Posts by Guest Post

Reflections on Palliative Care: Uncomfortable

By: Dr. Allison Schneider Throughout my Palliative Care rotation during this last year of medical school at UCSF, I began turning to writing as a way to both process and remember some of my patients and the intimate moments we shared. This is the second pair of poems I’ve written as a small way to pay tribute to them. (For the first installment in the series, click here.) Uncomfortable Where is your pain? Everywhere. Please give me something. I just want to sleep. It’s okay not to fight anymore. Thank you. But will he wake up? My kids are in school. They'll be here at five. Can you be here? Thank you. Thank you so much. Mr. L, metastatic nasopharyngeal carcinoma, age 49 45 Liters I led 1000 men into battle. Most of them didn't make it to 93. Isn't that right, Bruce? It's been a good life. So can I go…
Dr. Allison Schneider grew up in Washington, D.C., and received a BA in Public Policy and American Institutions from Brown University. She then worked for the Kaiser Family Foundation Commission on Medicaid and the Uninsured prior to entering medical school at the University of California, San Francisco. She graduated this month and will be starting her residency training in Obstetrics and Gynecology at Kaiser Oakland Medical Center in July.

Reflections on Palliative Care: Clinging to Life

by Dr. Allison Schneider
By Dr. Allison Schneider My first day on the Palliative Care service ended with me in a heap on my couch sobbing into my husband’s shoulder. That day I attended family meetings for two patients in their 40s dying of cancer and leaving young kids behind. I also sat at the bedside with the mother of a young man dying of AIDS. As a fourth year medical student, I had experienced hard days; that day was one of the hardest. Yet, it was also beautiful. The interdisciplinary palliative care team navigated each conversation with inspiring empathy and grace. They worked together seamlessly to support and honor the goals of each patient and their families. The team also made it a priority to support each other. Through frequent check-ins, debriefs and formal talks about self-care, the rotation created a truly safe space to express and work through the raw emotion that…
Dr. Allison Schneider grew up in Washington, D.C., and received a BA in Public Policy and American Institutions from Brown University. She then worked for the Kaiser Family Foundation Commission on Medicaid and the Uninsured prior to entering medical school at the University of California, San Francisco. She graduated this month and will be starting her residency training in Obstetrics and Gynecology at Kaiser Oakland Medical Center in July.

Quality Improvement – The Role of Each Provider

by Dr. Moises Auron
by Dr. Moises Auron MD, FAAP, FACP It is certain that since the seminal publication of the Institute of Medicine “To Err is Human,” physicians and society in general have pursued a legitimate effort to gain perspective and understand the incredibly complex system which is the healthcare system. The increased focus on the degree of quality of healthcare delivery has even yielded into the incorporation of quality metrics that impacts on hospital revenue by CMS. This has prompted healthcare institution to implement changes in practice in order to achieve compliance with the measures and avoid financial penalties. This affects physicians' practice as they need to have enhanced mindfulness around a large number of quality metrics that don't necessarily impact the patients' outcome. The need for change and for creating mindfulness around the quality metrics and performance, has even evolved in the creation of formal quality curriculum for trainees of different…
Dr. Moises Auron is an academic Med-Peds hospitalist at the Cleveland Clinic in Cleveland, Ohio. He is an Associate Professor of Medicine and Pediatrics at the Lerner College of Medicine of Case Western Reserve University and a core faculty of the Internal Medicine Residency Training Program. His interests are medical education, acute and perioperative medicine and quality and patient safety. He is the Quality and Patient Safety Officer of the Department of Hospital Medicine at the Cleveland Clinic. He has been a member of the Quality and Pediatrics committees at SHM, and is currently a member of the SHM Public Policy committee. Dr. Auron is the Chair-elect of the Council of Early Career Physicians of the American College of Physicians.

Not So Involuntary: Hospitalists and Psych Holds

by Dr. Atashi Mandal
by Dr. Atashi Mandal MD He sat on the gurney, with averted eyes and contorted posture, as to avoid my encroaching examination. The usual jargon populated my assessment: psychomotor retardation, flat affect, poor vocalization… I glanced at his intake form and noted that he had been admitted to the emergency treatment unit for suicidal ideation, removed from a family with a history of incarceration, drug use and neglect. At my coaxing to face forward, I glimpsed at the tapestry of well healed linear scars from previous cutting attempts. I now needed to medically clear him so that he could receive his next placement in the “most appropriate setting”.  But I wondered if checking off boxes and signing a form was the most I could do for him. Sadly, as hospitalists, this scenario is one most, if not all, of us have encountered. We have also grown accustomed to separating medical…
Dr. Atashi Mandal is a practicing adult and pediatric hospitalist in Los Angeles and Orange County areas. She is also a member of SHM’s Public Policy Committee.

Do Patients Really Prefer Hospitalists to Teaching Service?

by Dr. Charlie M. Wray DO
by Dr. Charlie M. Wray DO After diligently listening to the intern’s presentation and deciding on what our treatment plan would be for our patient, Mrs. Ramirez, my senior resident led our two interns, two medical students, and myself into her room. As we all methodically filed in, slowly gathering around the patient, I could see her anxiously sit up in bed and look around at all the different faces, searching for one to focus on. As the intern reviewed the overnight labs and imaging with her, I stood there and imagined the confusion and overwhelming feelings she probably has every morning when a gaggle of doctors amass around her bed. I contrasted this experience with what would likely occur the following week when I would be back on service as a direct hospitalist, where instead of 6 different white-coated individuals to contend with, my patients would only have to…
Dr. Charlie M. Wray DO is currently a second year Hospitalist Research Fellow and Clinical Associate in the Section of Hospital Medicine at the University of Chicago. He completed medical school at Western University – College of Osteopathic Medicine and residency at Loma Linda University Medical Center prior to his fellowship. Dr. Wray’s research interests are focused on inpatient care transitions and care fragmentation in the hospital setting. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Following his fellowship, Dr. Wray will be joining the staff at the San Francisco VA Medical Center.
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