Teachable Moments

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

You start your day refreshed, enthusiastic, and ready to take on every challenge that comes your way.

You print your list of patients for the day – not too bad, a mere 15; quite doable for a seasoned hospitalist. You scan your list: a hypertensive crisis – piece of cake; 3 patients with acute systolic heart failure – just follow the guidelines; 2 with a COPD exacerbation – no worries. You know how to treat these conditions, almost with your eyes closed. But, of course, all conditions do not have such straightforward treatments.

The next patient on your list is a 35-year-old on a methadone maintenance program admitted with an accidental heroin overdose. So sad. Then there is a 59-year-old with chronic back pain and known drug-seeking behavior, well known to you and your entire team. So frustrating. Next, you read about a healthy 24-year-old mother of two who slipped on a baby bottle and tumbled down two flights of stairs, breaking both femurs, a clavicle, and nine ribs.

As you mull over your approach to the first two, you cannot help but be concerned about the likelihood that this young mother will require strong narcotics to manage her pain for a considerable time, long after discharge. She has a legitimate reason to receive opioid analgesics, but how can you minimize her chances of becoming another statistic?

In 2012, an estimated 2.1 million Americans suffered from substance use disorders due to prescription opioid pain relievers while close to 467,000 were addicted to heroin.

To complicate matters, many who were legitimately prescribed painkillers go on to abuse heroin when they can no longer get prescription opiates from their health care providers. Naturally, we want to take away our patients’ pain, but in 2016 we must be keenly aware that every time we prescribe opiates for our patients there is a risk, whether great or small, that individual may some day suffer from a substance abuse disorder.

Evidence shows that the way the human brain deals with opiates, and subsequent opiate dependence, necessitates that we rethink how we view addiction. Addicts simply cannot be stereotyped as derelicts, always looking for their next high. They have a real disease.

According to the American Society of Addiction Medicine, addiction is a primary, chronic, and relapsing disease of the brain. When one thinks of addiction as a true disease, and not simply as a weakness of pleasure seekers with morals we deem beneath our own, it paints the addict in a completely different light.

We would never order a procedure or prescribe a medication that had more than a negligible risk of causing diabetes or hypertension. Remember, “First, do no harm?” Perhaps we should approach opiate prescribing by considering not only the immediate benefit our patients will receive, and thus how quickly they can be discharged, but the potential long term pain they may experience in the future should they become addicted.

The heroin epidemic has hit America with a vengeance. It is an equal opportunity destroyer with an unprecedented predilection to decimate lives in all communities – affluent, impoverished, and everyplace in between. It has no regard for race or ethnicity and knows no boundaries whatsoever.

No doubt, some of our most challenging patients are the ones who are least sick, medically speaking, but suffer from addictions that are beyond our expertise. They often require us to reach down much deeper than a textbook to find more understanding, more insight, more wisdom, and a huge helping of compassion, even in the midst of own frustration.

Sure, we want to relieve pain and suffering. There are few things as rewarding as doing so. Yet, because we have not understood the long-term consequences of writing an opioid prescription, health care professionals have played a tremendous role in the epidemic of addiction that is decimating lives. In the past, we simply didn’t know, but now we do and this knowledge empowers us to take the lead in turning around this monstrous epidemic.

I believe 3 simple steps can help us all become more responsible opiate prescribers and thus begin the long process of conquering the beast of addiction.

1. Think before you order. Is it possible that pain can be controlled with a non-narcotic medication, such as tramadol or NSAIDs?

2. Hone your prescribing skills by taking CMEs or simply reading reputable journal articles and other noteworthy resources.

3. Do not hesitate to consult your pain management service. Doing so does not denote weakness; it signifies wisdom and humility when you put your patient’s best interest above your pride. It’s honorable to “know what you don’t know” and seek help when needed.

Finally, I would like to dedicate this article to Mark, my 25-year-old, athletic father-to-be who accidentally overdosed on heroin long before his baby was born. May your child grow up in an America that rids itself of this drug nightmare long before he is old enough to know what drug addiction means. Rest in peace, Mark.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

It was close to 2 decades ago, but it is still as clear as if it had been yesterday. I sat in the intensive care unit, fresh from my residency, tears streaming down my face, which was firmly nestled between my hands as I tried to hide my pain from every soul around me – doctors, nurses, patients’ family members – anyone and everyone.

I had just lost a very dear patient and emotions were running high. I only hoped no one at the nurses’ station would notice me, at least until I had a chance to regain my composure. After all, who would expect to see, or even respect, a doctor found sobbing like a child over a patient who died? Isn’t that all part of the job? Don’t we anticipate the death of some of our most critically ill patients?

Almost paralyzed with grief, I had a hard decision to make.

Option one: I could sit firmly planted in my seat and deal with my personal loss, the loss of my patient with chart number 0001 – yes, my very first patient in private practice. Over time, she and I had developed a very warm, loving relationship, almost like that of a mother and daughter as she was several decades my elder. I had a right to grieve my loss just as anyone else would grieve after losing someone they cared for, didn’t I?

Option two: I could bury my personal feelings and deal with them later in the comfort of my home, safe from the incessant pages from nurses calling about other patients’ urgent needs, hidden from accusing, sometimes condescending glances from other medical professionals who could never understand why I would react so strongly to the death of a patient – especially in a place surrounded by the watchful eyes of others who hold physicians to such a high standard.

Not so much to save face, but for the sake of other critically ill patients who needed a calm, clear-thinking physician to make prudent decisions regarding their care, I chose option two.

As hospitalists, our work is exciting and extremely rewarding, yet with all the suffering and death we see, we must be very careful to guard our hearts and minds, lest we fall into a state of perpetual inner turmoil and stress, and find ourselves seeking counseling or even prescription medication to cope. Compassion satisfaction and compassion fatigue are two ends of a spectrum that caregivers, including medical professionals, often experience. As the names suggest, the former refers to the positive feelings of helping others in need, while the latter refers to a potentially pathologic psychological adaptation to the suffering we experience.

Dr. Charles Figley, director of the Tulane Traumatology Institute in New Orleans, describes compassion fatigue as “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

We all have different coping mechanisms. Some hospitalists are so focused on the art of healing the sick that they have learned to dissociate themselves from the suffering of the individuals they serve, while still delivering excellent care to each and every patient. Not everyone has reached that level.

“Striking the right work-life balance helps me,” said Dr. Marianne Cunanan-Bush, medical director of the inpatient team at Baltimore Washington Medical Center in Glen Burnie, Md. “The first part of my day is spent in personal quiet time, [so] I can just relax and let my mind go free. And my family life is vital. My husband and I play tennis with our children and do other fun things as a family and that helps keep me grounded.”

Dr. Jiayan Chen, a hospitalist at Baltimore Washington Medical Center, finds it almost impossible to completely avoid compassion fatigue. “As hospitalists, I think we can only try to minimize it,” she said. “Try to be sympathetic to patient and family but remain neutral to avoid too high compassion fatigue. Talk to colleagues a couple of times a day, give yourself a few small breaks, including lunch time, drink a cup of water, anything to help break the tension of care during the day.”

