Hospitalist Medicine

Hospitalists writing on KevinMD about inpatient medicine: the handoff between the ward and primary care, patient satisfaction scores, the electronic record as it is lived on rounds, the pandemic years that reshaped hospital medicine, and whether AI makes the hospitalist more or less necessary. Most of the archive dates from 2008 to 2020. Three maintained records draw on this archive: The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and COVID-19: what physicians wrote as it happened.

The dynamics of global health in hospital medicine

Robert Wachter, MD

Physician

January 3, 2014

As my Division of Hospital Medicine has grown — now to about 60 faculty — I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretzky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently.

The story of how we became the nation’s leading program for “global health hospitalists” is a very …

Car dealerships have something to teach hospitals

Suneel Dhand, MD

Health Technology

December 4, 2013

A couple of weeks ago I took my car in for its regular servicing. I’ve always had excellent service at this dealership and have gotten used to some pretty high standards. But on this particular visit, I was about to receive a dose of new technology as well. After I pulled my car into the garage, I was immediately greeted by a welcoming and friendly customer service agent. She had …

The primary care opposition to transition care

Michael Cetta, MD

Physician

November 7, 2013

The lack of access to primary care physicians is a well known problem impacting our healthcare system. The problem sends all sorts of negative ripples through the system, not the least of which is increasingly crowded emergency rooms packed with patients whose conditions could have been addressed earlier and cheaper had primary care been available.

What is less talked about is the mixed reaction of primary care physicians to the kinds …

Dissection of a needless hospitalization

Jordan Grumet, MD

Physician

September 13, 2013

If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.

The cardiologist hemmed and …

Should hospitals subsidize physician salaries?

Janice Boughton, MD

Health Policy

August 28, 2013

I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don’t work, and make up cool theories. I have time to read and listen to people and have become curious about several …

What I learned from my mother’s hospital admission

Robert Wachter, MD

Physician

August 26, 2013

A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.

Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized …

Medicare places hospitals in a discharge conundrum

David Mokotoff, MD

Health Policy

August 25, 2013

A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …

Aviation doesn’t hold all the answers to patient safety in health care

Suneel Dhand, MD

Health Policy

August 24, 2013

Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …

Observation status: How Medicare’s solution could make things worse

Robert Wachter, MD

Health Policy

August 11, 2013

There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians.

“Obs status” began life as Medicare’s way of characterizing those patients who needed a little more time after their ED stay to sort out whether they truly needed admission. In many hospitals, …

Why I pray for my patients

Rajeev Kurapati, MD

Physician

August 7, 2013

We have come a long way in medicine, treating serious illnesses and preventing life-threatening diseases. As a hospital-based physician, I treat various severe diseases every day throughout the ICU, medical, and surgical floors. On a normal day, I roll at a fast pace — admitting, treating and, discharging patients has become fairly routine for me. On any given day, we have an …

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Why I pray for my patients

Why doctors should take sabbaticals

Janice Boughton, MD

Physician

July 5, 2013

In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …

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Why doctors should take sabbaticals

The spiritual bond between two souls

Eva S. Vertelney, MD

Physician

June 12, 2013

Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …

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The spiritual bond between two souls

Where has evidence based medicine taken us in 20 years?

Robert Donnell, MD

Physician

June 3, 2013

A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.

What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …

The winds of change are blowing us out of the hospital

Jordan Grumet, MD

Physician

May 25, 2013

The sweat coalesced on my forehead. I leaned forward to push the weight of my body into the wheel chair. I was terrified. Behind me strode the baffled parents with their arms full of coats and scarves. The young boy shrunk into the chair and balanced his IV’ed arm on the rest, trying not to disrupt the tubing that had been so painfully inserted.

I was lost. A week into my rotation as a volunteer …

My first year as a locum tenens physician

Janice Boughton, MD

Physician

February 18, 2013

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that …

Experiencing the revolving door of physicians in the hospital

Elaine Waples

Patient

February 4, 2013

Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.

I was diagnosed with a blocked bile duct and I …

Dear hospitalists, we emergency physicians appreciate you

Edwin Leap, MD

Physician

January 24, 2013

Dear hospitalists,

This is just a note to say that we, in emergency medicine, appreciate you. Like all of us, you are stuck in an endless loop of unending residency. Don’t worry, it isn’t an episode of The Twilight Zone. It’s just your life. No, it’s our life!

As specialty after specialty withdraws from the practice of medicine, you, and all of us, …

Using the iPad Mini in the hospital: One doctor’s experience

Vineet Arora, MD

Health Technology

January 22, 2013

On my birthday several weeks ago, I was lucky to get an iPad Mini from my husband. I already have an iPad and have shared my experience. In fact, we gave all of our residents iPads (one of them contacted Steve Jobs and got a response), and documented an improvement in efficiency on the wards. So why the Mini? What is …

The recipe for a great hospitalist program

Janice Boughton, MD

Physician

January 7, 2013

Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …

It’s amazing what I’ve learned from patients

Janice Boughton, MD

Physician

November 29, 2012

Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …

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