By: Charlie M. Wray DO, MS
I’ll be honest – I can’t remember who won the 2012 Super Bowl, World Series or any other pop culture phenomenon*, but I do recall stumbling across something called Choosing Wisely® one afternoon while sitting in my clinic. With a burgeoning awareness that much of the care I was providing seemed superfluous and wasteful, the discovery that there was a group of physicians who shared this same sentiment was exciting! Five years in, the Choosing Wisely® campaign has published more than 500 specialty recommendations – with the Society of Hospital Medicine working on the upcoming version 2.0 (all are welcome to contribute!). Just as Choosing Wisely is gearing up for round 2, the Journal of Hospital Medicine’s (JHM) online journal club, #JHMChat, is rebooting as well!
After a brief summer hiatus, we’re happy to announce that #JHMChat will be returning to discuss “Against Medical Advice Discharges” with Dr. David Alfandre. In another great addition to the “Things We Do For No Reason” series, Alfandre et al discuss how this seemingly innocuous decision has ramifications beyond what we might suspect – increased patient distrust, poor follow-up, and no liability protection, to name a few. While our #VisualAbstract (seen above) hopes to capture the essence of the article, we know that there is nuance to a topic like this. In exploring this topic, we want to hear your personal experiences and opinions on this all-too-common practice at the next #JHMChat. To help get your thoughts brewing:
- How do you approach a patient wishing to leave AMA?
- Do you have a strategy you commonly utilize in these (often) difficult situations?
- Does your institution have a system in-place for AMA discharges? What about follow-up care?
As we all know, these clinical situations are often difficult and seemingly have no right answer. But like most things in medicine, there are bad, good, and better ways to do something. We’re hoping this conversation will get us all on the better end of the spectrum.
Not familiar with #JHMChat? Since October 2015, JHM has reviewed and discussed more than a dozen articles with many focusing on improving the value of care we provide to hospitalized patients. Medical students, residents and practicing hospitalists are encouraged to join, as we discuss a broad array of topics that affect the care of the hospitalized patient. It’s a great opportunity to meet others, learn and even earn free CME.
To participate, just type “#JHMChat” in the search box on the top right corner of your Twitter face page, click on the “latest” tab at the top left of the page and join the conversation.
*PS. The NY Giants won the Super Bowl over the New England Patriots ending their run at a perfect season, the SF Giants swept the Detroit Tigers, 4-0, and The Artist won Best Picture.
Charlie M. Wray DO, MS is an Assistant Professor of Medicine at the University of California, Francisco and the San Francisco VA Medical Center. He completed medical school at Western University – College of Osteopathic Medicine, residency at Loma Linda University Medical Center, and a Hospital Medicine Research Fellowship at The University of Chicago. Dr. Wray’s research interests are focused on inpatient care transitions, care fragmentation in the hospital setting, and overutilization of hospital resources. Additionally, he has strong interests in medical education, with specific focus in evidence-based medicine, the implementation of value-based care, and how learners negotiate medical uncertainty. Dr. Wray can often be found tweeting under @WrayCharles.