Archive for August 2017

We Have a Voice. It’s Time We Use It. #DoctorsSpeakOut

Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a trainwreck in progress. You may have thought about saying something, but paused and wondered, “Is this professional? What will this say about me as a doctor? What would my colleagues/supervisors think? What would my patients think?” You are not alone. I get stopped, emailed, and messaged frequently by others wondering if they should enter the fray. Something interesting happened with the recent Repeal and Replace or Repeal and Delay or Repeal and whatever roller coaster: Doctors did speak up! One group that was truly impressive was the pediatricians on Twitter, known as “tweetiatricians” who all recorded short…

Hospital Medicine Moves, JHM Research & Choosing Wisely Make HM News

­SHM & Hospital Medicine in the News: August 3 – August 17, 2017 Check out the latest hospital medicine and SHM-related stories in mainstream and healthcare news. For the full stories, click on the links below: Patrick Conway, MD, MSc, MHM announced that he will be leaving his position as chief medical officer at CMS to join Blue Cross Blue Shield North Carolina as President and CEO. Vineet Arora, MD, MPP, MHM was quoted in Becker’s Hospital Review providing insight on why female physicians may be less engaged with their work. Journal of Hospital Medicine research on breakdowns in care was highlighted in an article on The Clinical Advisor. Another Journal of Hospital Medicine article on communication methods in the hospital was cited in an article on HealthIT Security. SHM’s efforts in the Choosing Wisely campaign with the ABIM were cited in a recent article on Medscape. SHM Senior Marketing…

Is It Time for Health Policy M&Ms?

[caption id="attachment_16917" align="alignnone" width="609"] https://twitter.com/ChrisMoriates/status/890259986873450508[/caption] There are few experiences in my medical training that felt more intimidating, and ultimately more impactful, than our Mortality and Morbidity (M&M) conferences. The patients whose diagnoses I missed. The times I should have called my attending or pushed harder for the cardiologist to come in overnight. They stick with me and I believe ultimately have helped make me a better doctor. This is why I was intrigued by the idea of explicitly incorporating health policy issues into M&M. Over the past few years, I increasingly have seen adverse events that result from issues related to health policy. Inability to access care for appropriate hospital follow-up. Failure to fill a critical prescription due to cost or gaps in coverage. A patient I admitted for “expedited work-up” for rectal bleeding after he told me he had been trying to get a recommended colonoscopy for many months…

Why 7 On/7 Off Doesn’t Meet the Needs of Long-Stay Hospital Patients

by Lauren Doctoroff, MD
By: Lauren Doctoroff, MD Much has been written about the loss of the perspective of the primary care doctor for hospitalized patients and the impact on their hospitalization. However, few have reflected on the challenges posed by the 7 on/7 off hospitalist schedule for complicated long-stay patients. I have been a hospitalist for more than 10 years, and, for the past 3, I have been responsible for a complex patient strategy for my hospital. Having looked at the charts of hundreds of patients with long and complicated hospital stays, it is clear that there is an incompatibility between the on again/off again hospitalist schedule and the needs of these patients. With frequently changing providers, patients suffer not only from their own medical fluctuations, but also the changing plans of their providers. These are not the patients awaiting guardianship or insurance to allow for an adequate discharge plan. These are the…
Dr. Lauren Doctoroff is a hospitalist at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. She completed medical school at the University of California at San Francisco in 2003, and a primary care internal medicine internship and residency at Massachusetts General Hospital in 2006. Her clinical responsibilities include hospitalist work on a teaching and a non-teaching service at the BIDMC. In addition, she was the founding medical director of the Healthcare Associates Post Discharge Clinic, a hospitalist-staffed, primary care-based post hospitalization clinic from 2009-2015. She also serves as the medical director of the PACT Transitional Care Program. As of 2015, she serves as the Medical Director for Utilization Management for the BIDMC, and chairs the Utilization Review Committee, and leads multiple initiatives on hospital utilization. She is a fellow of the Society of Hospital Medicine and serves on the SHM Public Policy Committee. She is an Assistant Professor at Harvard Medical School. Her academic interests include transitions in care and post discharge care, as well as hospital utilization particularly among patients with prolonged stays. She has published on post discharge care and outlier patients and has spoken locally and nationally on topics of transitions of care and post discharge care.

You Have Lowered Length of Stay. Congratulations. You’re Fired.

For several decades, providers working within hospitals have had incentives to reduce stay durations and keep patient flow tip-top. DRG-based and capitated payments expedited that shift. Accompanying the change, physicians became more aware of the potential repercussions of sicker and quicker discharges. They began to monitor their care and as best as possible, use what measures they could ascertain as a proxy for quality (readmissions and hospital acquired conditions). Providers balanced the harms of a continued stay over the benefits of added days, not to mention the need for cost savings. However, the narrow focus on the hospital stay, the first three to seven days of illness, distracted us from the out weeks after discharge. With the acceleration of inpatient episodes, we cast patients to post-acute settings unprepared for the hardship they would face. By the latter, I mean, frailty risk, more reliance on others for help, and a greater need…
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