Whatever your personal style or inner make-up, be true to yourself. It’s okay to be stoic and to cry sometimes, but if you need help dealing with the trauma and stress this profession sometimes brings, don’t be ashamed to seek the counsel of friends, family members, or even professionals. Two useful resources for help in dealing with, and preventing, compassion fatigue are the Compassion Fatigue Awareness Project and ProQOL.org.

Those of you with small children will appreciate this more than others: As the words of a popular song sung by little girls from coast to coast say, “Let it go, let it go. Don’t hold it back anymore!”

Dr. Hester is a hospitalist at Baltimore Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

It was close to 2 decades ago, but it is still as clear as if it had been yesterday. I sat in the intensive care unit, fresh from my residency, tears streaming down my face, which was firmly nestled between my hands as I tried to hide my pain from every soul around me – doctors, nurses, patients’ family members – anyone and everyone.

I had just lost a very dear patient and emotions were running high. I only hoped no one at the nurses’ station would notice me, at least until I had a chance to regain my composure. After all, who would expect to see, or even respect, a doctor found sobbing like a child over a patient who died? Isn’t that all part of the job? Don’t we anticipate the death of some of our most critically ill patients?

Almost paralyzed with grief, I had a hard decision to make.

Option one: I could sit firmly planted in my seat and deal with my personal loss, the loss of my patient with chart number 0001 – yes, my very first patient in private practice. Over time, she and I had developed a very warm, loving relationship, almost like that of a mother and daughter as she was several decades my elder. I had a right to grieve my loss just as anyone else would grieve after losing someone they cared for, didn’t I?

Option two: I could bury my personal feelings and deal with them later in the comfort of my home, safe from the incessant pages from nurses calling about other patients’ urgent needs, hidden from accusing, sometimes condescending glances from other medical professionals who could never understand why I would react so strongly to the death of a patient – especially in a place surrounded by the watchful eyes of others who hold physicians to such a high standard.

Not so much to save face, but for the sake of other critically ill patients who needed a calm, clear-thinking physician to make prudent decisions regarding their care, I chose option two.

As hospitalists, our work is exciting and extremely rewarding, yet with all the suffering and death we see, we must be very careful to guard our hearts and minds, lest we fall into a state of perpetual inner turmoil and stress, and find ourselves seeking counseling or even prescription medication to cope. Compassion satisfaction and compassion fatigue are two ends of a spectrum that caregivers, including medical professionals, often experience. As the names suggest, the former refers to the positive feelings of helping others in need, while the latter refers to a potentially pathologic psychological adaptation to the suffering we experience.

Dr. Charles Figley, director of the Tulane Traumatology Institute in New Orleans, describes compassion fatigue as “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

We all have different coping mechanisms. Some hospitalists are so focused on the art of healing the sick that they have learned to dissociate themselves from the suffering of the individuals they serve, while still delivering excellent care to each and every patient. Not everyone has reached that level.

“Striking the right work-life balance helps me,” said Dr. Marianne Cunanan-Bush, medical director of the inpatient team at Baltimore Washington Medical Center in Glen Burnie, Md. “The first part of my day is spent in personal quiet time, [so] I can just relax and let my mind go free. And my family life is vital. My husband and I play tennis with our children and do other fun things as a family and that helps keep me grounded.”

Dr. Jiayan Chen, a hospitalist at Baltimore Washington Medical Center, finds it almost impossible to completely avoid compassion fatigue. “As hospitalists, I think we can only try to minimize it,” she said. “Try to be sympathetic to patient and family but remain neutral to avoid too high compassion fatigue. Talk to colleagues a couple of times a day, give yourself a few small breaks, including lunch time, drink a cup of water, anything to help break the tension of care during the day.”

Whatever your personal style or inner make-up, be true to yourself. It’s okay to be stoic and to cry sometimes, but if you need help dealing with the trauma and stress this profession sometimes brings, don’t be ashamed to seek the counsel of friends, family members, or even professionals. Two useful resources for help in dealing with, and preventing, compassion fatigue are the Compassion Fatigue Awareness Project and ProQOL.org.

Those of you with small children will appreciate this more than others: As the words of a popular song sung by little girls from coast to coast say, “Let it go, let it go. Don’t hold it back anymore!”

Dr. Hester is a hospitalist at Baltimore Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

It was close to 2 decades ago, but it is still as clear as if it had been yesterday. I sat in the intensive care unit, fresh from my residency, tears streaming down my face, which was firmly nestled between my hands as I tried to hide my pain from every soul around me – doctors, nurses, patients’ family members – anyone and everyone.

I had just lost a very dear patient and emotions were running high. I only hoped no one at the nurses’ station would notice me, at least until I had a chance to regain my composure. After all, who would expect to see, or even respect, a doctor found sobbing like a child over a patient who died? Isn’t that all part of the job? Don’t we anticipate the death of some of our most critically ill patients?

Almost paralyzed with grief, I had a hard decision to make.

Option one: I could sit firmly planted in my seat and deal with my personal loss, the loss of my patient with chart number 0001 – yes, my very first patient in private practice. Over time, she and I had developed a very warm, loving relationship, almost like that of a mother and daughter as she was several decades my elder. I had a right to grieve my loss just as anyone else would grieve after losing someone they cared for, didn’t I?

Option two: I could bury my personal feelings and deal with them later in the comfort of my home, safe from the incessant pages from nurses calling about other patients’ urgent needs, hidden from accusing, sometimes condescending glances from other medical professionals who could never understand why I would react so strongly to the death of a patient – especially in a place surrounded by the watchful eyes of others who hold physicians to such a high standard.

Not so much to save face, but for the sake of other critically ill patients who needed a calm, clear-thinking physician to make prudent decisions regarding their care, I chose option two.

As hospitalists, our work is exciting and extremely rewarding, yet with all the suffering and death we see, we must be very careful to guard our hearts and minds, lest we fall into a state of perpetual inner turmoil and stress, and find ourselves seeking counseling or even prescription medication to cope. Compassion satisfaction and compassion fatigue are two ends of a spectrum that caregivers, including medical professionals, often experience. As the names suggest, the former refers to the positive feelings of helping others in need, while the latter refers to a potentially pathologic psychological adaptation to the suffering we experience.

Dr. Charles Figley, director of the Tulane Traumatology Institute in New Orleans, describes compassion fatigue as “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

We all have different coping mechanisms. Some hospitalists are so focused on the art of healing the sick that they have learned to dissociate themselves from the suffering of the individuals they serve, while still delivering excellent care to each and every patient. Not everyone has reached that level.

“Striking the right work-life balance helps me,” said Dr. Marianne Cunanan-Bush, medical director of the inpatient team at Baltimore Washington Medical Center in Glen Burnie, Md. “The first part of my day is spent in personal quiet time, [so] I can just relax and let my mind go free. And my family life is vital. My husband and I play tennis with our children and do other fun things as a family and that helps keep me grounded.”

