Posts by Tracy Cardin

Up Your Game in APP Integration

I receive lots of calls and emails from HM group leaders, APP leads and others looking to up their game in APP integration. The calls fall into certain domains, and I thought it might be a good time to address some of these concerns. Training/Onboarding: This is the number one domain I get questions about. And it is important. Poor onboarding and lack of standardized training for APPs is a major barrier to success in HM practices looking to maximize their APP providers. Didactic that is congruent with SHM’s Core Competencies in Hospital Medicine is a good place to start. But before you embark on this fabulous onboarding program that is the envy of all who survey, realize that another key to success is appropriate expectations.The best onboarding or training program cannot “season” an APP the way time does. New grads can easily take nine months to a year to…

Should We Really Focus on “Patient-Centered” Care?

“Patient-centered care implies that the patient is always right and that their opinion should win out over the physician’s opinion.” I read that quote from Dr. Katie Neuendorf in a recent article in The Hospitalist, and it resonated with me right away. In the article, Dr. Neuendorf explains that patient-centered care should really be “relationship-centered care,” which means that the relationship should be prioritized, even when there is disagreement in the plan of care. In this scenario, she pointed out that she can support the patient and still not prescribe a treatment that she feels is inappropriate. This is brilliant and beautiful. We know, as numerous articles have shown us, that giving patients what they want is not necessarily good for them. Patients with the highest satisfaction scores also have the highest mortality ratings. This is thought to be because patients may be asking for interventions, tests or prescription drugs…

How Do We Keep Our Providers Safe?

Editor's note: As the topic of violence in healthcare has become a hot topic, The Hospital Leader is offering perspectives from two of our expert bloggers. This piece authored by Tracy Cardin is the first of two. The second from Danielle Scheurer will publish next Thursday, August 31. In the last three weeks while on clinical service, the police had to be called twice for incidents involving my patients. One involved a patient threatening me and a nurse with physical violence outside of the hospital, and the second included a patient hitting a nurse in the face. She was saved from more serious injury, simply because she fell backwards just as the punch landed. This was just in my panel of patients. Lest you think maybe I need some training on interacting with patients, another patient threw a full cup of coffee, then the cup, at an attending physician. Another patient had…

Follow You, Follow Me

Recently, a friend forwarded this blog post to me. In this post, the author, a physician, expresses concern both about the number of clinical hours that an NP needs to be licensed as well as the use of the title “doctor” for NP providers. (While many NPs are now doctorally prepared, it is against most state statutes to use the term "doctor" in a clinical setting if you do not possess a medical degree, although the author fails to mention this.) The writer then follows with a horrible story about the care an NP gave to a pediatric patient. In so many ways, this is an archetypical physician blog post, along with the requisite horror story that inflames the reader about just how dire this situation is. While these situations occur, it’s important to remember that they are the exception and not the norm. In response, I ask: is it…

It’s Time for a Buzz Cut

I sometimes joke that hospitalists are the medicine version of the mullet haircut – you know, all business in "the front" (i.e. the patient care area) and all party in "the back" (i.e. the work room). In "the back", the usual scenario is to complain and moan about our frequent flyers, our drug seekers, our many unsaveable patients, the incredible situations ("He put a nail where??), with good-natured but somewhat bitter truculence about sharing duties with housestaff and general whining about hospital leadership. Generally, as long as these semi-inappropriate conversations and remarks were kept "backstage", and our demeanor was professional "onstage", I felt it was harmless. You know, gallows humor. A coping mechanism. And often entertaining. But there was always a part of me that wondered if these "backstage" conversations were having a more corrosive impact on communication with our patients. Does it normalize a negative judgement about patients if…
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