Communication

Rounds: Are We Spinning our Wheels?

As a Johns Hopkins undergraduate, I used to run the Welch lecture series in medical history. Through this role, I learned about an interesting tidbit – the origin of the word “rounds.” Johns Hopkins Hospital had a circular ward where the infamous and quotable Dr. Osler made his “rounds” to see patients. While medicine has come a long way since Osler’s days, have rounds? This is the crux of a paper in the Journal of Hospital Medicine by led one of our former Pritzker students Olliver Hulland along with mentors and hospitalists Dr. Jeanne Farnan and Dr. Barrett Fromme. In a 3-site study with UCSF and Georgetown, they conducted focus groups with attendings and medical students to ask the quintessential question, “What is the purpose of rounds?” Interestingly, the answers were markedly similar and revealed the multi-faceted nature of rounds: Communication, which included coordination of patient care team, patient/family communication,…

Navigating a Near Miss

When my daughter was around 5 years old, she disappeared. We were outside, my wife and I doing some work around the house, and our 5-year-old playing on the driveway. She was deeply engrossed in some colored chalk, creating an infinite hopscotch board. I stepped inside to grab something, and my wife went to grab something else on the side of the house. We both returned to the driveway to find chalk rolling down towards the sidewalk – and no daughter. She couldn’t have run into the house; that’s where I was. Nor the backyard, where my wife had been. We call her name, look around, and then realize she must have run off down the sidewalk. But we don’t see her. Images flash by. She runs into the street and gets struck by a car. She turns towards a backyard and vanishes in the next neighborhood. She hides behind…

Making the Implicit Explicit

Last month, I wrote about some interesting workplace trends, in particular about how the implied compact between U.S. workers and their employers is evolving rapidly. Few of us in the workforce today can conceive of an employment relationship in which we are guaranteed lifelong employment and a generous benefits package including full healthcare and retirement in exchange for hard work and loyalty to a single employer. Since then, I’ve had several conversations about the term “compact” as I used it in that post. At its most fundamental, a compact is an agreement between two or more parties. In my recent post, I used the term to refer to the generally accepted but rarely articulated set of expectations that workers and their employers have of each other. There is an implied compact between physicians and the hospitals where they practice as well. Historically that compact assumed that doctors would refer lots…

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…

What We Expect and What We Get from Work

Are American workers becoming happier with less? An interesting article in last Friday’s Wall Street Journal reported on the findings of a recent survey of U.S. workers by the Conference Board, a research organization. Although the survey wasn’t specific to healthcare, much less hospitalists, I see some parallels that might cause many of us to stop and think more carefully about what we expect from our work. The Conference Board’s findings highlight how American workers’ employment relationships are evolving and how that is impacting what Americans think of as a “good” job. The biggest shift has come in the nature of the implied compact between workers and their employers; unlike a generation or two ago, U.S. workers no longer expect to receive a generous benefits and lifelong employment in exchange for hard work and loyalty. In fact, I suspect many younger workers today would face the prospect of lifelong employment…
12345...10...