Public Health

Hospitalists Rise, Medicare Falls

Sorta. A new study out today in JAMA you will want to know about: How has Medicare done on the inpatient side from 1999-2013? Medicare all-cause mortality?  DOWN (more…)

Yes, Again

OK it's another anti-narcotic rant.  This is directed to all the providers out there.  A couple of things you should know: 1. Don't give narcotics for benign musculoskeletal pain. Give physical therapy and a prescription for weight loss instead. 2.  Don't give narcotics for osteoarthritis. Give physical therapy and Tylenol instead. 3.  Don't give narcotics for functional abdominal pain. Give fiber and a prescription for cognitive behavioral therapy instead. 4.  Don't give narcotics for depression. Give hope, listening and a prescription for cognitive behavioral therapy instead. 5.  Don't give narcotics for a personality disorder.  Give boundaries and a prescription for cognitive behavioral therapy instead. 6.  Don't give narcotics for fibromyalgia.  Give sunshine, aerobic exercise and a prescription for cognitive behavioral therapy instead. 7.  Don't give narcotics for headache.  Unless the headache is due to a brain tumor or metastatic cancer.  Then feel free. 8.  Don't give narcotics to keep the…

Antibiotic Stewardship and Hospitalists: The Bedside Is the Front Line

by Eric Howell, MD, SFHM “Tell me what you know about antibiotics.” That’s the discussion I start with hospitalized patients all the time, right after they ask me to prescribe antibiotics for their simple cough, or other viral-like illness. And, from their perspective, asking for antibiotics makes sense. After all, antibiotics have been the physician’s knee-jerk reaction to a number of patient symptoms for decades, especially for a cough or upper respiratory infection. And we have inadvertently trained our patients that there is an easy solution to almost any common medical problem. But patients often answer my question with something like “not much” and a little surprise that I haven’t already started ordering the prescription. That’s when I talk about the potential harms of antibiotics. And that’s also when their eyebrows go up. I start with the easy harms, like that many antibiotics can cause diarrhea, a symptom nobody wants…

Passion to Improve Pain Care

by Dr. Solomon Liao Students and residents often ask me why I like my job so much and why I always walk around with a smile on my face when I’m on service. I respond that helping to relieve people’s pain is very rewarding. It provides instant gratification. The more challenging the case is, the more rewarding the result. Very few interventions in medicine provide as immediate an impact on patient’s function and quality of life as reducing their pain. The volume of pain patients is huge. Over 116 million Americans have chronic pain. As my father taught me, “You go where the need is.” However, as I learned from one of my college mentors, “The need is part of the calling, but the need is not the calling itself.” As a palliative medicine hospitalist, I provide pain management as part of a larger calling of symptom relief and whole…

Flu: Treat Early, Late and Often? Thanks, CDC.

by Dr. Weijen Chang MD FAAP, SFHM Recently, Dr. Tom Frieden, Director of the CDC, in response to criticism about the reduced efficacy of this season’s influenza vaccination has been prominently advocating use of antiviral medications (oseltamivir and zanamivir) for the treatment of influenza infections in adults and children. In short, his philosophy can be paraphrased as, “Treat early, treat late, treat often.” This treatment recommendation, however, seems to be swimming upstream against a growing river of evidence that questions the efficacy of influenza antiviral medications, especially in light of its unfavorable adverse effect profile.  The current CDC recommendations advocate treatment with antivirals for all children hospitalized with influenza infection, despite recent studies showing lack of efficacy in otherwise healthy children.  Considering my concerns as a pediatric hospitalist with the recommendations and the lack of evidence, I decided to touch base with two other pediatric hospitalists Matthew Garber, MD and…
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