Dr. Jiayan Chen, a hospitalist at Baltimore Washington Medical Center, finds it almost impossible to completely avoid compassion fatigue. “As hospitalists, I think we can only try to minimize it,” she said. “Try to be sympathetic to patient and family but remain neutral to avoid too high compassion fatigue. Talk to colleagues a couple of times a day, give yourself a few small breaks, including lunch time, drink a cup of water, anything to help break the tension of care during the day.”

Whatever your personal style or inner make-up, be true to yourself. It’s okay to be stoic and to cry sometimes, but if you need help dealing with the trauma and stress this profession sometimes brings, don’t be ashamed to seek the counsel of friends, family members, or even professionals. Two useful resources for help in dealing with, and preventing, compassion fatigue are the Compassion Fatigue Awareness Project and ProQOL.org.

Those of you with small children will appreciate this more than others: As the words of a popular song sung by little girls from coast to coast say, “Let it go, let it go. Don’t hold it back anymore!”

Dr. Hester is a hospitalist at Baltimore Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

Big things come in small packages, very small – so small they may even be invisible to the naked eye. Take for instance a huge infection causing multiorgan system failure, disseminated intravascular coagulation, even septic shock refractory to high-dose pressors. This catastrophe may be the end result of exposure to tiny pathogenic microbes that can take down an otherwise healthy 300-pound man, tout suite!

Microorganisms are everywhere. We can’t live without them, but we can’t live with certain ones either. Unless you live in a bubble you are going to be exposed to countless bacteria each and every day. They are in the air we breathe, the water we drink, the beds we sleep in. While it is a given that we all will be continuously exposed to bacteria, having a well-considered strategy to curtail the spread of disease can dramatically decrease the risk that we, our families, and our patients are needlessly exposed to potentially life-threatening organisms.

We all know we are to wash our hands on the way in, and out, of patients’ rooms. This practice is our front line of defense against the spread of numerous potentially lethal diseases. Yet, many clinicians, as well as ancillary hospital personnel, repeatedly fail to abide by this rule, thinking that ‘this one time won’t hurt anything.’ Whether it’s the nurse who rushes into a patient’s room to stop a beeping IV pole or the doctor who eyes a family member in the room and makes a beeline to discuss the discharge plan, all of us have been guilty of entering or leaving a patient’s room without following appropriate infection control standards.

Or, how many times have you followed the protocol meticulously, at least initially, and removed your gown and gloves and washed your hands on your way out the door when the patient remembers another question, or asks you to hand him something that leads to more contact with him or his surroundings? You already washed your hands once, so must you really do it again? After all, what is the likelihood that you pick up (or pass along) any germs anyway? Sometimes, more than we realize. Something as simple as handing a patient his nurses’ call button can expose us to enough C. difficile spores to cause infection in us or others we come into contact with unwittingly. So wash those hands, and wash them again if you touch anything in a patient’s room, even if it is not the patient himself.

Direct observation (AKA “Secret Santas”) can provide invaluable information about adherence to hand hygiene among health care workers and providing feedback is key. This can be unit based, group based, and even provider based. Once collected, this information should be used to drive changes in behavior, which could be punitive or positive; each hospital should decide how to best use its data.

Visitor contact is another important issue and not everyone agrees on how to enforce, or whether to even try to enforce, infection control procedures. The Society for Healthcare Epidemiology of America (SHEA) has several helpful pocket guidelines to address this and other infection control issues. For instance, the society recommends that hospitals consider adopting guidelines to minimize horizontal transmission by visitors, though these guidelines should be feasible to enforce. Factors such as the specific organism and its potential to cause harm are important to consider when developing these guidelines. For instance, the spouse of a patient admitted with influenza has likely already been exposed, and postexposure prophylaxis may be more feasible to her than wearing an uncomfortable mask during an 8-hour hospital visit.

A pharmacy stewardship program is another invaluable infection control tool. With this model, a group of pharmacists, under the direction of an infectious disease specialist, reviews culture results daily and makes recommendations to the physician regarding narrowing antibiotic coverage. I greatly appreciate receiving calls to notify me that the final culture results are in long before I would have actually seen them myself. This allows me to adjust antibiotics in a timely fashion, thus reducing the emergence of drug-resistant organisms or precipitating an unnecessary case of C. difficile.

In addition, written guidelines should be established for indwelling catheters, both urinary and venous. The indication for continued use should be reassessed daily; a computer alert that requires a response is very helpful, as is a call from the friendly floor nurse asking, “Does this patient really still need his catheter?”

Infection control is everyone’s responsibility and we all need to work together toward this common goal.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

Big things come in small packages, very small – so small they may even be invisible to the naked eye. Take for instance a huge infection causing multiorgan system failure, disseminated intravascular coagulation, even septic shock refractory to high-dose pressors. This catastrophe may be the end result of exposure to tiny pathogenic microbes that can take down an otherwise healthy 300-pound man, tout suite!

Microorganisms are everywhere. We can’t live without them, but we can’t live with certain ones either. Unless you live in a bubble you are going to be exposed to countless bacteria each and every day. They are in the air we breathe, the water we drink, the beds we sleep in. While it is a given that we all will be continuously exposed to bacteria, having a well-considered strategy to curtail the spread of disease can dramatically decrease the risk that we, our families, and our patients are needlessly exposed to potentially life-threatening organisms.

We all know we are to wash our hands on the way in, and out, of patients’ rooms. This practice is our front line of defense against the spread of numerous potentially lethal diseases. Yet, many clinicians, as well as ancillary hospital personnel, repeatedly fail to abide by this rule, thinking that ‘this one time won’t hurt anything.’ Whether it’s the nurse who rushes into a patient’s room to stop a beeping IV pole or the doctor who eyes a family member in the room and makes a beeline to discuss the discharge plan, all of us have been guilty of entering or leaving a patient’s room without following appropriate infection control standards.

Or, how many times have you followed the protocol meticulously, at least initially, and removed your gown and gloves and washed your hands on your way out the door when the patient remembers another question, or asks you to hand him something that leads to more contact with him or his surroundings? You already washed your hands once, so must you really do it again? After all, what is the likelihood that you pick up (or pass along) any germs anyway? Sometimes, more than we realize. Something as simple as handing a patient his nurses’ call button can expose us to enough C. difficile spores to cause infection in us or others we come into contact with unwittingly. So wash those hands, and wash them again if you touch anything in a patient’s room, even if it is not the patient himself.

Direct observation (AKA “Secret Santas”) can provide invaluable information about adherence to hand hygiene among health care workers and providing feedback is key. This can be unit based, group based, and even provider based. Once collected, this information should be used to drive changes in behavior, which could be punitive or positive; each hospital should decide how to best use its data.

Visitor contact is another important issue and not everyone agrees on how to enforce, or whether to even try to enforce, infection control procedures. The Society for Healthcare Epidemiology of America (SHEA) has several helpful pocket guidelines to address this and other infection control issues. For instance, the society recommends that hospitals consider adopting guidelines to minimize horizontal transmission by visitors, though these guidelines should be feasible to enforce. Factors such as the specific organism and its potential to cause harm are important to consider when developing these guidelines. For instance, the spouse of a patient admitted with influenza has likely already been exposed, and postexposure prophylaxis may be more feasible to her than wearing an uncomfortable mask during an 8-hour hospital visit.

