Posts by Danielle Scheurer

Wrongful Life

There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live”, but rather on the “right to die”. These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost of care at the end of life in the U.S., and the frequency with which patients do not receive end of life care that is concordant with their wishes. These conversations have spurned providers and patients to discuss and document their wishes, via advanced care directives and/or POLST orders (Physicians Orders for Life Sustaining Treatment). There is now even a national day devoted to advanced care decision making (National Healthcare Decisions Day). While these documents are increasingly available for hospitalists…

Overcoming a Continued Physician Shortage

Updated statistics from the Association of American Medical Colleges (AAMC) show that the United States will continue to face a physician shortage over the next decade, ranging from a conservative estimate of a shortfall of approximately 40,000 to a pessimistic estimate of about 105,000 by 2030. The statistics are based on modeling a variety of policy and health care scenarios over the next 10-20 years to determine what the physician workforce requirements will be compared to the expected pipeline. Although the current and projected healthcare landscape is complex, dynamic, and uncertain, every estimate projects a shortage that is significant enough to affect patient care in the United States. The US population is both growing and aging, which creates an ongoing need for hospitalists and hospital-based patient care; between 2015 and 2030, the US population aged 65 and older will increase by 55%. Hospitalist groups will not only be impacted by…

The Impact of Hospital Design on Health – for Patients AND Providers

I was rounding on the inpatient general medicine teaching service last weekend and offered to meet my team of students and residents in the “resident library” on Saturday morning. (Although it holds the name “library,” there were no books or periodicals to be seen.) I had not been in the library for many months and was struck by a few things as I entered. It is a dimly lit space, lined on 3 of the 4 walls with rickety desks and desktop computers all facing the walls. The walls are painted an off-white color with innumerable dings and nicks, presumably accumulated over the course of years. There was a string of garland in the shape of a Christmas tree pinned to the wall (P.S. it is March), the entire left side of which was sagging and misshapen. There were various tattered and coffee-stained papers scattered haphazardly throughout the room, including…

Do Clinicians Understand Quality Metric Data?

The number and complexity of quality metrics within healthcare continues to expand, many of which are used to compare performance between hospitals, systems, and/or clinicians. To make these comparisons fair, many quality reporting agencies attempt to “risk stratify” these metrics, so as not to penalize those caring for higher complexity patients. Although laudable, these attempts also increase the complexity of the data and may reduce the ability of clinicians to understand and analyze quality performance. A recent article in the Journal of Hospital Medicine explores clinicians’ understanding of quality metrics using central line associated bloodstream infections (CLABSIs) as an example. The investigators used a unique Twitter-based survey to explore clinicians’ interpretation of basic concepts in public-reported CLABSI rates and ratios. I recently caught up with the lead author, Dr. Sushant Govindan, to better understand his team’s research and its implications for quality reporting. Dr. Govindan is a Pulmonary-Critical Care fellow…

THIS Is What Teamwork Looks Like

We talk a lot about teamwork in hospital medicine. Since the inception of the specialty, we have long been embedded in, and understand and respect the need for, a multidisciplinary approach to patient care. We heavily depend on our pharmacists, nurses, respiratory therapists, case managers, physical therapists, LPNs, etc. to develop and implement a care plan for our patients. Although hospitalists intrinsically understand the importance of teamwork, many of us let logistics and schedules get in the way of truly performing as a team. To date, few hospitals have implemented true team-based care. It is often too difficult to coordinate complex admission rules and differing schedules. And even if we can manage to coordinate locations and calendars, we still have to figure out how to communicate amongst our teams in a way that is efficient and effective. I recently ran across a series of award-winning healthcare photographs; this one struck…
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