hospitalists because it brings several advantages, mainly a greater availability of the surgeon for consult.
“We don’t have to hunt them down, trying to call their office, trying to see if they’re available to call back,” says Dr. Singh, who is now also the chair of medical staff performance at Sutter Amador and adds that the change has helped with his job satisfaction.
A Clear Delineation
Arrangements between hospitalists and surgicalists vary depending on the hospital, but there typically are clearly delineated criteria on who cares for whom, with the more urgent surgical cases tending to fall under the surgicalists’ care and those with less urgent problems, even though surgery might be involved, tending to go to hospitalists.
When a surgery-related question or the need for actual surgery arises, the model calls for a quick response time from the surgicalist. Hospitalists and surgicalists collaborate on ways to reduce length of stay and prevent readmissions since they share the same institutional goals. Hospitalists are also more in tune with the needs of the surgeons, for instance, not feeding a patient who is going to need quick surgery and not administering blood thinners when a surgery is imminent unless there’s an overriding reason not to do so.
One advantage of this collaboration is that a hospitalist working alongside a surgicalist can get extra surgery-related guidance even when surgery probably isn’t needed, says John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM.
“Maybe the opinion of a general surgeon could be useful, but maybe I can get along without it because the general surgeons are busy. It’s going to be hard for them to find time to see this patient, and they’re not going to be very interested in it,” he says. “But if instead I have a surgical hospitalist who’s there all day, it’s much less of a bother for them to come by and take a look at my patient.”
Remaining Challenges
The model is not without its hurdles. When surgicalists are on a 24-hour shift, the patients will see a new one each day, sometimes prompting them to ask, “Who’s my doctor?” Also, complex cases can pose a challenge as they move from one surgicalist to another day to day.
John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,1 says he is now concerned that the principles he helped make popular—the absorption of surgeons into a system as they work hand in hand with other hospital staff all the time—might be eroding. Some small staffing companies are calling themselves surgicalists, promising fast response times, but are actually locum tenens surgeons under a surgicalist guise, he says.
Properly rolled out, surgicalist programs mean a much better working relationship between hospitalists and surgeons, says Lynette Scherer, MD, FACS, chief medical officer at Surgical Affiliates Management Group in Sacramento. The company, founded in 1996, employs about 200 surgeons, twice as many as three years ago, Dr. Scherer says, but the company declined to share what that amounts to in full-time equivalent positions.
“The hospitalists know all of our algorithms, and they know when to call us,” Dr. Scherer says. “We share the patients on the inpatient side as we need to. We keep the ones that are appropriate for us, and they keep the ones that are appropriate for them.”
The details depend on the hospital, she says.
“Whenever we go to a new site, we sit down with the hospitalist team and say, ‘What do you need here?’ And our admitting grids are different based on what the different needs of the hospitals are.”
To stay on top of complex cases with very sick patients, the medical director rounds with the team nearly every day to help guide that care, Dr. Scherer says.
At Sutter Amador, the arrival of the surgicalist model has helped shorten the length of stay by almost one day for surgery admissions, Dr. Singh says.
Reported outcomes, however, seem to be mixed.
In 2008, Sutter Medical Center in Sacramento switched from a nine-surgeon call panel to four surgeons who covered the acute-care surgery service in 24-hour shifts. Researchers looked at outcomes from 2007, before the new model was adopted, and from the four subsequent years. The results were published in 2014 in the Journal of the American College of Surgeons.2
The total number of operations rose significantly, with 497 performed in 2007 and 640 in 2011. The percentage of cases with complications also fell significantly, from 21% in 2007 to 12% in 2011, with a low of 11% in 2010.
But the mortality rate rose significantly, from 1.4% in 2007 to 2.2% in 2011, with a high of 4.1% in 2008. The study authors note that the mortality rate ultimately fell back to levels not statistically significantly higher than the rate before the service. They suggested the spike could have been due to a greater willingness by the service to treat severely ill patients and due to the “immaturity” of the service in its earlier years. The percentage of cases with a readmission fell from 6.4% in 2007 to 4.7% in 2011, with a low of 3% in 2009, but that change wasn’t quite statistically significant.
“The data’s really bearing out that emergency patients are different in terms of the care they demand,” Dr. Scherer says. “So the patient with alcoholic cirrhosis who presents with a hole in his colon is very different than somebody who presents for an elective colon resection. And you can really reduce complications when you have a team of educated people taking care of these patients.”
Dr. Nelson says adopting the model “just means you’re a smoother operator and you can provide better service to people.” He adds that for any hospital that is getting poor surgical coverage and is paying for it, “it might make sense to consider it.”
Thomas R. Collins is a freelance medical writer based in Florida.
References
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007;205(5):704-711.
- O’Mara MS, Scherer L, Wisner D, Owens LJ. Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg. 2014;219(1):90-98.
For a Model That Many Say Makes Sense, Why Not More Growth?
So why hasn’t the surgicalist field exploded? About 10 years ago, that’s what was predicted. In 2007, John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM, wrote an article saying the field could be close to a “surge” similar to the medical hospitalist explosion.1
It’s not known how many of the nation’s roughly 5,600 hospitals use a surgicalist model. There is no association for surgicalists, who are also sometimes called “surgical hospitalists.”
But according to Dr. Nelson’s anecdotal impressions, the number could range from 300 to 800 hospitals, he says. That would mean it is in place only in roughly 10% of U.S. hospitals.
Expansion of the field has been slowed by cost and politics.
Most hospitals don’t have enough surgeons to pull off a surgicalist program, and adding the right number of surgeons costs money, Dr. Nelson says.
And at smaller community hospitals that have used on-call surgeons for years, it’s a thorny issue. Those surgeons often get a call stipend for being on call. If surgeons don’t have a full slate of elective surgeries, they could rely on that on-call pay and resist the adoption of the surgicalist model, which would mean losing that pay, Dr. Nelson says.
“Some of the surgeons in the community might say, ‘I don’t really like ED call, but I have to keep doing it because of the stipend. I depend on it for my income,’” he says.
Even those who wouldn’t mind losing that on-call pay might not be enthusiastic about a move to a surgicalist model because it would bring more general surgeons into the region.