A pharmacy stewardship program is another invaluable infection control tool. With this model, a group of pharmacists, under the direction of an infectious disease specialist, reviews culture results daily and makes recommendations to the physician regarding narrowing antibiotic coverage. I greatly appreciate receiving calls to notify me that the final culture results are in long before I would have actually seen them myself. This allows me to adjust antibiotics in a timely fashion, thus reducing the emergence of drug-resistant organisms or precipitating an unnecessary case of C. difficile.

In addition, written guidelines should be established for indwelling catheters, both urinary and venous. The indication for continued use should be reassessed daily; a computer alert that requires a response is very helpful, as is a call from the friendly floor nurse asking, “Does this patient really still need his catheter?”

Infection control is everyone’s responsibility and we all need to work together toward this common goal.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

Big things come in small packages, very small – so small they may even be invisible to the naked eye. Take for instance a huge infection causing multiorgan system failure, disseminated intravascular coagulation, even septic shock refractory to high-dose pressors. This catastrophe may be the end result of exposure to tiny pathogenic microbes that can take down an otherwise healthy 300-pound man, tout suite!

Microorganisms are everywhere. We can’t live without them, but we can’t live with certain ones either. Unless you live in a bubble you are going to be exposed to countless bacteria each and every day. They are in the air we breathe, the water we drink, the beds we sleep in. While it is a given that we all will be continuously exposed to bacteria, having a well-considered strategy to curtail the spread of disease can dramatically decrease the risk that we, our families, and our patients are needlessly exposed to potentially life-threatening organisms.

We all know we are to wash our hands on the way in, and out, of patients’ rooms. This practice is our front line of defense against the spread of numerous potentially lethal diseases. Yet, many clinicians, as well as ancillary hospital personnel, repeatedly fail to abide by this rule, thinking that ‘this one time won’t hurt anything.’ Whether it’s the nurse who rushes into a patient’s room to stop a beeping IV pole or the doctor who eyes a family member in the room and makes a beeline to discuss the discharge plan, all of us have been guilty of entering or leaving a patient’s room without following appropriate infection control standards.

Or, how many times have you followed the protocol meticulously, at least initially, and removed your gown and gloves and washed your hands on your way out the door when the patient remembers another question, or asks you to hand him something that leads to more contact with him or his surroundings? You already washed your hands once, so must you really do it again? After all, what is the likelihood that you pick up (or pass along) any germs anyway? Sometimes, more than we realize. Something as simple as handing a patient his nurses’ call button can expose us to enough C. difficile spores to cause infection in us or others we come into contact with unwittingly. So wash those hands, and wash them again if you touch anything in a patient’s room, even if it is not the patient himself.

Direct observation (AKA “Secret Santas”) can provide invaluable information about adherence to hand hygiene among health care workers and providing feedback is key. This can be unit based, group based, and even provider based. Once collected, this information should be used to drive changes in behavior, which could be punitive or positive; each hospital should decide how to best use its data.

Visitor contact is another important issue and not everyone agrees on how to enforce, or whether to even try to enforce, infection control procedures. The Society for Healthcare Epidemiology of America (SHEA) has several helpful pocket guidelines to address this and other infection control issues. For instance, the society recommends that hospitals consider adopting guidelines to minimize horizontal transmission by visitors, though these guidelines should be feasible to enforce. Factors such as the specific organism and its potential to cause harm are important to consider when developing these guidelines. For instance, the spouse of a patient admitted with influenza has likely already been exposed, and postexposure prophylaxis may be more feasible to her than wearing an uncomfortable mask during an 8-hour hospital visit.

A pharmacy stewardship program is another invaluable infection control tool. With this model, a group of pharmacists, under the direction of an infectious disease specialist, reviews culture results daily and makes recommendations to the physician regarding narrowing antibiotic coverage. I greatly appreciate receiving calls to notify me that the final culture results are in long before I would have actually seen them myself. This allows me to adjust antibiotics in a timely fashion, thus reducing the emergence of drug-resistant organisms or precipitating an unnecessary case of C. difficile.

In addition, written guidelines should be established for indwelling catheters, both urinary and venous. The indication for continued use should be reassessed daily; a computer alert that requires a response is very helpful, as is a call from the friendly floor nurse asking, “Does this patient really still need his catheter?”

Infection control is everyone’s responsibility and we all need to work together toward this common goal.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

I recently attended a CME conference at Johns Hopkins University titled “Infectious Diseases Update for Primary Care and Hospital Medicine.” As one would assume, some things were highly germane to my practice as a hospitalist, while others were, well, not relevant at all.

Don’t get me wrong, the conference was excellent and very thought provoking. It not only taught me clinically useful information, it challenged me to do more than I am used to doing for my patients; thus, I pass this challenge along to you.

One expert presented a case of an otherwise healthy patient who was found to have mildly elevated liver function tests on routine lab work done for life insurance purposes. His ALT and AST were 73 and 36, respectively, numbers that many of us would simply defer to the primary care provider to follow. But what if there is no primary care doctor? What if we are all they have?

Upon further evaluation, this patient was found to have hepatitis C. A more detailed history revealed that he had injected drugs with friends a few times over 20 years ago. The conference presenter shared statistics showing there are 2.7 million to 5 million people living with chronic HCV in America, and an estimated 45% to 60% of them are unaware of their disease – a disease that responds so well to treatment that simply screening baby boomers has the potential to prevent over 120,000 HCV-related deaths! It’s mind boggling to imagine how many people of all ages will die from this disease alone, completely oblivious to its existence.

Many people have obtained health insurance as a direct result of the Affordable Care Act, yet there are still many Americans who remain uninsured. When they are hospitalized for an acute illness, it may be the only encounter they have had with a medical professional in years. So, I ask the question again: What if we are all they have?

We can design all the elaborate hand-offs, discharge summaries, and patient instruction forms we want, but what if patients are unable to actually act on our “easy-to-understand” recommendations? Many of our patients will, out of embarrassment, nod their heads in agreement when we stress the extreme importance of following up with a primary care doctor and getting their prescriptions filled, knowing all the while that they simply don’t have the means to do so. I don’t think I will ever forget how out of touch I felt after giving a patient my spiel about taking his medication as prescribed to decrease his risk of a heart attack. He looked straight into my eyes and frankly, yet ever so respectively said, “Dr. Hester, I can either buy my medicine or I can eat.”

Sometimes it’s just that simple.

We all feel the urgency to provide high-quality care while keeping that care cost effective and time efficient, but hospitalists have a unique opportunity to not only serve our patients’ acute needs when they present via EMS to the ED, but to protect them from unforeseen catastrophes in the future. An extra (needed) test here and there, a little more time spent counseling on lifestyle changes, a few more minutes spent trying to help coordinate affordable (or free) follow-up care can all pay big dividends, and you may never have to see those patients in the hospital again. Isn’t that the goal?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

When I think of the word “relationship,” I imagine gazing into the loving eyes of my husband, playing hide and seek with my children, or texting my best friend for no good reason other than to just say hello.

