Communication

We Have a Voice. It’s Time We Use It. #DoctorsSpeakOut

Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a trainwreck in progress. You may have thought about saying something, but paused and wondered, “Is this professional? What will this say about me as a doctor? What would my colleagues/supervisors think? What would my patients think?” You are not alone. I get stopped, emailed, and messaged frequently by others wondering if they should enter the fray. Something interesting happened with the recent Repeal and Replace or Repeal and Delay or Repeal and whatever roller coaster: Doctors did speak up! One group that was truly impressive was the pediatricians on Twitter, known as “tweetiatricians” who all recorded short…

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…

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…

The Essentials of QI Leadership: A Conversation with Dr. Eric Howell, Part 2

My last blog post, featuring my Q and A with Dr. Eric Howell, Division Director, Collaborative Inpatient Medicine Service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore, MD, and SHM's Senior Physician Advisor, focused on his early days in Quality Improvement (QI) and advice for training in QI. This next post discusses the Center’s role within SHM and how hospitalists can become involved in quality improvement. How did you get involved in The Center, and can you explain your role in The Center today? It was a lot of luck, good timing and being prepared. I’ve been in The Center for two years. Before that, I was involved with a number of The Center’s successful QI projects. I was reasonably well known in the Project BOOST (SHM's program for improving care transitions) community. Along with Mark Williams and Jeff Greenwald, I was one of the original three who pitched Project…

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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