A clever little study was published last month in the Archives of Internal Medicine, and it – plus the fact that I’ve just started a stint as ward attending – prompted me to think about the importance of managing a set of tasks in the hospital. In my quarter-century of mentoring residents and faculty, I [...]
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In Today’s JAMA: Abraham Verghese and I Discuss the Changing World of Ward Attendings
Senior attendings like to quip that the medical students seem to be getting younger every year. They’re not. But the attendings on the wards of American teaching hospitals actually have gotten younger. At UCSF Medical Center, for example, about 90% of our ward attending-months are now staffed by hospitalists, about half of them physicians in [...]
Gregory House, MD, RIP
The final episode of the show House, MD airs on FOX tonite. I wrote the following op-ed piece for USA Today; it’ll appear there tomorrow morning and is reproduced here with permission. Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the [...]
Bedside Ultrasound for Hospitalists: Our Time Has Come
In 1949, the English-born physician John Wild, working at the University of Minnesota, discovered that he could determine the thickness of bowels injured in the war by bouncing sound waves though the abdominal wall. Over the next 30 years, medical ultrasound technology improved markedly, ultimately leading to the many uses we’re all familiar with. Once [...]
In Search of a New Rhythm on Today’s Wards
When I was a medical student, I remember wondering what my attendings did when they weren’t on the wards. As an attending now myself, trying to cram three half-month ward blocks into my hyperscheduled life each year, I find that sentiment charmingly naïve. I – like most of my faculty colleagues – am awfully busy [...]
Leaders and Leadership in Hospital Medicine: The Story Behind the IPC-UCSF Fellowship
This is a tale of leaders and leadership. And about keeping an open mind. I first met Adam Singer in 1996, when the hospitalist field still had its training wheels on. A pulmonary/critical care physician by training, Adam had become a physician-entrepreneur and was now focused on making his new enterprise, IPC, the nation’s preeminent [...]
Role Models of Diagnostic Excellence: Goop Dhaliwal and the Car Talk Guys
In a “Clinical Problem Solving” session at my annual Hospital Medicine conference last week, I presented a fiendishly hard case to Gurpreet Dhaliwal, a UCSF associate professor of medicine based at our San Francisco V.A. You can imagine how hard this is for the discussant: he’s hearing a case for the first time, absorbing and [...]
Acute Physicians: Hospitalists Bounded by Time and Space
Besides studying patient safety and watching all five seasons of The Wire, my other major goal for my London sabbatical was to understand the way the Brits organize hospital care. Mirroring the U.S. hospitalist movement, a new field—called “acute medicine”— emerged about 15 years ago and became the country’s fastest growing specialty. But there is [...]
Hospitalists and Squeezed Balloons
I began thinking about – and yes, advocating for – the concept of hospitalists in the mid-1990s, when I became convinced that having separate inpatient and outpatient physicians would improve the quality, safety, and efficiency of healthcare. A study in today’s Annals of Internal Medicine reports that, while hospitalists did cut hospital lengths of stay [...]
The Hospitalist Field Turns 15: What The Past Says About The Future
I just returned from the Society of Hospital Medicine’s annual meeting in Dallas. Seeing more than 2,000 hospitalists in one place is remarkable, since I remember the days when we all fit into a mid-sized conference room at a Holiday Inn. I have clearly assumed the mantle of elder statesman at these meetings. I find [...]
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