Some, Dr. Nelson says, might say, “How do I know that in two years they aren’t stealing my referrals? The new surgical hospitalist is also a potential competitor for referrals I depend on.”
And other surgeons might resist simply because they like the professional gratification of emergency surgery work, he says.
According to John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,2 “In a lot of academic centers that didn’t pay call stipend, this was just very simple for them to implement some model of this. … Once you try to send someone to an established group where there was already someone taking call, that became very controversial, and I’ve seen litigation result from that.”
Trauma surgeons resisted the model, at least in part, because of semantics: The term “surgical hospitalist” was too similar to “medical hospitalist,” and they worried it might imply a lack of surgical training, says Dr. Maa.
For now, the typical assessment of the model that Dr. Nelson hears is: “They’ve thought about it, they may in the future, but no, they don’t have one.”
“It’s not growing as fast as the medical hospitalist idea did,” he says. “But it is growing. It’s not going to go away, but it’s still relatively small.”
—Thomas R. Collins
References
- Nelson J. The surgical surge. The Hospitalist website. Accessed October 25, 2016.
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007 ;205(5):704-711.
Time was critical. He needed surgery right away to remove his gallbladder. But for that, he needed a surgeon.
“There was a surgeon on call, but the surgeon was not picking up the phone,” Dr. Singh says. “I’m scratching my head. Why is the surgeon not calling back? Where is the surgeon? Did the pager get lost? What if the patient has a bad outcome?”
Eventually, Dr. Singh had to give up on the on-call surgeon, and the patient was flown to a hospital 45 miles away in downtown Sacramento. His surgery had been delayed for almost 12 hours.
The man lived largely due to good luck, Dr. Singh says. The unresponsive surgeon had disciplinary proceedings started against his license but retired rather than face the consequences.
Today, hospitalists at Sutter Amador no longer have to anxiously wait for those responses to emergency pages. It’s one of many hospitals that have turned to a “surgicalist” model, with a surgeon always on hand at the hospital. Surgicalists perform both emergency procedures and procedures that are tied to a hospital admission, without which a patient can’t be discharged. Although it is growing in popularity, the model is still only seen in a small fraction of hospitals.
The model is widely supported by hospitalists because it brings several advantages, mainly a greater availability of the surgeon for consult.
“We don’t have to hunt them down, trying to call their office, trying to see if they’re available to call back,” says Dr. Singh, who is now also the chair of medical staff performance at Sutter Amador and adds that the change has helped with his job satisfaction.
A Clear Delineation
Arrangements between hospitalists and surgicalists vary depending on the hospital, but there typically are clearly delineated criteria on who cares for whom, with the more urgent surgical cases tending to fall under the surgicalists’ care and those with less urgent problems, even though surgery might be involved, tending to go to hospitalists.
When a surgery-related question or the need for actual surgery arises, the model calls for a quick response time from the surgicalist. Hospitalists and surgicalists collaborate on ways to reduce length of stay and prevent readmissions since they share the same institutional goals. Hospitalists are also more in tune with the needs of the surgeons, for instance, not feeding a patient who is going to need quick surgery and not administering blood thinners when a surgery is imminent unless there’s an overriding reason not to do so.
One advantage of this collaboration is that a hospitalist working alongside a surgicalist can get extra surgery-related guidance even when surgery probably isn’t needed, says John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM.
“Maybe the opinion of a general surgeon could be useful, but maybe I can get along without it because the general surgeons are busy. It’s going to be hard for them to find time to see this patient, and they’re not going to be very interested in it,” he says. “But if instead I have a surgical hospitalist who’s there all day, it’s much less of a bother for them to come by and take a look at my patient.”
Remaining Challenges
The model is not without its hurdles. When surgicalists are on a 24-hour shift, the patients will see a new one each day, sometimes prompting them to ask, “Who’s my doctor?” Also, complex cases can pose a challenge as they move from one surgicalist to another day to day.
John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,1 says he is now concerned that the principles he helped make popular—the absorption of surgeons into a system as they work hand in hand with other hospital staff all the time—might be eroding. Some small staffing companies are calling themselves surgicalists, promising fast response times, but are actually locum tenens surgeons under a surgicalist guise, he says.
Properly rolled out, surgicalist programs mean a much better working relationship between hospitalists and surgeons, says Lynette Scherer, MD, FACS, chief medical officer at Surgical Affiliates Management Group in Sacramento. The company, founded in 1996, employs about 200 surgeons, twice as many as three years ago, Dr. Scherer says, but the company declined to share what that amounts to in full-time equivalent positions.
“The hospitalists know all of our algorithms, and they know when to call us,” Dr. Scherer says. “We share the patients on the inpatient side as we need to. We keep the ones that are appropriate for us, and they keep the ones that are appropriate for them.”
The details depend on the hospital, she says.
“Whenever we go to a new site, we sit down with the hospitalist team and say, ‘What do you need here?’ And our admitting grids are different based on what the different needs of the hospitals are.”
To stay on top of complex cases with very sick patients, the medical director rounds with the team nearly every day to help guide that care, Dr. Scherer says.
At Sutter Amador, the arrival of the surgicalist model has helped shorten the length of stay by almost one day for surgery admissions, Dr. Singh says.
Reported outcomes, however, seem to be mixed.
In 2008, Sutter Medical Center in Sacramento switched from a nine-surgeon call panel to four surgeons who covered the acute-care surgery service in 24-hour shifts. Researchers looked at outcomes from 2007, before the new model was adopted, and from the four subsequent years. The results were published in 2014 in the Journal of the American College of Surgeons.2
The total number of operations rose significantly, with 497 performed in 2007 and 640 in 2011. The percentage of cases with complications also fell significantly, from 21% in 2007 to 12% in 2011, with a low of 11% in 2010.
But the mortality rate rose significantly, from 1.4% in 2007 to 2.2% in 2011, with a high of 4.1% in 2008. The study authors note that the mortality rate ultimately fell back to levels not statistically significantly higher than the rate before the service. They suggested the spike could have been due to a greater willingness by the service to treat severely ill patients and due to the “immaturity” of the service in its earlier years. The percentage of cases with a readmission fell from 6.4% in 2007 to 4.7% in 2011, with a low of 3% in 2009, but that change wasn’t quite statistically significant.