There is a special comfort zone we expect from people who are close to us; a feeling of love and acceptance that we can’t find elsewhere.

But in a much broader sense, our important relationships extend far beyond our inner circle to include every single person who is involved with our health care team. Our team includes the hospital executives who create new safety initiatives, develop budgets, and oversee a host of other patient care and fiscal functions. The physical therapists who evaluate our patients and make recommendations on how to safely transition them out of the hospital are on our team. The housekeepers who scrub the toilets and wash the linens to prevent nosocomial infections are on our team. They, along with many others, play a pivotal role in our patients’ care, although many important players make their impact behind the scenes.

Yet, of course, our most important professional relationships are not with the CEO, the pharmacist, or even the nursing staff. Our most important relationships are with our patients and their families. I recently attended an all-day conference on a little-known gem called Relationship-Based Care (RBC), a culture transformation and operational model that is gaining steam globally. The RBC model focuses not only on well-known metrics, such as patient safety, quality care, and patient satisfaction; it also emphasizes staff satisfaction by improving each and every relationship. Specifically, it creates therapeutic relationships between caregivers and the patients and families they serve, strengthens relationships between members of the health care team, and last, but certainly not least, it nurtures each caregiver’s relationship with himself or herself. What a novel, and much needed concept!

Numerous hospitals that have implemented this training model have achieved impressive outcomes, including significant improvement in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, and staff satisfaction survey scores so high that one hospital gained national recognition as one of the best places to work in America.

I look forward to future training on RBC and am glad to see that addressing the needs of caregivers, not just care receivers, is starting to take center stage, as it rightfully should. After all, how can we give our all to our patients when we are not whole?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

When I think of the word “relationship,” I imagine gazing into the loving eyes of my husband, playing hide and seek with my children, or texting my best friend for no good reason other than to just say hello.

There is a special comfort zone we expect from people who are close to us; a feeling of love and acceptance that we can’t find elsewhere.

But in a much broader sense, our important relationships extend far beyond our inner circle to include every single person who is involved with our health care team. Our team includes the hospital executives who create new safety initiatives, develop budgets, and oversee a host of other patient care and fiscal functions. The physical therapists who evaluate our patients and make recommendations on how to safely transition them out of the hospital are on our team. The housekeepers who scrub the toilets and wash the linens to prevent nosocomial infections are on our team. They, along with many others, play a pivotal role in our patients’ care, although many important players make their impact behind the scenes.

Yet, of course, our most important professional relationships are not with the CEO, the pharmacist, or even the nursing staff. Our most important relationships are with our patients and their families. I recently attended an all-day conference on a little-known gem called Relationship-Based Care (RBC), a culture transformation and operational model that is gaining steam globally. The RBC model focuses not only on well-known metrics, such as patient safety, quality care, and patient satisfaction; it also emphasizes staff satisfaction by improving each and every relationship. Specifically, it creates therapeutic relationships between caregivers and the patients and families they serve, strengthens relationships between members of the health care team, and last, but certainly not least, it nurtures each caregiver’s relationship with himself or herself. What a novel, and much needed concept!

Numerous hospitals that have implemented this training model have achieved impressive outcomes, including significant improvement in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, and staff satisfaction survey scores so high that one hospital gained national recognition as one of the best places to work in America.

I look forward to future training on RBC and am glad to see that addressing the needs of caregivers, not just care receivers, is starting to take center stage, as it rightfully should. After all, how can we give our all to our patients when we are not whole?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

When I think of the word “relationship,” I imagine gazing into the loving eyes of my husband, playing hide and seek with my children, or texting my best friend for no good reason other than to just say hello.

There is a special comfort zone we expect from people who are close to us; a feeling of love and acceptance that we can’t find elsewhere.

But in a much broader sense, our important relationships extend far beyond our inner circle to include every single person who is involved with our health care team. Our team includes the hospital executives who create new safety initiatives, develop budgets, and oversee a host of other patient care and fiscal functions. The physical therapists who evaluate our patients and make recommendations on how to safely transition them out of the hospital are on our team. The housekeepers who scrub the toilets and wash the linens to prevent nosocomial infections are on our team. They, along with many others, play a pivotal role in our patients’ care, although many important players make their impact behind the scenes.

Yet, of course, our most important professional relationships are not with the CEO, the pharmacist, or even the nursing staff. Our most important relationships are with our patients and their families. I recently attended an all-day conference on a little-known gem called Relationship-Based Care (RBC), a culture transformation and operational model that is gaining steam globally. The RBC model focuses not only on well-known metrics, such as patient safety, quality care, and patient satisfaction; it also emphasizes staff satisfaction by improving each and every relationship. Specifically, it creates therapeutic relationships between caregivers and the patients and families they serve, strengthens relationships between members of the health care team, and last, but certainly not least, it nurtures each caregiver’s relationship with himself or herself. What a novel, and much needed concept!

Numerous hospitals that have implemented this training model have achieved impressive outcomes, including significant improvement in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, and staff satisfaction survey scores so high that one hospital gained national recognition as one of the best places to work in America.

I look forward to future training on RBC and am glad to see that addressing the needs of caregivers, not just care receivers, is starting to take center stage, as it rightfully should. After all, how can we give our all to our patients when we are not whole?

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Teach residents…really? You want to add yet another time-consuming responsibility to my already hectic schedule?” Residency. The mere mention of the word conjures up chilling memories of 3 am codes, 20-30 hour zombie shifts, and anxiety and stress levels that we never knew before and, fortunately, have not known since. That was a time in life many of us want to put in the deepest recesses of our minds, never to emerge again.

But, on the other hand, there were a lot of good things about our residency training that we should probably never forget, such as the humility with which we approached patient care. At that time in our lives we gladly acknowledged we did not know everything and we were eager to research each and every condition to get a firm handle on what we could and should do to help our patients get better.

Fast forward a decade or two. Now many of us have spouses, children, aging parents, mortgages, and retirement accounts we are feverishly trying to fund. There never seems to be enough time to finish even the most fundamental responsibilities. Not to mention now there are national initiatives, mandatory rules, and sometimes frightening regulations in place that dramatically impact how we practice medicine and sometimes make us feel more like automatons than the physicians we dreamed of becoming when we first applied to medical school years ago.

With all of our current and future responsibilities, how can the average hospitalist embrace young physicians and pour himself into their lives? Or, perhaps the question is better asked, how can we not? None of us morphed from a green medical school graduate to a knowledgeable, well-respected physician without a great deal of hand holding (and sometimes hand wringing), encouragement and investment of time from our teaching attendings. But even if you are hesitant to invest the time and energy to teach resident physicians should you have the opportunity. Keep in mind, in 2015 we are not only teaching them, they are teaching us too!

Young physicians are overflowing with technological knowledge that many of us have never been exposed to, knowledge that can help escalate our own skill sets. They bring fresh ideas, novel approaches to patient care, and frequently, cutting edge medical innovations from the universities from which come.

