Communication

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…

From SXSW to SHM: Our Tour to Promote Value Conversations Between Doctors & Patients

By Chris Moriates, MD, SFHM and Vineet Arora, MD, MAPP, SFHM At a movie premiere for the new Terrence Malick flick, “Song to Song”, Ryan Gosling, Michael Fassbender, and Rooney Mara walked the red carpet to flashing cameras and screaming fans in front of the famous Paramount Theatre in Austin. The next day, down the street, to a lot less fanfare, our Costs of Care team – Neel Shah and both of us – took the stage at the annual SXSW festival for own version of a premiere. We were about to step out of the normal medical conference crowd (i.e. no screaming fans but some with #pinksocks on) and see for the first time if videos we made depicting scenarios of doctors and patients confronting healthcare costs would translate to the real world. Would it work, or would the critics, like with the “Song to Song” premier, give us…

Vegas Awaits: Hospital Medicine 2017

I’m packing up for Vegas. I always look forward to the yearly conference. And back in Vegas, expectations are high. However, we all know there will be one or two distractions from the conference schedule. Here are few takeaways I hope to obtain from both the conference and Vegas. Building Community The Power of Networking Placing the Right Bets The Importance of Arts AYCE Benefits Building Community While I’m in Vegas, I may wander north of the strip and head for Container Park and the Downtown Project. The Zappos CEO poured $350 million of his wealth into this downtown Las Vegas project, with the goal of rapidly building a community from scratch as start-up city. Health can be impacted by the design of a city, and many cities are taking that cue. The Downtown Project wanted to create a walkable city and a new tech industry while experimenting with city building at the private level.…
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