“The data’s really bearing out that emergency patients are different in terms of the care they demand,” Dr. Scherer says. “So the patient with alcoholic cirrhosis who presents with a hole in his colon is very different than somebody who presents for an elective colon resection. And you can really reduce complications when you have a team of educated people taking care of these patients.”
Dr. Nelson says adopting the model “just means you’re a smoother operator and you can provide better service to people.” He adds that for any hospital that is getting poor surgical coverage and is paying for it, “it might make sense to consider it.”
Thomas R. Collins is a freelance medical writer based in Florida.
References
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007;205(5):704-711.
- O’Mara MS, Scherer L, Wisner D, Owens LJ. Sustainability and success of the acute care surgery model in the nontrauma setting. J Am Coll Surg. 2014;219(1):90-98.
For a Model That Many Say Makes Sense, Why Not More Growth?
So why hasn’t the surgicalist field exploded? About 10 years ago, that’s what was predicted. In 2007, John Nelson, MD, MHM, a hospitalist at Overlake Medical Center in Bellevue, Wash., a hospitalist management consultant, and a past president of SHM, wrote an article saying the field could be close to a “surge” similar to the medical hospitalist explosion.1
It’s not known how many of the nation’s roughly 5,600 hospitals use a surgicalist model. There is no association for surgicalists, who are also sometimes called “surgical hospitalists.”
But according to Dr. Nelson’s anecdotal impressions, the number could range from 300 to 800 hospitals, he says. That would mean it is in place only in roughly 10% of U.S. hospitals.
Expansion of the field has been slowed by cost and politics.
Most hospitals don’t have enough surgeons to pull off a surgicalist program, and adding the right number of surgeons costs money, Dr. Nelson says.
And at smaller community hospitals that have used on-call surgeons for years, it’s a thorny issue. Those surgeons often get a call stipend for being on call. If surgeons don’t have a full slate of elective surgeries, they could rely on that on-call pay and resist the adoption of the surgicalist model, which would mean losing that pay, Dr. Nelson says.
“Some of the surgeons in the community might say, ‘I don’t really like ED call, but I have to keep doing it because of the stipend. I depend on it for my income,’” he says.
Even those who wouldn’t mind losing that on-call pay might not be enthusiastic about a move to a surgicalist model because it would bring more general surgeons into the region.
Some, Dr. Nelson says, might say, “How do I know that in two years they aren’t stealing my referrals? The new surgical hospitalist is also a potential competitor for referrals I depend on.”
And other surgeons might resist simply because they like the professional gratification of emergency surgery work, he says.
According to John Maa, MD, who wrote a seminal paper on surgicalists in 2007 based on an early surgicalist model he started at San Mateo Medical Center in California,2 “In a lot of academic centers that didn’t pay call stipend, this was just very simple for them to implement some model of this. … Once you try to send someone to an established group where there was already someone taking call, that became very controversial, and I’ve seen litigation result from that.”
Trauma surgeons resisted the model, at least in part, because of semantics: The term “surgical hospitalist” was too similar to “medical hospitalist,” and they worried it might imply a lack of surgical training, says Dr. Maa.
For now, the typical assessment of the model that Dr. Nelson hears is: “They’ve thought about it, they may in the future, but no, they don’t have one.”
“It’s not growing as fast as the medical hospitalist idea did,” he says. “But it is growing. It’s not going to go away, but it’s still relatively small.”
—Thomas R. Collins
References
- Nelson J. The surgical surge. The Hospitalist website. Accessed October 25, 2016.
- Maa J, Carter JT, Gosnell JE, Wachter R, Harris HW. The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007 ;205(5):704-711.
Tips for Hospitalists on Solving Difficult Situations
At Bay Area Medical Center in Marinette, Wis., the time had come to start talking about an elderly woman’s end-of-life care.
Her hospitalist thought that those discussions should take place with the patient present, but the woman’s family felt otherwise and made this known to the hospitalist, who stood his ground.
Eventually, the family told a nurse that they wanted to fire the physician. But the only other hospitalist on shift didn’t want to take the patient.
As case managers and hospital administrators tried to wrap their heads around the situation, it became clear: They didn’t really know what to do.
Could the patient fire a physician? Was the second physician obligated to take what he knew from the outset would be a difficult case? What if nobody wanted to take care of this patient?
“There was no black-and-white to this,” says Robin Dequaine, director of medical staff services at the hospital, who was involved in the case.
Some “difficult patient” scenarios are fairly straightforward. A patient is violent? Enact your security measures. An addict wants narcotics? Don’t give them.
But there are other situations that enter murkier territory: What if a patient makes inappropriate or abusive remarks? How much should a hospitalist put up with? What if a patient’s request for treatment might not be the hospitalist’s first choice but could be seen as reasonable? Is the patient’s request accommodated? And what about those firings?
Hospitalists, administrators, and patient advocates say these tense situations with patients involving firings, or would-be firings, while not a daily occurrence, are actually fairly common.1 Getting to the root of the problem is essential. And as with so much in healthcare, good communication is the absolute crux of it all, they say.
“These are almost all communication issues,” says John Bulger, DO, MBA, FACP, SFHM, chief medical officer at Geisinger Health Plan in Danville, Pa., who has had a long career as a hospitalist and administrator handling and trying to resolve these situations. “They’re all [about] the way the hospitalist and the team is relating to the patient.”
Jackie O’Doherty, a private patient advocate who practices in New Jersey and New York across a gamut of hospital types, has a similar view.
“For me, the biggest problem, period, against hospitalists, doctors, everybody in the hospital, is communication—the lack of it,” she says. “Their communication skills are really poor.”
Patients accustomed to choice in the outpatient setting might not handle it well when they don’t have an established relationship with their hospitalist, says John Vazquez, MD, associate director for the Emory University School of Medicine’s Division of Hospital Medicine in Atlanta.
But the system, he says, “does not allow for, unfortunately, that much patient choice.”
End-of-life Discussion at a Small Hospital
Dequaine says the staff at Bay Area Medical Center was caught flat-footed with the case of the family not wanting end-of-life care discussed with their elderly mother.
“The doctor felt very confident that he was in a position that he could have that discussion in front of the patient,” she says.
At the 99-bed center, there were just two hospitalists, who were also employees of the hospital, on shift. And the communication channels involving the medical director of hospital medicine, a case manager, and the chief nursing executive were not well-controlled, Dequaine says.
