Among the challenging psychiatric conditions hospitalists encounter are factitious disorders in which patients fabricate symptoms to draw attention, elicit empathy, and intentionally take on a sick role.

For example, at the University of Chicago, a patient in her 30s complained of blood in her urine, stool, and vomit. The staff performed an extensive evaluation, including laboratory analyses and upper and lower gastrointestinal endoscopies, but they found no source of the alleged bleeding, says Gregory Ruhnke, MD, MS, MPH, assistant professor in the section of hospital medicine at the university’s Pritzker School of Medicine.

After lengthy discussions with several nurses and direct observation, caregivers became suspicious, in part, because the patient was ordering predominantly red food and drinks, such as Jell-O and cranberry juice. She emptied them into a basin and claimed to have vomited blood, Dr. Ruhnke says. Lab results confirmed the absence of any blood.

In this instance, the patient’s objective was “to stay in the hospital,” says Marie Tobin, MD, associate professor of psychiatry and consult-liaison psychiatrist at the University of Chicago. “That’s the goal—to be taken care of as a patient.”

The staff later learned that the patient had engaged in similar tactics at other hospitals. When physicians wanted to obtain medical records from those facilities, the patient declined to grant permission.

“We do have to respect the patient’s confidentiality,” Dr. Tobin says. “If they refuse, we really can’t [obtain their records].”

Aside from previous records, “room searches can help confirm suspicions,” Dr. Ruhnke says. Security personnel should conduct a room search when necessary. This preserves the patient’s therapeutic rapport with healthcare providers. A search could uncover knives or needles, which a patient could use to inflict harm. More important, room searches can resolve inconsistencies and help hospitalists avoid ordering unjustified tests and procedures.

“It’s not a pleasant situation, but it is for safety,” Dr. Tobin says of investigations.

“These are people who can be at high risk to themselves.” TH

Susan Kreimer is a freelance writer in New York.

 

Among the challenging psychiatric conditions hospitalists encounter are factitious disorders in which patients fabricate symptoms to draw attention, elicit empathy, and intentionally take on a sick role.

For example, at the University of Chicago, a patient in her 30s complained of blood in her urine, stool, and vomit. The staff performed an extensive evaluation, including laboratory analyses and upper and lower gastrointestinal endoscopies, but they found no source of the alleged bleeding, says Gregory Ruhnke, MD, MS, MPH, assistant professor in the section of hospital medicine at the university’s Pritzker School of Medicine.

After lengthy discussions with several nurses and direct observation, caregivers became suspicious, in part, because the patient was ordering predominantly red food and drinks, such as Jell-O and cranberry juice. She emptied them into a basin and claimed to have vomited blood, Dr. Ruhnke says. Lab results confirmed the absence of any blood.

In this instance, the patient’s objective was “to stay in the hospital,” says Marie Tobin, MD, associate professor of psychiatry and consult-liaison psychiatrist at the University of Chicago. “That’s the goal—to be taken care of as a patient.”

The staff later learned that the patient had engaged in similar tactics at other hospitals. When physicians wanted to obtain medical records from those facilities, the patient declined to grant permission.

“We do have to respect the patient’s confidentiality,” Dr. Tobin says. “If they refuse, we really can’t [obtain their records].”

Aside from previous records, “room searches can help confirm suspicions,” Dr. Ruhnke says. Security personnel should conduct a room search when necessary. This preserves the patient’s therapeutic rapport with healthcare providers. A search could uncover knives or needles, which a patient could use to inflict harm. More important, room searches can resolve inconsistencies and help hospitalists avoid ordering unjustified tests and procedures.

“It’s not a pleasant situation, but it is for safety,” Dr. Tobin says of investigations.

“These are people who can be at high risk to themselves.” TH

Susan Kreimer is a freelance writer in New York.

 

Among the challenging psychiatric conditions hospitalists encounter are factitious disorders in which patients fabricate symptoms to draw attention, elicit empathy, and intentionally take on a sick role.

For example, at the University of Chicago, a patient in her 30s complained of blood in her urine, stool, and vomit. The staff performed an extensive evaluation, including laboratory analyses and upper and lower gastrointestinal endoscopies, but they found no source of the alleged bleeding, says Gregory Ruhnke, MD, MS, MPH, assistant professor in the section of hospital medicine at the university’s Pritzker School of Medicine.

After lengthy discussions with several nurses and direct observation, caregivers became suspicious, in part, because the patient was ordering predominantly red food and drinks, such as Jell-O and cranberry juice. She emptied them into a basin and claimed to have vomited blood, Dr. Ruhnke says. Lab results confirmed the absence of any blood.

In this instance, the patient’s objective was “to stay in the hospital,” says Marie Tobin, MD, associate professor of psychiatry and consult-liaison psychiatrist at the University of Chicago. “That’s the goal—to be taken care of as a patient.”

