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Hospital Medicine Community: How do we instill some order into the daily chaos? – Part II

Yesterday I highlighted and identified that the daily chaos that has come to characterize hospital medicine needs to be changed. The problem, in a nutshell, as a specialty colleague remarked to me one morning, “I don’t know how on earth you can do this. You are getting called and paged from all directions at the same time about admissions, discharges and urgent floor situations!” We hospitalists need to find order in the chaos, do what we do best, and modify the systems within which we work to improve hospital medicine and patient care. The fact is that you take even the best job in the whole world and instill complete chaos and disorder into it and people will eventually leave that job. So how can we instill and establish some order? I don’t pretend to have all the answers, but here are some ideas: ·Impose stricter limits on the daily patient census.…

Hospital Medicine Community: How do we instill some order into the daily chaos? – Part I

Several years into my career in hospital medicine, I have to say that I still enjoy my job as much as ever and have absolutely no regrets in choosing this profession. I firmly believe that at its best, being a hospital doctor is one of the most rewarding jobs anyone could ever hope to have. You are the “captain of the ship” utilizing your skills to treat patients’ complex illnesses, guiding them through their hospitalization. You get to form very close relationships with patients and their families as you strive to get them better. Having worked in several hospitals up and down the East Coast, I’ve been fortunate enough to work mostly in supportive environments where I’m afforded the opportunity to do this to the best of my abilities. However, I know that many in our specialty across the country work in situations less conducive to optimal patient care. The…

Hospital Doctors: We should never allow ourselves to become shift workers

Growing up, I had always associated shift work with blue-collar jobs - typically those jobs that didn’t require a degree or graduate education. Not that there’s anything wrong with those jobs (a lot of them are vital public services), but I never expected to one day be working in a job where I would see myself as a “shift worker,” or worse still one where I "clocked in and clocked out" at the start and finish of the day. Graduating from medical school and beginning a career in medicine, I surely had started a noble profession—a calling—where I was as far away from this as possible; in a position where I would receive autonomy and a certain degree of freedom. Now several years into a career in hospital medicine, I sometimes feel surprised at where my chosen specialty has found itself. I'm also surprised by how some of my peers view their own work schedules. Having…

Hospital Docs: To round on Only One Floor, or Not to?

A major debate taking place in the hospital medicine community over the last several years concerns the way in which we cohort patients on the medical floors. The traditional way is to have patients belonging to each doctor scattered across the hospital on several different floors. This is in contrast to designing a geographical system where all the patients for any one doctor are located on a single floor. On the surface, it seems like a good idea to have this latter model, which is why some people are advocating for it. Theoretically, rounding in this manner will be more efficient and the amount of pages and calls from nurses should be reduced. As someone who has worked in both extremes as an attending physician, I have had the opportunity to experience the pros and cons of both types of rounding—which I’m going to call geographical versus traditional. I believe…

Oh, what to do about that background hospital beeping?!

You enter a patient’s room, begin a conversation, and then hear it. It may be from your patient’s machine, or the next bed; from the intravenous infusion or the telemetry monitor. “Beep, beep, beep!” What do you do? Do you: A. Look into the situation yourself and work out what’s wrong? B. Try to silence the alarm immediately? C. Call the nurse to look into it? D. Just let the machine keep beeping for now and carry on your conversation? Which one you usually do probably depends on the clinical situation and what type of machine the alert is coming from. Obviously an emergency telemetry monitor alarm will provoke an immediate response. However, all hospital medicine doctors will be familiar with the above everyday scenario. More often than not, it’s a simple issue with the IV machine, such as an occluded line or an alert that the infusion has finished.…
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