“It didn’t go up the ladder correctly,” she says. “Too many people got involved, not knowing that somebody else was already involved.”
The second hospitalist at first said he would take the case, but later Dequaine learned that he changed his mind.
“He knew his care would be no different, and we were very, very busy, so they both had a high census already,” Dequaine says.
A third physician reluctantly took over until the issue subsided. And the family still brings the patient to the hospital for care.
Ultimately, the center adopted a new policy that doesn’t guarantee a patient a new doctor, only that the hospital will have frank discussions to try to resolve the issue and then try to arrange for a transfer if the situation can’t be resolved.
“The goal is not to get rid of the patient or to force them to keep the provider,” Dequaine says. “The goal is to resolve it in a mutually satisfactory way.”
A Patient Demands a Contraindicated Medication
A middle-aged woman with Crohn’s disease was hospitalized at Emory with an infection. The woman, worried about her disease flaring, wanted to keep getting her immunosuppressant, but the hospitalist suspended it because she needed to fight off the infection. The patient became upset. At a point when the hospitalist wasn’t in the room, the woman insisted to a nurse that she get her medication. The nurse called a doctor who was on call, but that doctor wouldn’t give the immunosuppressant either.
The patient began to think she wasn’t being listened to. Dr. Vazquez went in to see the patient and apologized for the misunderstanding.
“I went back into the room and explained here’s why I’m doing it: ‘I totally understand where you’re coming from; you don’t want your disease to be out of control. I appreciate that. What I’m worried about is killing you if we give you an immunosuppressant at the wrong time,’” Dr. Vazquez says.
Dr. Vazquez has underscored at his center how important it is for the physicians to be consulted and go back into the room when patients want to fire them, even though the expedient step might be to just bring in a new doctor. At previous centers, he says, it wouldn’t be unusual for the director to get a call from a nurse, who would say, “Yeah, they want to fire this physician, so let me know who’s going to see the patient.”
But simply switching doctors, he cautions, is like saying, “I agree with you we have incompetent doctors here, so we’re going to remove that doctor and I’m going to put a doctor on who actually knows what they’re doing.”
When doctors try to resolve the issues, good things tend to happen, Dr. Vazquez says.
“There’s generally a large amount of appreciation that someone comes back into the room and says, ‘We want to do this right.’”
Of course, there are times when, if tension remains after such discussions, patient care might be better served by a swap. At large centers, that might be possible, Dr. Bulger of Geisinger says.
“If the patient doesn’t tell the doctor something because he or she doesn’t like the doctor, then the doctor’s decisions are made on partial information—that’s the issue,” he says.
O’Doherty, the patient advocate, says that if patients frustrated with poor communication actually fired physicians as often as they would like, there would be more firings.
“Patients don’t like firing the doctors because they don’t want to be the patient who everybody doesn’t like,” she says. “They’re afraid that if they argue or disagree or ask too many questions, that they’re not going to get the care they need. And the family is afraid of that as well, especially in the older population. They think doctors are like God, they hold your life in their hands. So they don’t want to really question doctors.”
She says patients don’t necessarily need a particular finesse or expert bedside manner. In many cases, she says, it’s “just giving the information.”
A Patient Demands Pain Medication
Martin Austin, MD, SFHM, recently cared for a patient with chronic headaches. The patient asked for higher doses of pain medication, insinuating that she might turn to heroin if denied.
“I was trying to make the argument that I kind of disagreed with that but, ‘I respect your opinion,’” says Dr. Austin, medical director at the Gwinnett Medical Center Inpatient Medical Group in Georgia. “We came to a negotiation about how long we would use narcotics acutely until her other acute issues were over, but then we would try to get her away from narcotics.”
A good approach, he says, is to “outline to the patient why you’re doing what you’re doing. We try not to pick battles and give the patient some degree of control if it’s not contraindicated.”
But sometimes there can be no negotiating these kinds of requests, he says.
“Sometimes we’ll just say, ‘Look, it’s not a good thing for you to continue on this medication. You’re showing side effects, you’re sedated. … We think that the risk outweighs the benefit in this case,” he says.
A Patient Feels Left in the Dark
One patient at Emory wanted to fire his hospitalist because he wouldn’t tell him what was on his CT scan.
Dr. Vazquez held a discussion between the patient and the doctor. If not for the seriousness of the patient’s condition (he had tremors and neurological concerns), it would have been almost comical.
The patient had asked, “What’s on my scan?” The patient interpreted the doctor’s response, “It’s negative,” to mean that he wasn’t being told something about the scan.
Dr. Vazquez realized that the patient had felt dismissed.
“He was a sick gentleman,” Dr. Vazquez says. “And what he wanted to hear was, ‘Look, the great news is your CT scan looks good. There’s not an anatomical abnormality. It’s not a tumor. It’s not a big bleed. … That’s great news, but I, as a physician, I am concerned about you. You’re sick. We’ve got to really figure out what’s going on with you.’… He wanted a pat on the back, and that’s all it took.”
After that, the patient no longer wanted to fire the hospitalist.
Verbal Abuse
One case at Gwinnett involves a hospitalist who was quite shy and easily intimidated and was not comfortable with a patient.
“They were struggling with a patient who was very difficult and very angry and a little abusive,” Dr. Austin says. “This doctor was really suffering psychically from this whole thing, and we switched.” Another doctor, who would not be thrown by the situation, took over the case. And Dr. Austin says he had great respect for the first doctor’s request to hand over the case.
“They needed a different personality,” he says. “It worked out beautifully. The patient and the doctor got along much better. The doctor was firm with the patient but respectful, and the other doctor felt relieved. And the [original] doctor is great with patients who need a lot of emotional support, probably better than the other doctor. So that worked out really well.”
It might be a challenge during a busy day, but it’s helpful to step back and see the situation as a whole, Dr. Bulger says. Sometimes, hospitalists can get flustered when patients are not acting rationally. But there’s usually a good reason they’re acting that way, he says.
“The patient is sick. And if it’s the patient’s family, they’re stressed by the fact that the patient’s sick. So you really need to take a step back and understand that.” TH
Thomas R. Collins is a freelance writer based in West Palm Beach, Fla.
