Hey NEJM, where’s the beef?

  I opened the most recent copy of NEJM with anticipation.  At last, a review on severe alcohol withdrawal.  Perhaps a solution to the age old conflict between psychiatry (start benzo on Monday, decrease by 20-25% daily and discharge on Thursday or Friday) versus medicine (start benzo on Monday, and if they look like a rose on Tuesday, send them home).  No such luck. I did find this though: "The doses needed to control agitation and insomnia vary dramatically among patients and can be prodigious (e.g., >2000 mg of diazepam in the first 2 days in some patients); this underscores the advisability of providing treatment in a hospital, preferably in an ICU." UM.  You think?   (more…)

Do I look like a PGY?

    Working as a hospitalist since our society's founding, I have reaped insights and a dose of confidence those starting in our specialty lack.  I am not speaking just of clinical understanding. Hospital-based practitioners collaborate with colleagues from many specialties, and like us, each has its own identity. Surgery sees the world through their lens, as do we. Over time, through the dances we do, we come to expect a predictable dynamic when we interact. Presumably, the dynamic produces a mature partnership built on respect.  One discipline welcomes the efforts of another, and in turn, all parties feel appreciated.  That’s a good thing. (more…)

7-on/7-off Is Growing, but Will We Be Asked to Peel It back?

The new SHM/MGMA State of Hospital Medicine (SOHM) report has just been released and as always it is full of interesting nuggets about the way hospital medicine is practiced these days in our country. One fact/trend caught my eye. The number of 7-on/7-off scheduled programs is climbing. In the past two years, we have seen a rise from 41.9% in 2012 to now 53.8% of programs are working their schedule this way. I personally have always been a fan of win-win solutions and 7-on/7-off to me has been the mother of win-win solutions in hospital medicine. It’s a win for many doctors (but not all) in allowing blocks of time off to either focus on personal pursuits, or to manage your quality/safety/educational side of your job at your own pace and schedule. It’s a win for hospitals because it guarantees a steady presence of invested doctors ready to care for…

Do hospital-based docs get sued more? Part II

  I left off last week’s post with a tease.  If you recall, I made note of the frequent mentions med mal gets in the lay and professional press, as well as the outsized influence the threat of getting sued has on physician psyches. Physician surveys, albeit with their biases, can tell us how we feel about medical torts.  However, as a field, from those same surveys, we discern little of our actual risk. Relative to our outpatient or subspecialty colleagues, the system has saddled us with a distinct data disadvantage. We have no unique identifier or tracking ability, so assessing suitable premiums and sussing out trends within our specialty--and where we fall short (or not), make corrective actions difficult. It would be nice to have a study like this, for example, as the day may come when malpractice carriers disaggregate inpatient from outpatient claims.  Our discipline has weaknesses for sure, like…

Do hospital-based docs get sued more? Part I

  If you want to get the hair on the necks of an audience full of docs to stand on end at a health reform lecture, utter the words salary or malpractice.  Without question, the two most galvanizing issues in our field, they hit hard because we feel their impact both in our professional and personal lives.  In addition, the outsized effects med mal has on our psyche cannot be overstated—especially by those whose shoes have never tread hospital ground.   (more…)