Communication

You Can Observe A Lot by Just Watching.

"You can observe a lot by just watching." -Yogi Berra "You see, but you do not observe." - Sherlock Holmes, A Scandal In Bohemia. Sir Arthur Conan Doyle I walked into the patient's room day after day and heard the same line. "Sorry, Doc…not ready to get home. My breathing is still bad." He was sitting up, resting on the bedside table, looking tiny in the expansive, sterile hospital room. This small man with advanced COPD came in six days earlier with an acute exacerbation. The team rounded on him daily. We filled up his room, piling on the windowsill, filing around his bed. His vital signs improved quickly, and by day three, his numbers were great and his lungs opened up. He barely made it through each syllable on day one; almost a week later he was sounding out sentences, making his way to paragraphs. "It seems you are…

Let the Countdown Begin: EMR Re-Launch

The current state of the electronic medical record (EMR) at my organization feels like being in an old hospital complex which has clearly been built up over the course of decades; room numbers are not necessarily logical or in sequence, buildings connect on different floors, and most elevators do not actually go all the way from the bottom to the top of each building. Our current EMR “system” has sprung up over the course of several decades, as each area serially sprung for the system that best met their needs. Interfaces were partial or non-existent, and most single users did not have access to over half of the systems on campus. The result was a dizzying complex of EMRs that few users knew how to fully navigate. So now my organization, like so many others, decided to raise the white flag, spend an enormous sum of cash, and buy a…

Time to Toss Twitter? Not before Trying It out

A recent article in the Atlantic went so far as to eulogize the popular 140-character microblogging service.  This was met with mixed feelings on Twitter, with some agreeing and others lamenting and saying it ain’t so.  Knowing that all technology has a life cycle curve, could it be Twitter would be retired and go the way of MySpace or Friendster?  It seems hard to believe, especially in medicine.  After all, it seems like doctors are just starting to adopt Twitter. This was readily apparent since after attending the typical series of medical conference this Spring, including Hospital Medicine 2014, where the backchannel of Twitter was a flutter with real-time reactions to plenaries and the best places to eat in a particular locale.  Many presenters often had their Twitter handle proudly on display and invited further interaction through Twitter after their presentations.  While it is true that Twitter now is not…

Small, Good Things

“Eating is a small good thing, in a time like this.” -Raymond Carver, A Small Good Thing HM 2014 in Vegas delivered on its expectations.  Big city, big glitz, big turnout, and big ideas. The largest SHM conference yet, with plenty of opportunities to network, learn, while gorging on big bacchanal buffets. I leave these conferences ready to save the world. In the past, these conferences helped inspire me to bring Project BOOST, or glycemic management, or VTE prevention projects back to my hospital. All big projects, needing big teams and big commitments. They all achieved a measure of success, but became complex fast, and difficult to control over time; they certainly weren’t starter projects. I think twice before beginning big, complex projects today. In the world of big systems, with hospitals merging, I witness the small community and culture getting lost. The ability to be nimble, form a small team, and affect change…

The Gift of Cancer

From the start, let me say that I do not mean to imply that anyone diagnosed with cancer or any other disease is lucky for having received the diagnosis. I also want to emphasize that there is a tremendous spectrum that anyone living with cancer can experience, from benign to devastating. The word “cancer” has a lot of power in our culture.  It can hang as a black cloud over our lives or the lives of loved ones.  We may think of powerlessness, uncertainty, death, pain, suffering, weakness, debility, or a host of other fearful connotations. It is almost assured to suck the air out of any conversation when it comes up. When someone I have not seen in a while asks, “What’s new?” I have to decide whether to bring up the CLL diagnosis and let that hijack the conversation, or to leave it unsaid. But cancer can also…
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