Reference
- Centor R. Can I fire my hospitalist? SGIM Forum. 32(5):112-13.
Physician Communication Often Abysmal, Patient Advocate Says
Hospitalists, no doubt, encounter many challenging patient situations that have a lot to do with inappropriate behavior on the part of patients.
But from patient advocate Jackie O’Doherty’s point of view, many tough situations involving the patient-physician dynamic evolve from hospitalists who seem almost incapable of communicating well.
“I’m not saying they’re bad; their communication is not as great as it should be,” she says. “It has to be just giving the information. People get really frustrated when they’re in the hospital and they don’t know what’s going on.”
O’Doherty, a private patient advocate who represents patients in their efforts to get good healthcare at hospitals in New York and New Jersey, says sometimes the communication gaps are staggering.
For example, she represents a patient who had a heart attack and was transferred to a larger center to have open-heart surgery. The surgery went well, but when a Swan catheter was pulled, a plaque was hit and the man had a stroke. Suddenly, his care became a lot more complicated.
A series of specialists came in to see him. One told him that he would be sitting at home at the dinner table and watching football on Thanksgiving. Others gave him a far less rosy outlook. Some told him to drink water; others said not to.
The patient became frustrated, and O’Doherty demanded a meeting to sort out the mess. Eventually, all five of the patient’s doctors, a social worker, and the director of nursing met.
If the hospitalist is supposed to be a unifying force, that hadn’t happened in that case, O’Doherty says. Such cases, while not the norm, are frequent enough to cause concern.
“They’re the quarterbacks, supposedly, of the whole hospital experience, and I haven’t really seen that happen,” she says.
In another case, a patient getting suspect care—O’Doherty had pictures of the patient with a tracheostomy almost falling out of the bed—got a good response.
“They want to do whatever they can to make this work, and that’s a great response,” she says. “The question is, would that have been the response had I not been there?”
She understands the pressures that hospitalists can feel. And she says the system in which the hospitalist is working can matter as much as the hospitalist’s own communication skills.
“If you have a hospital that’s crazy busy, understaffed, and there’s not time,” she says, “that’s what goes first is the communication.”
At Bay Area Medical Center in Marinette, Wis., the time had come to start talking about an elderly woman’s end-of-life care.
Her hospitalist thought that those discussions should take place with the patient present, but the woman’s family felt otherwise and made this known to the hospitalist, who stood his ground.
Eventually, the family told a nurse that they wanted to fire the physician. But the only other hospitalist on shift didn’t want to take the patient.
As case managers and hospital administrators tried to wrap their heads around the situation, it became clear: They didn’t really know what to do.
Could the patient fire a physician? Was the second physician obligated to take what he knew from the outset would be a difficult case? What if nobody wanted to take care of this patient?
“There was no black-and-white to this,” says Robin Dequaine, director of medical staff services at the hospital, who was involved in the case.
Some “difficult patient” scenarios are fairly straightforward. A patient is violent? Enact your security measures. An addict wants narcotics? Don’t give them.
But there are other situations that enter murkier territory: What if a patient makes inappropriate or abusive remarks? How much should a hospitalist put up with? What if a patient’s request for treatment might not be the hospitalist’s first choice but could be seen as reasonable? Is the patient’s request accommodated? And what about those firings?
Hospitalists, administrators, and patient advocates say these tense situations with patients involving firings, or would-be firings, while not a daily occurrence, are actually fairly common.1 Getting to the root of the problem is essential. And as with so much in healthcare, good communication is the absolute crux of it all, they say.
“These are almost all communication issues,” says John Bulger, DO, MBA, FACP, SFHM, chief medical officer at Geisinger Health Plan in Danville, Pa., who has had a long career as a hospitalist and administrator handling and trying to resolve these situations. “They’re all [about] the way the hospitalist and the team is relating to the patient.”
Jackie O’Doherty, a private patient advocate who practices in New Jersey and New York across a gamut of hospital types, has a similar view.
“For me, the biggest problem, period, against hospitalists, doctors, everybody in the hospital, is communication—the lack of it,” she says. “Their communication skills are really poor.”
Patients accustomed to choice in the outpatient setting might not handle it well when they don’t have an established relationship with their hospitalist, says John Vazquez, MD, associate director for the Emory University School of Medicine’s Division of Hospital Medicine in Atlanta.
But the system, he says, “does not allow for, unfortunately, that much patient choice.”
End-of-life Discussion at a Small Hospital
Dequaine says the staff at Bay Area Medical Center was caught flat-footed with the case of the family not wanting end-of-life care discussed with their elderly mother.
“The doctor felt very confident that he was in a position that he could have that discussion in front of the patient,” she says.
At the 99-bed center, there were just two hospitalists, who were also employees of the hospital, on shift. And the communication channels involving the medical director of hospital medicine, a case manager, and the chief nursing executive were not well-controlled, Dequaine says.
“It didn’t go up the ladder correctly,” she says. “Too many people got involved, not knowing that somebody else was already involved.”
The second hospitalist at first said he would take the case, but later Dequaine learned that he changed his mind.
“He knew his care would be no different, and we were very, very busy, so they both had a high census already,” Dequaine says.
A third physician reluctantly took over until the issue subsided. And the family still brings the patient to the hospital for care.
Ultimately, the center adopted a new policy that doesn’t guarantee a patient a new doctor, only that the hospital will have frank discussions to try to resolve the issue and then try to arrange for a transfer if the situation can’t be resolved.
“The goal is not to get rid of the patient or to force them to keep the provider,” Dequaine says. “The goal is to resolve it in a mutually satisfactory way.”
A Patient Demands a Contraindicated Medication
A middle-aged woman with Crohn’s disease was hospitalized at Emory with an infection. The woman, worried about her disease flaring, wanted to keep getting her immunosuppressant, but the hospitalist suspended it because she needed to fight off the infection. The patient became upset. At a point when the hospitalist wasn’t in the room, the woman insisted to a nurse that she get her medication. The nurse called a doctor who was on call, but that doctor wouldn’t give the immunosuppressant either.
The patient began to think she wasn’t being listened to. Dr. Vazquez went in to see the patient and apologized for the misunderstanding.
