Posts by Tracy Cardin

Dysfunction Isn’t Fun

I was talking with a colleague in another section today and she was noting the difference between our hospitalist group and her section.  She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship.  She is a bit frustrated with her new home and its team members because she feels like there are a lot of "B's".  You know- b*tching, bickering and backbiting. I was asking her to tell me the reasons she thought this is occurring. Is it a top down issue, is it just a personality problem with people attracted to her specialty, is it that there is instability with the people and processes that make up that section?  What is it?  No answer was forthcoming.  In the clinical setting, when no answers are clear and forthcoming we say the problem is "multifactorial". After speaking with  her,…

Collaboration Nation

Hospital medicine is defined by its excellent collaboration.  We "co-manage" with orthopedics.  We reach out to primary care physicians. We enroll the nurses at the bedside. We wrap families into the medical plan.  But how good are we?  Depending on the pace of my Friday I may feel like I'm winning the war or losing the battle. I think it's good to step back and reflect on what is going right in our world and what needs a bit of tweaking. In that vein, and using this elegant article I read about Nurse-Physician Workplace Collaboration as a guide (Lindeke, L., Sieckert, A. (January 31, 2005).  "Nurse-Physician Workplace Collaboration". OJIN: The Online Journal of Issues in Nursing. Vol.10 No. 1, Manuscript 4.). I'd like to review the highlights.  Feel free to score yourself (and your fellow collaborators) and break out the champagne or the Kleenex. Question 1: I have emotional maturity…

Spontaneous Generation

It's kind of funny, but a bunch of people sent me this recent Medscape article entitled, Can a Nurse Practitioner Be the 'Attending Physician' in the Hospital Setting.  I found this quite humorous. I'm pretty sure that the "spontaneous generation theory"  was debunked by Louis Pasteur in the early 1900s and would apply to nurse practitioners and physicians as well as bananas and fruit flies. Of course I can't be an attending physician. I am not a physician, and my transmogrification skills are woefully under-developed! I guess I also find it funny that people would think that I would react to this in some way - that being the 'attending physician' is the goal of nurse practitioners, along with mandating the strength of coffee in America and controlling the weather. The article itself was a very factual one looking at the federal statute, in Medicare's Conditions of Participation, which requires…

House Elves of Hospital Medicine

I read a fascinating article from ProPublica about an NP, Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso were not listed. This is because the Physician Payment Sunshine Act doesn't require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions. This behavior by the nurse practitioner is unconscionable really, and there have certainly been many physicians who have succumbed to the same temptations. Dr. Richard Grimm, a Minnesota researcher, served twice on government-sponsored hypertension panels that create guidelines about when to prescribe blood pressure pills. When state records revealed…

The War That No One Wins

My uncle just died.  He was my mother's brother,  an irascible blowhard, a mercurial bit of a family dictator with a soft spot for small children. He had the unfortunately common clinical course of catastrophic illness followed by steadfast decline into the heartbreaking oblivion of dementia. This dementia was of a steep descent and his daily life was reduced to a nursing home, albeit one where my mother and his wife visited multiple times a day and advocated fiercly for adequate care. On Sunday he suddenly vomited, was noted to be febrile and tachypneic. He was, sensibly enough, a DNR with a "no transfer" to hospital order on the chart-though not in hospice care. His oxygen saturations fell to critical levels despite aggressive supplemental oxygen, and he began to struggle for breath. His breathing was noisy, and he developed tremendous secretions which he was unable to clear. My mother, at…
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