The staff later learned that the patient had engaged in similar tactics at other hospitals. When physicians wanted to obtain medical records from those facilities, the patient declined to grant permission.

“We do have to respect the patient’s confidentiality,” Dr. Tobin says. “If they refuse, we really can’t [obtain their records].”

Aside from previous records, “room searches can help confirm suspicions,” Dr. Ruhnke says. Security personnel should conduct a room search when necessary. This preserves the patient’s therapeutic rapport with healthcare providers. A search could uncover knives or needles, which a patient could use to inflict harm. More important, room searches can resolve inconsistencies and help hospitalists avoid ordering unjustified tests and procedures.

“It’s not a pleasant situation, but it is for safety,” Dr. Tobin says of investigations.

“These are people who can be at high risk to themselves.” TH

Susan Kreimer is a freelance writer in New York.

 

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

Click here to listen to Dr. Hilger

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

Click here to listen to Dr. Duckworth

Click here to listen to Dr. Duckworth

Click here to listen to Dr. Duckworth

Click here to listen to Dr. Brotman

Click here to listen to Dr. Feinberg

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Click here to listen to Dr. Brotman

Click here to listen to Dr. Feinberg

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

Click here to listen to Dr. Brotman

Click here to listen to Dr. Feinberg

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

CME: Coming to a Screen Near You Hospitalists often turn to

SHM for continuing medical education (CME) credits. Soon, SHM members will have even more options for earning and tracking CME through its new Learning Portal.

Due to launch in May, the Learning Portal will give hospitalists new online content for hospitalist-specific CME credits. It will offer personalized portfolios to track CME credits earned through the Learning Portal and other CME sources.

For more on the portal, visit www.hospitalmedicine.org in May.

HMX: Expanding the Conversation with More Than 1,400 Hospitalists

More and more hospitalists are turning to HMX, SHM's online collaboration and discussion site, for questions and answers from their HM colleagues. More than 1,400 hospitalists have logged into HMX; earlier this year, HMX notched its 10,000th log-in.

For topics ranging from paid time off to working with post-discharge clinics to reduce readmissions, HMX has quickly become the source for practical, up-to-date information from hospitalists in the know. Plus, HMX users have posted dozens of helpful documents and other resources to more than three dozen active, topic-based communities on HMX. Others have used HMX to connect with other hospitalists directly through the HMX directory.

Are you ready to connect? Visit www.hmxchange.org.

Project BOOST: It's Not Too Early to Apply

The best hospital discharge processes start at admission. And, as with planning for patient discharges, applying for SHM's Project BOOST is best done in advance. SHM will be accepting applications for its 2013 cohort through June, but the process requires a letter of support from an executive sponsor and an application, so April is a great time to get started.

Just ask Jean Range of The Joint Commission: "Project BOOST provides a clear plan of action for hospitals who want to improve the discharge process for their older patients. Utilizing the free resources that BOOST provides will result in decreased rehospitalization and better patient outcomes—a win-win situation for all involved."

For more information, visit www.hospitalmedicine.org/boost.

Hospitalists Can Lead by Following (and Friending)

SHM's presence is growing. More than 1,600 hospitalists and others interested in HM are getting the latest updates about hospital medicine from @SHMLive, SHM's Twitter feed. And SHM's Facebook page has received nearly 2,200 "likes."

To join the HM movement through social media, visit SHM's profiles on:

• Twitter: www.twitter.com/shmlive
• Facebook: www.facebook.com/Hospitalists
• LinkedIn: www.linkedin.com/company/society-of-hospital-medicine
• YouTube: www.youtube.com/user/SHMLive

CME: Coming to a Screen Near You Hospitalists often turn to

SHM for continuing medical education (CME) credits. Soon, SHM members will have even more options for earning and tracking CME through its new Learning Portal.

Due to launch in May, the Learning Portal will give hospitalists new online content for hospitalist-specific CME credits. It will offer personalized portfolios to track CME credits earned through the Learning Portal and other CME sources.

For more on the portal, visit www.hospitalmedicine.org in May.

HMX: Expanding the Conversation with More Than 1,400 Hospitalists

More and more hospitalists are turning to HMX, SHM's online collaboration and discussion site, for questions and answers from their HM colleagues. More than 1,400 hospitalists have logged into HMX; earlier this year, HMX notched its 10,000th log-in.

For topics ranging from paid time off to working with post-discharge clinics to reduce readmissions, HMX has quickly become the source for practical, up-to-date information from hospitalists in the know. Plus, HMX users have posted dozens of helpful documents and other resources to more than three dozen active, topic-based communities on HMX. Others have used HMX to connect with other hospitalists directly through the HMX directory.