“I went back into the room and explained here’s why I’m doing it: ‘I totally understand where you’re coming from; you don’t want your disease to be out of control. I appreciate that. What I’m worried about is killing you if we give you an immunosuppressant at the wrong time,’” Dr. Vazquez says.
Dr. Vazquez has underscored at his center how important it is for the physicians to be consulted and go back into the room when patients want to fire them, even though the expedient step might be to just bring in a new doctor. At previous centers, he says, it wouldn’t be unusual for the director to get a call from a nurse, who would say, “Yeah, they want to fire this physician, so let me know who’s going to see the patient.”
But simply switching doctors, he cautions, is like saying, “I agree with you we have incompetent doctors here, so we’re going to remove that doctor and I’m going to put a doctor on who actually knows what they’re doing.”
When doctors try to resolve the issues, good things tend to happen, Dr. Vazquez says.
“There’s generally a large amount of appreciation that someone comes back into the room and says, ‘We want to do this right.’”
Of course, there are times when, if tension remains after such discussions, patient care might be better served by a swap. At large centers, that might be possible, Dr. Bulger of Geisinger says.
“If the patient doesn’t tell the doctor something because he or she doesn’t like the doctor, then the doctor’s decisions are made on partial information—that’s the issue,” he says.
O’Doherty, the patient advocate, says that if patients frustrated with poor communication actually fired physicians as often as they would like, there would be more firings.
“Patients don’t like firing the doctors because they don’t want to be the patient who everybody doesn’t like,” she says. “They’re afraid that if they argue or disagree or ask too many questions, that they’re not going to get the care they need. And the family is afraid of that as well, especially in the older population. They think doctors are like God, they hold your life in their hands. So they don’t want to really question doctors.”
She says patients don’t necessarily need a particular finesse or expert bedside manner. In many cases, she says, it’s “just giving the information.”
A Patient Demands Pain Medication
Martin Austin, MD, SFHM, recently cared for a patient with chronic headaches. The patient asked for higher doses of pain medication, insinuating that she might turn to heroin if denied.
“I was trying to make the argument that I kind of disagreed with that but, ‘I respect your opinion,’” says Dr. Austin, medical director at the Gwinnett Medical Center Inpatient Medical Group in Georgia. “We came to a negotiation about how long we would use narcotics acutely until her other acute issues were over, but then we would try to get her away from narcotics.”
A good approach, he says, is to “outline to the patient why you’re doing what you’re doing. We try not to pick battles and give the patient some degree of control if it’s not contraindicated.”
But sometimes there can be no negotiating these kinds of requests, he says.
“Sometimes we’ll just say, ‘Look, it’s not a good thing for you to continue on this medication. You’re showing side effects, you’re sedated. … We think that the risk outweighs the benefit in this case,” he says.
A Patient Feels Left in the Dark
One patient at Emory wanted to fire his hospitalist because he wouldn’t tell him what was on his CT scan.
Dr. Vazquez held a discussion between the patient and the doctor. If not for the seriousness of the patient’s condition (he had tremors and neurological concerns), it would have been almost comical.
The patient had asked, “What’s on my scan?” The patient interpreted the doctor’s response, “It’s negative,” to mean that he wasn’t being told something about the scan.
Dr. Vazquez realized that the patient had felt dismissed.
“He was a sick gentleman,” Dr. Vazquez says. “And what he wanted to hear was, ‘Look, the great news is your CT scan looks good. There’s not an anatomical abnormality. It’s not a tumor. It’s not a big bleed. … That’s great news, but I, as a physician, I am concerned about you. You’re sick. We’ve got to really figure out what’s going on with you.’… He wanted a pat on the back, and that’s all it took.”
After that, the patient no longer wanted to fire the hospitalist.
Verbal Abuse
One case at Gwinnett involves a hospitalist who was quite shy and easily intimidated and was not comfortable with a patient.
“They were struggling with a patient who was very difficult and very angry and a little abusive,” Dr. Austin says. “This doctor was really suffering psychically from this whole thing, and we switched.” Another doctor, who would not be thrown by the situation, took over the case. And Dr. Austin says he had great respect for the first doctor’s request to hand over the case.
“They needed a different personality,” he says. “It worked out beautifully. The patient and the doctor got along much better. The doctor was firm with the patient but respectful, and the other doctor felt relieved. And the [original] doctor is great with patients who need a lot of emotional support, probably better than the other doctor. So that worked out really well.”
It might be a challenge during a busy day, but it’s helpful to step back and see the situation as a whole, Dr. Bulger says. Sometimes, hospitalists can get flustered when patients are not acting rationally. But there’s usually a good reason they’re acting that way, he says.
“The patient is sick. And if it’s the patient’s family, they’re stressed by the fact that the patient’s sick. So you really need to take a step back and understand that.” TH
Thomas R. Collins is a freelance writer based in West Palm Beach, Fla.
Reference
- Centor R. Can I fire my hospitalist? SGIM Forum. 32(5):112-13.
Physician Communication Often Abysmal, Patient Advocate Says
Hospitalists, no doubt, encounter many challenging patient situations that have a lot to do with inappropriate behavior on the part of patients.
But from patient advocate Jackie O’Doherty’s point of view, many tough situations involving the patient-physician dynamic evolve from hospitalists who seem almost incapable of communicating well.
“I’m not saying they’re bad; their communication is not as great as it should be,” she says. “It has to be just giving the information. People get really frustrated when they’re in the hospital and they don’t know what’s going on.”
O’Doherty, a private patient advocate who represents patients in their efforts to get good healthcare at hospitals in New York and New Jersey, says sometimes the communication gaps are staggering.
For example, she represents a patient who had a heart attack and was transferred to a larger center to have open-heart surgery. The surgery went well, but when a Swan catheter was pulled, a plaque was hit and the man had a stroke. Suddenly, his care became a lot more complicated.
A series of specialists came in to see him. One told him that he would be sitting at home at the dinner table and watching football on Thanksgiving. Others gave him a far less rosy outlook. Some told him to drink water; others said not to.
The patient became frustrated, and O’Doherty demanded a meeting to sort out the mess. Eventually, all five of the patient’s doctors, a social worker, and the director of nursing met.
If the hospitalist is supposed to be a unifying force, that hadn’t happened in that case, O’Doherty says. Such cases, while not the norm, are frequent enough to cause concern.