So, if you are ever asked to teach our future colleagues, remember: you may very well find that the time you invest benefits you as much, if not more, than it does them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Teach residents…really? You want to add yet another time-consuming responsibility to my already hectic schedule?” Residency. The mere mention of the word conjures up chilling memories of 3 am codes, 20-30 hour zombie shifts, and anxiety and stress levels that we never knew before and, fortunately, have not known since. That was a time in life many of us want to put in the deepest recesses of our minds, never to emerge again.

But, on the other hand, there were a lot of good things about our residency training that we should probably never forget, such as the humility with which we approached patient care. At that time in our lives we gladly acknowledged we did not know everything and we were eager to research each and every condition to get a firm handle on what we could and should do to help our patients get better.

Fast forward a decade or two. Now many of us have spouses, children, aging parents, mortgages, and retirement accounts we are feverishly trying to fund. There never seems to be enough time to finish even the most fundamental responsibilities. Not to mention now there are national initiatives, mandatory rules, and sometimes frightening regulations in place that dramatically impact how we practice medicine and sometimes make us feel more like automatons than the physicians we dreamed of becoming when we first applied to medical school years ago.

With all of our current and future responsibilities, how can the average hospitalist embrace young physicians and pour himself into their lives? Or, perhaps the question is better asked, how can we not? None of us morphed from a green medical school graduate to a knowledgeable, well-respected physician without a great deal of hand holding (and sometimes hand wringing), encouragement and investment of time from our teaching attendings. But even if you are hesitant to invest the time and energy to teach resident physicians should you have the opportunity. Keep in mind, in 2015 we are not only teaching them, they are teaching us too!

Young physicians are overflowing with technological knowledge that many of us have never been exposed to, knowledge that can help escalate our own skill sets. They bring fresh ideas, novel approaches to patient care, and frequently, cutting edge medical innovations from the universities from which come.

So, if you are ever asked to teach our future colleagues, remember: you may very well find that the time you invest benefits you as much, if not more, than it does them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Teach residents…really? You want to add yet another time-consuming responsibility to my already hectic schedule?” Residency. The mere mention of the word conjures up chilling memories of 3 am codes, 20-30 hour zombie shifts, and anxiety and stress levels that we never knew before and, fortunately, have not known since. That was a time in life many of us want to put in the deepest recesses of our minds, never to emerge again.

But, on the other hand, there were a lot of good things about our residency training that we should probably never forget, such as the humility with which we approached patient care. At that time in our lives we gladly acknowledged we did not know everything and we were eager to research each and every condition to get a firm handle on what we could and should do to help our patients get better.

Fast forward a decade or two. Now many of us have spouses, children, aging parents, mortgages, and retirement accounts we are feverishly trying to fund. There never seems to be enough time to finish even the most fundamental responsibilities. Not to mention now there are national initiatives, mandatory rules, and sometimes frightening regulations in place that dramatically impact how we practice medicine and sometimes make us feel more like automatons than the physicians we dreamed of becoming when we first applied to medical school years ago.

With all of our current and future responsibilities, how can the average hospitalist embrace young physicians and pour himself into their lives? Or, perhaps the question is better asked, how can we not? None of us morphed from a green medical school graduate to a knowledgeable, well-respected physician without a great deal of hand holding (and sometimes hand wringing), encouragement and investment of time from our teaching attendings. But even if you are hesitant to invest the time and energy to teach resident physicians should you have the opportunity. Keep in mind, in 2015 we are not only teaching them, they are teaching us too!

Young physicians are overflowing with technological knowledge that many of us have never been exposed to, knowledge that can help escalate our own skill sets. They bring fresh ideas, novel approaches to patient care, and frequently, cutting edge medical innovations from the universities from which come.

So, if you are ever asked to teach our future colleagues, remember: you may very well find that the time you invest benefits you as much, if not more, than it does them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

There is an old saying, “Sticks and stones may break my bones, but words will never hurt me.” When it comes to our patients’ impressions of us, nothing could be farther from the truth. As a matter of fact, their words, expressed in post-discharge patient satisfaction surveys, can play a tremendous role in the financial stability of our hospitals.

Throughout the years, hospitals have employed a wide variety of methods to evaluate their patients’ experiences, if only to improve their service and strengthen their brand. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative has taken patient satisfaction to a new level by creating the first national, standardized survey tool to measure patients’ perspectives of the care they received while hospitalized. In addition, HCAHPS was designed to provide objective, meaningful comparisons of hospitals, and these comparisons are publicly reported, which increases transparency of the quality of care provided to hospitalized patients.

The survey is administered between 48 hours and 6 weeks post discharge to a random sample of adult patients by mail, telephone, mail and telephone, or Interactive Voice Response (IVR). Discharged patients are asked 27 questions about their recent hospitalization including communication with doctors and nurses, pain management, discharge information, communication about medication, overall hospital rating, and whether they would recommend the hospital to others.

Four times per year, the Centers for Medicaid & Medicare Services publishes HCAHPS scores of participating hospitals on the Hospital Compare website (www.hospitalcompare.hhs.gov), though the survey is not restricted to Medicare patients. Patients can pick and choose which hospitals they like, and which ones they would avoid like the plague.

Of course, it’s not realistic to think that we are going to please all of our patients all of the time, but this initiative does have the potential to create a new sense of accountability, as well as competitiveness for hospital systems and providers alike. No one wants to be at the bottom of the pack.

So, how do we increase our scores? Many models and companies claim to help improve patient satisfaction. Just do an Internet search. Keep in mind, what works well for one group may be ineffective for another.

For instance, 5-minute per patient multidisciplinary bedside rounding – including the provider, nurse, pharmacist, and case manager – may be easy to implement and skyrocket patient satisfaction in some institutions. In others, getting appropriate staffing may be prohibitive. Regardless of the approach that may be right for your group, it is important to keep in mind that the tide of health care is ever changing. Patients are demanding, and receiving, a bigger role in their health care. We all want to be in the forefront, not at the tail end, of that tide.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

There is an old saying, “Sticks and stones may break my bones, but words will never hurt me.” When it comes to our patients’ impressions of us, nothing could be farther from the truth. As a matter of fact, their words, expressed in post-discharge patient satisfaction surveys, can play a tremendous role in the financial stability of our hospitals.

Throughout the years, hospitals have employed a wide variety of methods to evaluate their patients’ experiences, if only to improve their service and strengthen their brand. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative has taken patient satisfaction to a new level by creating the first national, standardized survey tool to measure patients’ perspectives of the care they received while hospitalized. In addition, HCAHPS was designed to provide objective, meaningful comparisons of hospitals, and these comparisons are publicly reported, which increases transparency of the quality of care provided to hospitalized patients.

The survey is administered between 48 hours and 6 weeks post discharge to a random sample of adult patients by mail, telephone, mail and telephone, or Interactive Voice Response (IVR). Discharged patients are asked 27 questions about their recent hospitalization including communication with doctors and nurses, pain management, discharge information, communication about medication, overall hospital rating, and whether they would recommend the hospital to others.

Four times per year, the Centers for Medicaid & Medicare Services publishes HCAHPS scores of participating hospitals on the Hospital Compare website (www.hospitalcompare.hhs.gov), though the survey is not restricted to Medicare patients. Patients can pick and choose which hospitals they like, and which ones they would avoid like the plague.