Are you ready to connect? Visit www.hmxchange.org.

Project BOOST: It's Not Too Early to Apply

The best hospital discharge processes start at admission. And, as with planning for patient discharges, applying for SHM's Project BOOST is best done in advance. SHM will be accepting applications for its 2013 cohort through June, but the process requires a letter of support from an executive sponsor and an application, so April is a great time to get started.

Just ask Jean Range of The Joint Commission: "Project BOOST provides a clear plan of action for hospitals who want to improve the discharge process for their older patients. Utilizing the free resources that BOOST provides will result in decreased rehospitalization and better patient outcomes—a win-win situation for all involved."

For more information, visit www.hospitalmedicine.org/boost.

Hospitalists Can Lead by Following (and Friending)

SHM's presence is growing. More than 1,600 hospitalists and others interested in HM are getting the latest updates about hospital medicine from @SHMLive, SHM's Twitter feed. And SHM's Facebook page has received nearly 2,200 "likes."

To join the HM movement through social media, visit SHM's profiles on:

• Twitter: www.twitter.com/shmlive
• Facebook: www.facebook.com/Hospitalists
• LinkedIn: www.linkedin.com/company/society-of-hospital-medicine
• YouTube: www.youtube.com/user/SHMLive

CME: Coming to a Screen Near You Hospitalists often turn to

SHM for continuing medical education (CME) credits. Soon, SHM members will have even more options for earning and tracking CME through its new Learning Portal.

Due to launch in May, the Learning Portal will give hospitalists new online content for hospitalist-specific CME credits. It will offer personalized portfolios to track CME credits earned through the Learning Portal and other CME sources.

For more on the portal, visit www.hospitalmedicine.org in May.

HMX: Expanding the Conversation with More Than 1,400 Hospitalists

More and more hospitalists are turning to HMX, SHM's online collaboration and discussion site, for questions and answers from their HM colleagues. More than 1,400 hospitalists have logged into HMX; earlier this year, HMX notched its 10,000th log-in.

For topics ranging from paid time off to working with post-discharge clinics to reduce readmissions, HMX has quickly become the source for practical, up-to-date information from hospitalists in the know. Plus, HMX users have posted dozens of helpful documents and other resources to more than three dozen active, topic-based communities on HMX. Others have used HMX to connect with other hospitalists directly through the HMX directory.

Are you ready to connect? Visit www.hmxchange.org.

Project BOOST: It's Not Too Early to Apply

The best hospital discharge processes start at admission. And, as with planning for patient discharges, applying for SHM's Project BOOST is best done in advance. SHM will be accepting applications for its 2013 cohort through June, but the process requires a letter of support from an executive sponsor and an application, so April is a great time to get started.

Just ask Jean Range of The Joint Commission: "Project BOOST provides a clear plan of action for hospitals who want to improve the discharge process for their older patients. Utilizing the free resources that BOOST provides will result in decreased rehospitalization and better patient outcomes—a win-win situation for all involved."

For more information, visit www.hospitalmedicine.org/boost.

Hospitalists Can Lead by Following (and Friending)

SHM's presence is growing. More than 1,600 hospitalists and others interested in HM are getting the latest updates about hospital medicine from @SHMLive, SHM's Twitter feed. And SHM's Facebook page has received nearly 2,200 "likes."

To join the HM movement through social media, visit SHM's profiles on:

• Twitter: www.twitter.com/shmlive
• Facebook: www.facebook.com/Hospitalists
• LinkedIn: www.linkedin.com/company/society-of-hospital-medicine
• YouTube: www.youtube.com/user/SHMLive

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

 

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

 

SHM’s Boston area chapter is looking to award a $1,000 scholarship to a resident who has been accepted to present a research, innovation, or clinical vignette (RIV) poster at HM13 in May at the Gaylord National Resort and Conference Center just outside Washington, D.C. The scholarship is to help defray travel expenses to attend the four-day annual meeting.

“We want to encourage our trainees to be productive in academic work and contribute to the body of knowledge about hospital medicine,” says Joseph Ming Wah Li, MD SFHM FACP, director of hospital medicine at Beth Israel Deaconess Medical Center in Boston and past president of SHM, adding chapter organizers hope the scholarship will further the awardees’ interest in the HM and provide the resident the opportunity to meet and share ideas with leaders in the field. “Any resident in training in the state of Massachusetts whose abstract was accepted for poster presentation at HM13 is eligible,” he says.

The application [PDF] deadline is April 8. Interested applicants should contact Dr. Li. The 2013 RIV poster sessions are Friday, May 16, and Saturday, May 17.

SHM’s Maryland chapter also awards annual meeting scholarships, and SHM leaders are looking to broaden the effort in years to come.