“They’re the quarterbacks, supposedly, of the whole hospital experience, and I haven’t really seen that happen,” she says.
In another case, a patient getting suspect care—O’Doherty had pictures of the patient with a tracheostomy almost falling out of the bed—got a good response.
“They want to do whatever they can to make this work, and that’s a great response,” she says. “The question is, would that have been the response had I not been there?”
She understands the pressures that hospitalists can feel. And she says the system in which the hospitalist is working can matter as much as the hospitalist’s own communication skills.
“If you have a hospital that’s crazy busy, understaffed, and there’s not time,” she says, “that’s what goes first is the communication.”
At Bay Area Medical Center in Marinette, Wis., the time had come to start talking about an elderly woman’s end-of-life care.
Her hospitalist thought that those discussions should take place with the patient present, but the woman’s family felt otherwise and made this known to the hospitalist, who stood his ground.
Eventually, the family told a nurse that they wanted to fire the physician. But the only other hospitalist on shift didn’t want to take the patient.
As case managers and hospital administrators tried to wrap their heads around the situation, it became clear: They didn’t really know what to do.
Could the patient fire a physician? Was the second physician obligated to take what he knew from the outset would be a difficult case? What if nobody wanted to take care of this patient?
“There was no black-and-white to this,” says Robin Dequaine, director of medical staff services at the hospital, who was involved in the case.
Some “difficult patient” scenarios are fairly straightforward. A patient is violent? Enact your security measures. An addict wants narcotics? Don’t give them.
But there are other situations that enter murkier territory: What if a patient makes inappropriate or abusive remarks? How much should a hospitalist put up with? What if a patient’s request for treatment might not be the hospitalist’s first choice but could be seen as reasonable? Is the patient’s request accommodated? And what about those firings?
Hospitalists, administrators, and patient advocates say these tense situations with patients involving firings, or would-be firings, while not a daily occurrence, are actually fairly common.1 Getting to the root of the problem is essential. And as with so much in healthcare, good communication is the absolute crux of it all, they say.
“These are almost all communication issues,” says John Bulger, DO, MBA, FACP, SFHM, chief medical officer at Geisinger Health Plan in Danville, Pa., who has had a long career as a hospitalist and administrator handling and trying to resolve these situations. “They’re all [about] the way the hospitalist and the team is relating to the patient.”
Jackie O’Doherty, a private patient advocate who practices in New Jersey and New York across a gamut of hospital types, has a similar view.
“For me, the biggest problem, period, against hospitalists, doctors, everybody in the hospital, is communication—the lack of it,” she says. “Their communication skills are really poor.”
Patients accustomed to choice in the outpatient setting might not handle it well when they don’t have an established relationship with their hospitalist, says John Vazquez, MD, associate director for the Emory University School of Medicine’s Division of Hospital Medicine in Atlanta.
But the system, he says, “does not allow for, unfortunately, that much patient choice.”
End-of-life Discussion at a Small Hospital
Dequaine says the staff at Bay Area Medical Center was caught flat-footed with the case of the family not wanting end-of-life care discussed with their elderly mother.
“The doctor felt very confident that he was in a position that he could have that discussion in front of the patient,” she says.
At the 99-bed center, there were just two hospitalists, who were also employees of the hospital, on shift. And the communication channels involving the medical director of hospital medicine, a case manager, and the chief nursing executive were not well-controlled, Dequaine says.
“It didn’t go up the ladder correctly,” she says. “Too many people got involved, not knowing that somebody else was already involved.”
The second hospitalist at first said he would take the case, but later Dequaine learned that he changed his mind.
“He knew his care would be no different, and we were very, very busy, so they both had a high census already,” Dequaine says.
A third physician reluctantly took over until the issue subsided. And the family still brings the patient to the hospital for care.
Ultimately, the center adopted a new policy that doesn’t guarantee a patient a new doctor, only that the hospital will have frank discussions to try to resolve the issue and then try to arrange for a transfer if the situation can’t be resolved.
“The goal is not to get rid of the patient or to force them to keep the provider,” Dequaine says. “The goal is to resolve it in a mutually satisfactory way.”
A Patient Demands a Contraindicated Medication
A middle-aged woman with Crohn’s disease was hospitalized at Emory with an infection. The woman, worried about her disease flaring, wanted to keep getting her immunosuppressant, but the hospitalist suspended it because she needed to fight off the infection. The patient became upset. At a point when the hospitalist wasn’t in the room, the woman insisted to a nurse that she get her medication. The nurse called a doctor who was on call, but that doctor wouldn’t give the immunosuppressant either.
The patient began to think she wasn’t being listened to. Dr. Vazquez went in to see the patient and apologized for the misunderstanding.
“I went back into the room and explained here’s why I’m doing it: ‘I totally understand where you’re coming from; you don’t want your disease to be out of control. I appreciate that. What I’m worried about is killing you if we give you an immunosuppressant at the wrong time,’” Dr. Vazquez says.
Dr. Vazquez has underscored at his center how important it is for the physicians to be consulted and go back into the room when patients want to fire them, even though the expedient step might be to just bring in a new doctor. At previous centers, he says, it wouldn’t be unusual for the director to get a call from a nurse, who would say, “Yeah, they want to fire this physician, so let me know who’s going to see the patient.”
But simply switching doctors, he cautions, is like saying, “I agree with you we have incompetent doctors here, so we’re going to remove that doctor and I’m going to put a doctor on who actually knows what they’re doing.”
When doctors try to resolve the issues, good things tend to happen, Dr. Vazquez says.
“There’s generally a large amount of appreciation that someone comes back into the room and says, ‘We want to do this right.’”
Of course, there are times when, if tension remains after such discussions, patient care might be better served by a swap. At large centers, that might be possible, Dr. Bulger of Geisinger says.
“If the patient doesn’t tell the doctor something because he or she doesn’t like the doctor, then the doctor’s decisions are made on partial information—that’s the issue,” he says.
O’Doherty, the patient advocate, says that if patients frustrated with poor communication actually fired physicians as often as they would like, there would be more firings.
“Patients don’t like firing the doctors because they don’t want to be the patient who everybody doesn’t like,” she says. “They’re afraid that if they argue or disagree or ask too many questions, that they’re not going to get the care they need. And the family is afraid of that as well, especially in the older population. They think doctors are like God, they hold your life in their hands. So they don’t want to really question doctors.”