Of course, it’s not realistic to think that we are going to please all of our patients all of the time, but this initiative does have the potential to create a new sense of accountability, as well as competitiveness for hospital systems and providers alike. No one wants to be at the bottom of the pack.

So, how do we increase our scores? Many models and companies claim to help improve patient satisfaction. Just do an Internet search. Keep in mind, what works well for one group may be ineffective for another.

For instance, 5-minute per patient multidisciplinary bedside rounding – including the provider, nurse, pharmacist, and case manager – may be easy to implement and skyrocket patient satisfaction in some institutions. In others, getting appropriate staffing may be prohibitive. Regardless of the approach that may be right for your group, it is important to keep in mind that the tide of health care is ever changing. Patients are demanding, and receiving, a bigger role in their health care. We all want to be in the forefront, not at the tail end, of that tide.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

There is an old saying, “Sticks and stones may break my bones, but words will never hurt me.” When it comes to our patients’ impressions of us, nothing could be farther from the truth. As a matter of fact, their words, expressed in post-discharge patient satisfaction surveys, can play a tremendous role in the financial stability of our hospitals.

Throughout the years, hospitals have employed a wide variety of methods to evaluate their patients’ experiences, if only to improve their service and strengthen their brand. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative has taken patient satisfaction to a new level by creating the first national, standardized survey tool to measure patients’ perspectives of the care they received while hospitalized. In addition, HCAHPS was designed to provide objective, meaningful comparisons of hospitals, and these comparisons are publicly reported, which increases transparency of the quality of care provided to hospitalized patients.

The survey is administered between 48 hours and 6 weeks post discharge to a random sample of adult patients by mail, telephone, mail and telephone, or Interactive Voice Response (IVR). Discharged patients are asked 27 questions about their recent hospitalization including communication with doctors and nurses, pain management, discharge information, communication about medication, overall hospital rating, and whether they would recommend the hospital to others.

Four times per year, the Centers for Medicaid & Medicare Services publishes HCAHPS scores of participating hospitals on the Hospital Compare website (www.hospitalcompare.hhs.gov), though the survey is not restricted to Medicare patients. Patients can pick and choose which hospitals they like, and which ones they would avoid like the plague.

Of course, it’s not realistic to think that we are going to please all of our patients all of the time, but this initiative does have the potential to create a new sense of accountability, as well as competitiveness for hospital systems and providers alike. No one wants to be at the bottom of the pack.

So, how do we increase our scores? Many models and companies claim to help improve patient satisfaction. Just do an Internet search. Keep in mind, what works well for one group may be ineffective for another.

For instance, 5-minute per patient multidisciplinary bedside rounding – including the provider, nurse, pharmacist, and case manager – may be easy to implement and skyrocket patient satisfaction in some institutions. In others, getting appropriate staffing may be prohibitive. Regardless of the approach that may be right for your group, it is important to keep in mind that the tide of health care is ever changing. Patients are demanding, and receiving, a bigger role in their health care. We all want to be in the forefront, not at the tail end, of that tide.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Decrease readmissions, and decrease them stat!” This mantra, or some, perhaps more subtle version thereof, is echoed over and over at hospitals across the country, and for good reason. Not only do readmissions have the potential to cost hospital systems millions of dollars through Medicare payment reductions, they also signal a more important, though less vocalized concern. If our patients keep returning to the hospital, are we really providing them with 100% of the resources they need?

On the surface, it may seem like there is little we can do for that two-pack-per-day smoker with end-stage chronic obstructive pulmonary disease who keeps getting readmitted with an exacerbation. And, while in reality, we may never get him to stop smoking and start taking his mediations as prescribed, perhaps we can help decrease the frequency of readmissions from three to four per year to two to three. While seemingly small, this decrease is actually quite dramatic, correlating to a 25%-50% reduction in the use of hospital services, not to mention the profound impact that fewer days spent in the hospital will have on his quality of life.

It is remarkable how much change occurs in the health care system over time. One year a drug may be touted as a huge breakthrough in treatment, and the next it may be taken off the market because of previously unrecognized, potentially fatal side effects. And just as the field of medicine is ever changing, so are all the fields that support it.

For example, the Agency for Healthcare Research and Qualify (AHRQ) has developed the Re-Engineered Discharge (RED) tool kit, which has been highly successful in reducing hospital readmissions. Originally developed by a group of AHRQ-funded researchers in Boston, RED provides evidence-based tools that help hospitals re-engineer their discharge process. One success story – within 3 months of implementing RED, the Valley Baptist Medical Center in Harlingen, Tex., decreased readmissions from 26% to 15%.

The RED model focuses on comprehensive discharge planning, educating patients about their discharge, and postdischarge follow-up care. It uses dedicated discharge advocates to help patients reconcile their medications and schedule much-needed follow-up appointments.

Other models exist as well. For instance, some hospitals have a palliative care team that focuses not only on keeping patients comfortable while in the hospital, but also on helping them access community services after discharge and make necessary appointments, geared at optimizing their health and ultimately decreasing the need for excessive hospitalizations.

As every health care dollar spent will be scrutinized more and more over time, innovative programs to help us rethink our long-established routines will likely play a major role in catapulting us from where we are to where we want to be.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Decrease readmissions, and decrease them stat!” This mantra, or some, perhaps more subtle version thereof, is echoed over and over at hospitals across the country, and for good reason. Not only do readmissions have the potential to cost hospital systems millions of dollars through Medicare payment reductions, they also signal a more important, though less vocalized concern. If our patients keep returning to the hospital, are we really providing them with 100% of the resources they need?

On the surface, it may seem like there is little we can do for that two-pack-per-day smoker with end-stage chronic obstructive pulmonary disease who keeps getting readmitted with an exacerbation. And, while in reality, we may never get him to stop smoking and start taking his mediations as prescribed, perhaps we can help decrease the frequency of readmissions from three to four per year to two to three. While seemingly small, this decrease is actually quite dramatic, correlating to a 25%-50% reduction in the use of hospital services, not to mention the profound impact that fewer days spent in the hospital will have on his quality of life.

It is remarkable how much change occurs in the health care system over time. One year a drug may be touted as a huge breakthrough in treatment, and the next it may be taken off the market because of previously unrecognized, potentially fatal side effects. And just as the field of medicine is ever changing, so are all the fields that support it.

For example, the Agency for Healthcare Research and Qualify (AHRQ) has developed the Re-Engineered Discharge (RED) tool kit, which has been highly successful in reducing hospital readmissions. Originally developed by a group of AHRQ-funded researchers in Boston, RED provides evidence-based tools that help hospitals re-engineer their discharge process. One success story – within 3 months of implementing RED, the Valley Baptist Medical Center in Harlingen, Tex., decreased readmissions from 26% to 15%.

The RED model focuses on comprehensive discharge planning, educating patients about their discharge, and postdischarge follow-up care. It uses dedicated discharge advocates to help patients reconcile their medications and schedule much-needed follow-up appointments.