The Maryland chapter periodically solicits RIV abstracts from early-career hospitalists, residents, nurse practitioners, and physician assistants, inviting four or five to make oral presentations at a chapter meeting and then selecting a winner. Preeti Mehrotra, MD, internal medicine-pediatrics resident at the University of Maryland Medical Center in Baltimore, and Jameka Riley, PA-C, physician assistant with Physician Inpatient Care Specialists in Annapolis, won the latest Maryland chapter contest and will have their HM13 registration fees covered.

Visit the SHM website for more information about chapters.

 

Look no further than SHM’s Web application for HM13 at www.eventmobi.com/hm13.

This year, SHM is introducing the HM13 at Hand app as the sole source for HM13 content, including session presentations and speaker information for all of the conference. In previous years, attendees have used the meeting’s “paperless site” as the online location for all of the meeting’s content.

At HM13, attendees can get all of the content seamlessly on their tablets or smartphones in real time through the HM13 At Hand app.

HM13 At Hand puts HM13 in your hands with meeting content and tools:

• Presentations
• Speaker information
• HM13 schedule and planner
• “Scan to Win” contest
• Real-time alerts and updates
• Links to other HM13 resources and social media

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

Look no further than SHM’s Web application for HM13 at www.eventmobi.com/hm13.

This year, SHM is introducing the HM13 at Hand app as the sole source for HM13 content, including session presentations and speaker information for all of the conference. In previous years, attendees have used the meeting’s “paperless site” as the online location for all of the meeting’s content.

At HM13, attendees can get all of the content seamlessly on their tablets or smartphones in real time through the HM13 At Hand app.

HM13 At Hand puts HM13 in your hands with meeting content and tools:

• Presentations
• Speaker information
• HM13 schedule and planner
• “Scan to Win” contest
• Real-time alerts and updates
• Links to other HM13 resources and social media

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

Look no further than SHM’s Web application for HM13 at www.eventmobi.com/hm13.

This year, SHM is introducing the HM13 at Hand app as the sole source for HM13 content, including session presentations and speaker information for all of the conference. In previous years, attendees have used the meeting’s “paperless site” as the online location for all of the meeting’s content.

At HM13, attendees can get all of the content seamlessly on their tablets or smartphones in real time through the HM13 At Hand app.

HM13 At Hand puts HM13 in your hands with meeting content and tools:

• Presentations
• Speaker information
• HM13 schedule and planner
• “Scan to Win” contest
• Real-time alerts and updates
• Links to other HM13 resources and social media

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

 

How do you go from being an early-career hospitalist to a leader in healthcare? Are there opportunities to do quality-improvement (QI) programs as a hospitalist?

Medical students and residents often have lots of questions about the many career paths available to hospitalists, and a special lunch at HM13 is designed to help answer many of them. This year’s lunch is May 17, the first day of the full HM13 program. It will link the specialty’s future hospitalists with leaders in the field.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

How do you go from being an early-career hospitalist to a leader in healthcare? Are there opportunities to do quality-improvement (QI) programs as a hospitalist?

Medical students and residents often have lots of questions about the many career paths available to hospitalists, and a special lunch at HM13 is designed to help answer many of them. This year’s lunch is May 17, the first day of the full HM13 program. It will link the specialty’s future hospitalists with leaders in the field.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

How do you go from being an early-career hospitalist to a leader in healthcare? Are there opportunities to do quality-improvement (QI) programs as a hospitalist?

Medical students and residents often have lots of questions about the many career paths available to hospitalists, and a special lunch at HM13 is designed to help answer many of them. This year’s lunch is May 17, the first day of the full HM13 program. It will link the specialty’s future hospitalists with leaders in the field.

Check out our 6-minute feature video: "Five Reasons You Should Attend HM13"

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.

SHM Sections offer opportunities for members to connect with communities of their peers who share specialties or interests. At present, SHM Sections include:

• Med-Peds
• International
• Global Health and Human Rights
• Rural Hospitalists
• Practice Administrators

SHM Section of the Month

Seeing as how the focused-practice pathway for hospitalists is a first of its kind for physician credentialing boards, the ABIM is planning a “fairly significant” research effort tracking participants’ experience, Dr. Holmboe says.

Global Health and Human Rights is one of the newest SHM Sections, and represents a growing passion among hospitalists as increasing numbers of internal-medicine physicians express interest in overseas placements in resource-limited settings. SHM also recognizes the need for mentored training in global health.

Over the last decade, interest in global health has grown significantly amongst trainees, faculty, and staff. Current priorities for global health include: health-system strengthening, workforce training, QI and patient safety. These priorities align to core strengths of hospital medicine, which is therefore well suited to meet these global health challenges.

For more information about this and other Sections, visit www.hospitalmedicine.org/membership.