She says patients don’t necessarily need a particular finesse or expert bedside manner. In many cases, she says, it’s “just giving the information.”
A Patient Demands Pain Medication
Martin Austin, MD, SFHM, recently cared for a patient with chronic headaches. The patient asked for higher doses of pain medication, insinuating that she might turn to heroin if denied.
“I was trying to make the argument that I kind of disagreed with that but, ‘I respect your opinion,’” says Dr. Austin, medical director at the Gwinnett Medical Center Inpatient Medical Group in Georgia. “We came to a negotiation about how long we would use narcotics acutely until her other acute issues were over, but then we would try to get her away from narcotics.”
A good approach, he says, is to “outline to the patient why you’re doing what you’re doing. We try not to pick battles and give the patient some degree of control if it’s not contraindicated.”
But sometimes there can be no negotiating these kinds of requests, he says.
“Sometimes we’ll just say, ‘Look, it’s not a good thing for you to continue on this medication. You’re showing side effects, you’re sedated. … We think that the risk outweighs the benefit in this case,” he says.
A Patient Feels Left in the Dark
One patient at Emory wanted to fire his hospitalist because he wouldn’t tell him what was on his CT scan.
Dr. Vazquez held a discussion between the patient and the doctor. If not for the seriousness of the patient’s condition (he had tremors and neurological concerns), it would have been almost comical.
The patient had asked, “What’s on my scan?” The patient interpreted the doctor’s response, “It’s negative,” to mean that he wasn’t being told something about the scan.
Dr. Vazquez realized that the patient had felt dismissed.
“He was a sick gentleman,” Dr. Vazquez says. “And what he wanted to hear was, ‘Look, the great news is your CT scan looks good. There’s not an anatomical abnormality. It’s not a tumor. It’s not a big bleed. … That’s great news, but I, as a physician, I am concerned about you. You’re sick. We’ve got to really figure out what’s going on with you.’… He wanted a pat on the back, and that’s all it took.”
After that, the patient no longer wanted to fire the hospitalist.
Verbal Abuse
One case at Gwinnett involves a hospitalist who was quite shy and easily intimidated and was not comfortable with a patient.
“They were struggling with a patient who was very difficult and very angry and a little abusive,” Dr. Austin says. “This doctor was really suffering psychically from this whole thing, and we switched.” Another doctor, who would not be thrown by the situation, took over the case. And Dr. Austin says he had great respect for the first doctor’s request to hand over the case.
“They needed a different personality,” he says. “It worked out beautifully. The patient and the doctor got along much better. The doctor was firm with the patient but respectful, and the other doctor felt relieved. And the [original] doctor is great with patients who need a lot of emotional support, probably better than the other doctor. So that worked out really well.”
It might be a challenge during a busy day, but it’s helpful to step back and see the situation as a whole, Dr. Bulger says. Sometimes, hospitalists can get flustered when patients are not acting rationally. But there’s usually a good reason they’re acting that way, he says.
“The patient is sick. And if it’s the patient’s family, they’re stressed by the fact that the patient’s sick. So you really need to take a step back and understand that.” TH
Thomas R. Collins is a freelance writer based in West Palm Beach, Fla.
Reference
- Centor R. Can I fire my hospitalist? SGIM Forum. 32(5):112-13.
Physician Communication Often Abysmal, Patient Advocate Says
Hospitalists, no doubt, encounter many challenging patient situations that have a lot to do with inappropriate behavior on the part of patients.
But from patient advocate Jackie O’Doherty’s point of view, many tough situations involving the patient-physician dynamic evolve from hospitalists who seem almost incapable of communicating well.
“I’m not saying they’re bad; their communication is not as great as it should be,” she says. “It has to be just giving the information. People get really frustrated when they’re in the hospital and they don’t know what’s going on.”
O’Doherty, a private patient advocate who represents patients in their efforts to get good healthcare at hospitals in New York and New Jersey, says sometimes the communication gaps are staggering.
For example, she represents a patient who had a heart attack and was transferred to a larger center to have open-heart surgery. The surgery went well, but when a Swan catheter was pulled, a plaque was hit and the man had a stroke. Suddenly, his care became a lot more complicated.
A series of specialists came in to see him. One told him that he would be sitting at home at the dinner table and watching football on Thanksgiving. Others gave him a far less rosy outlook. Some told him to drink water; others said not to.
The patient became frustrated, and O’Doherty demanded a meeting to sort out the mess. Eventually, all five of the patient’s doctors, a social worker, and the director of nursing met.
If the hospitalist is supposed to be a unifying force, that hadn’t happened in that case, O’Doherty says. Such cases, while not the norm, are frequent enough to cause concern.
“They’re the quarterbacks, supposedly, of the whole hospital experience, and I haven’t really seen that happen,” she says.
In another case, a patient getting suspect care—O’Doherty had pictures of the patient with a tracheostomy almost falling out of the bed—got a good response.
“They want to do whatever they can to make this work, and that’s a great response,” she says. “The question is, would that have been the response had I not been there?”
She understands the pressures that hospitalists can feel. And she says the system in which the hospitalist is working can matter as much as the hospitalist’s own communication skills.
“If you have a hospital that’s crazy busy, understaffed, and there’s not time,” she says, “that’s what goes first is the communication.”
HM16 AUDIO: U.S. Surgeon General Vivek Murthy, MD, MBA, Discusses Hospital Medicine's Role in Public Health
U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.
U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.
U.S. Surgeon General Vivek Murthy, MD, MBA, talks about the role hospitalists can play in public health.
HM16 AUDIO: Alyssa Stephany, MD, Talks about the HM16 RIV Scientific Abstract Competition
Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident
Jennifer Ladd, MD, won an award for pediatric clinical vignette.
Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident
Jennifer Ladd, MD, won an award for pediatric clinical vignette.
Alyssa Stephany, MD, then assistant professor at Duke and now section chief of pediatric hospital medicine at Children’s Hospital of Wisconsin, talks about the evolution in training stemming from her experience in the HM16 RIV competition. This year, she oversaw a study for which resident
Jennifer Ladd, MD, won an award for pediatric clinical vignette.