Other models exist as well. For instance, some hospitals have a palliative care team that focuses not only on keeping patients comfortable while in the hospital, but also on helping them access community services after discharge and make necessary appointments, geared at optimizing their health and ultimately decreasing the need for excessive hospitalizations.

As every health care dollar spent will be scrutinized more and more over time, innovative programs to help us rethink our long-established routines will likely play a major role in catapulting us from where we are to where we want to be.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

“Decrease readmissions, and decrease them stat!” This mantra, or some, perhaps more subtle version thereof, is echoed over and over at hospitals across the country, and for good reason. Not only do readmissions have the potential to cost hospital systems millions of dollars through Medicare payment reductions, they also signal a more important, though less vocalized concern. If our patients keep returning to the hospital, are we really providing them with 100% of the resources they need?

On the surface, it may seem like there is little we can do for that two-pack-per-day smoker with end-stage chronic obstructive pulmonary disease who keeps getting readmitted with an exacerbation. And, while in reality, we may never get him to stop smoking and start taking his mediations as prescribed, perhaps we can help decrease the frequency of readmissions from three to four per year to two to three. While seemingly small, this decrease is actually quite dramatic, correlating to a 25%-50% reduction in the use of hospital services, not to mention the profound impact that fewer days spent in the hospital will have on his quality of life.

It is remarkable how much change occurs in the health care system over time. One year a drug may be touted as a huge breakthrough in treatment, and the next it may be taken off the market because of previously unrecognized, potentially fatal side effects. And just as the field of medicine is ever changing, so are all the fields that support it.

For example, the Agency for Healthcare Research and Qualify (AHRQ) has developed the Re-Engineered Discharge (RED) tool kit, which has been highly successful in reducing hospital readmissions. Originally developed by a group of AHRQ-funded researchers in Boston, RED provides evidence-based tools that help hospitals re-engineer their discharge process. One success story – within 3 months of implementing RED, the Valley Baptist Medical Center in Harlingen, Tex., decreased readmissions from 26% to 15%.

The RED model focuses on comprehensive discharge planning, educating patients about their discharge, and postdischarge follow-up care. It uses dedicated discharge advocates to help patients reconcile their medications and schedule much-needed follow-up appointments.

Other models exist as well. For instance, some hospitals have a palliative care team that focuses not only on keeping patients comfortable while in the hospital, but also on helping them access community services after discharge and make necessary appointments, geared at optimizing their health and ultimately decreasing the need for excessive hospitalizations.

As every health care dollar spent will be scrutinized more and more over time, innovative programs to help us rethink our long-established routines will likely play a major role in catapulting us from where we are to where we want to be.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at healthsavvy@aol.com.

How often have nonphysicians told you that they could never work the hours you do?

Most people think physicians are a unique breed, and in some respects, we are. But in important ways we are just like everyone else. When we work long hours under stressful conditions and go without adequate sleep or nourishment, we cannot function at peak performance. Just like everyone else, we can become irritable, grumpy, and cynical when our basic needs are not met. We are human too, and we are at higher risk than most people for burnout, depression, and even suicide.

An article in the Journal of Hospital Medicine in 2014 noted that slightly over 50% of hospitalists were affected by burnout. We scored high on the emotional exhaustion subscale, and 40.3% of us had symptoms of depression, with a surprising 9.2% rate of recent suicidality. Hospital medicine definitely has its advantages over many other fields of medicine, but as this study demonstrates, there is still much to be desired in our “work-life balance.”

Each practice has its own perks and negatives, and what will enhance the lives of hospitalists in one group may make intolerable the lives of members of another group. For instance, it is no surprise that 12-hour shifts with 7-on, 7-off block scheduling can be exhausting. If you have a family, this schedule leaves plenty of fun time on the weeks you are off, but you may still be missing 50% of your family’s life if you leave for work before your kids wake up and return after they go to bed.

Whatever your concerns and stressors may be, rest assured, you are not alone, and if enough of the members of your group have similar issues, you may be successful addressing them with your director or hospital administrator. Retaining good hospitalists is vital to the financial success of many hospitals, and being flexible enough to truly meet their reasonable needs can literally make or break a hospitalist team.

How often have nonphysicians told you that they could never work the hours you do?

Most people think physicians are a unique breed, and in some respects, we are. But in important ways we are just like everyone else. When we work long hours under stressful conditions and go without adequate sleep or nourishment, we cannot function at peak performance. Just like everyone else, we can become irritable, grumpy, and cynical when our basic needs are not met. We are human too, and we are at higher risk than most people for burnout, depression, and even suicide.

An article in the Journal of Hospital Medicine in 2014 noted that slightly over 50% of hospitalists were affected by burnout. We scored high on the emotional exhaustion subscale, and 40.3% of us had symptoms of depression, with a surprising 9.2% rate of recent suicidality. Hospital medicine definitely has its advantages over many other fields of medicine, but as this study demonstrates, there is still much to be desired in our “work-life balance.”

Each practice has its own perks and negatives, and what will enhance the lives of hospitalists in one group may make intolerable the lives of members of another group. For instance, it is no surprise that 12-hour shifts with 7-on, 7-off block scheduling can be exhausting. If you have a family, this schedule leaves plenty of fun time on the weeks you are off, but you may still be missing 50% of your family’s life if you leave for work before your kids wake up and return after they go to bed.

Whatever your concerns and stressors may be, rest assured, you are not alone, and if enough of the members of your group have similar issues, you may be successful addressing them with your director or hospital administrator. Retaining good hospitalists is vital to the financial success of many hospitals, and being flexible enough to truly meet their reasonable needs can literally make or break a hospitalist team.

How often have nonphysicians told you that they could never work the hours you do?

Most people think physicians are a unique breed, and in some respects, we are. But in important ways we are just like everyone else. When we work long hours under stressful conditions and go without adequate sleep or nourishment, we cannot function at peak performance. Just like everyone else, we can become irritable, grumpy, and cynical when our basic needs are not met. We are human too, and we are at higher risk than most people for burnout, depression, and even suicide.

An article in the Journal of Hospital Medicine in 2014 noted that slightly over 50% of hospitalists were affected by burnout. We scored high on the emotional exhaustion subscale, and 40.3% of us had symptoms of depression, with a surprising 9.2% rate of recent suicidality. Hospital medicine definitely has its advantages over many other fields of medicine, but as this study demonstrates, there is still much to be desired in our “work-life balance.”

Each practice has its own perks and negatives, and what will enhance the lives of hospitalists in one group may make intolerable the lives of members of another group. For instance, it is no surprise that 12-hour shifts with 7-on, 7-off block scheduling can be exhausting. If you have a family, this schedule leaves plenty of fun time on the weeks you are off, but you may still be missing 50% of your family’s life if you leave for work before your kids wake up and return after they go to bed.

Whatever your concerns and stressors may be, rest assured, you are not alone, and if enough of the members of your group have similar issues, you may be successful addressing them with your director or hospital administrator. Retaining good hospitalists is vital to the financial success of many hospitals, and being flexible enough to truly meet their reasonable needs can literally make or break a hospitalist team.