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Urban Legends
Registration for the Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) through the American Board of Internal Medicine (ABIM) opened March 15. Since then, hundreds of board-certified IM physicians have registered to complete their MOC through the FPHM. For those of you who haven’t gone through MOC yet, it is required every 10 years in order to maintain your board certification.
As a member of the committee tasked with helping ABIM develop the FPHM, as well as write the FPHM examination, I’m frequently asked questions about this process, especially since FPHM was featured on the May 2010 cover of this magazine. Some of the questions stem from the perplexity associated with this significant change to the MOC process. Others arise from misinformation and apprehension, and could rightly be called urban legends. Here is a sample of those questions, with their respective veracity.
Does This Certification Mean I’ll No Longer be an Internist?
No. I clearly remember the day I found out I passed the ABIM certification exam; it represented the culmination of years of work, the pinnacle. All those long hours of study, late-night admissions, and exam preparation had finally paid off. I was a board-certified internist! I cherish my board certification and hold it out as recognition of my mastery of the field of IM. As such, I certainly understand the concern that entering the FPHM will somehow result in “losing” IM certification. However, this just isn’t true.
First, all diplomates—ABIM terminology for those enrolled in the board (re)certification process—in the FPHM are certified as internists. This is simply, as the name suggests, recognition of focused practice in HM—the core certification is still in IM. We are still internists—just internists who have focused our practice to hospital care. The formal board designation will read: ABIM Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine.
Will Hospital Credentialing Boards Recognize This Certification?
Yes. The FPHM is certification in IM by the ABIM. This carries the same weight and meaning as the regular IM MOC. All credentialing boards that recognize the ABIM MOC in IM will recognize the FPHM.
Is the FPHM MOC More Rigorous Than the Regular IM MOC?
Yes, and it was intentional. It is recognized that hospitalists do things that make them “special” by acquiring and refining skills learned experientially outside of a supervised training program. Thus, one can attain FPHM board designation only after three years of practice as a hospitalist. The problem is that this is largely unsupervised time (unlike a fellowship), so the threshold to ensure we have achieved a level of competency has to be established through the MOC process.
As such, the bar for the MOC for FPHM has been set higher. The upshot is that to maintain designation of FPHM, hospitalists are required to achieve 60 self-evaluation points every three years, compared with 100 points every 10 years for IM MOC. Forty of those 60 points must come in the form of Practice Improvement Modules, or PIMs. While more rigorous, it only makes sense that a group committed to the improvement of healthcare quality would commit to higher levels of quality assurance.
Will the FPHM Confer Subspecialty Status to Hospitalists?
No. This is where there has been the greatest deal of controversy surrounding the FPHM program. FPHM is not a subspecialty certification. Rather, it is MOC for IM physicians who focus their practice in the hospital setting. The American Board of Medical Specialties (ABMS), the group that oversees the ABIM, is very clear that only training-based subspecialties can be deemed board-certified subspecialties.
Still, the new FPHM will differentiate hospitalists from nonhospitalists. To me, this is semantics, and the recognition that comes with the FPHM is enough to recognize what I do as “special.”
Will the Examination for the FPHM Reflect What I Do?
Yes. I’ve had several colleagues tell me they’ve heard that the examination will contain elements not found on the standard MOC test. This is true, but it also is the major benefit of the new test. As reported on the ABIM website, the FPHM MOC exam will consist of roughly 45% inpatient medicine, 15% consultative and comanagement work, 15% transitions and ambulatory medicine, 15% patient safety/quality improvement, 5% epidemiology, and 5% ethics and end-of-life care. In this respect, it better reflects what most of us spend most of our time doing—inpatient care, consultative medicine, and transitions of care. Those three areas comprise nearly 75% of the examination. The one area that is new is the focus on patient safety and quality. However, for a field built on the promise of improving the quality, safety, and efficiency of healthcare, this is a welcome change.
Will I Be Able to Prepare for the FPHM Exam?
Yes. Because the FPHM utilizes a different exam than the standard IM MOC, some physicians are concerned that they there are no avenues for preparation, but this is not true. While the exam will weigh various portions of the test differently (e.g., less ambulatory and more inpatient content), the inpatient content will be similar to what is currently on the standard MOC test. After all, heart failure, cellulitis, and pulmonary embolism are the same, regardless of the test it shows up on.
The difference is that there will be more of it—a good thing for the practicing hospitalist. Many of the standard IM test preparation options will help you prepare for the FPHM exam. The ABIM also offers HM knowledge modules as part of the enrollment fee, which, while not meant to be preparation for the exam, can help you identify gaps in your knowledge. The blueprint for the exam is on the ABIM website and can give you clues to areas in which to prepare.
It is true that there will be patient safety and QI content on the HM test, which might not be available for study in typical board review books. However, much of this is the kind of information hospitalists live every day, such as handoffs, transitions of care, and infection control.
Should I Fear the Change?
Humans are intrinsically wired to dislike change. It’s that old saw about choosing the devil we know rather than the devil we don’t. My guess is that much of the concern around the new process stems from this human sentiment—it’s just easier to not do the FPHM and go down the standard IM MOC route. We must avoid this temptation.
The FPHM is a key step in solidifying HM’s status in the healthcare milieu. It gives us credibility in a way no other designation can. It also allows those of us who are serious about an HM career to differentiate ourselves from those who masquerade as hospitalists. And, most importantly, it allows us to demonstrate to our patients our sincere commitment to improving the quality of the inpatient systems that envelop them at their sickest moments.
For that reason alone, I’m enrolling in the FPHM MOC. TH
Dr. Glasheen is physician editor of The Hospitalist.
Registration for the Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) through the American Board of Internal Medicine (ABIM) opened March 15. Since then, hundreds of board-certified IM physicians have registered to complete their MOC through the FPHM. For those of you who haven’t gone through MOC yet, it is required every 10 years in order to maintain your board certification.
As a member of the committee tasked with helping ABIM develop the FPHM, as well as write the FPHM examination, I’m frequently asked questions about this process, especially since FPHM was featured on the May 2010 cover of this magazine. Some of the questions stem from the perplexity associated with this significant change to the MOC process. Others arise from misinformation and apprehension, and could rightly be called urban legends. Here is a sample of those questions, with their respective veracity.
Does This Certification Mean I’ll No Longer be an Internist?
No. I clearly remember the day I found out I passed the ABIM certification exam; it represented the culmination of years of work, the pinnacle. All those long hours of study, late-night admissions, and exam preparation had finally paid off. I was a board-certified internist! I cherish my board certification and hold it out as recognition of my mastery of the field of IM. As such, I certainly understand the concern that entering the FPHM will somehow result in “losing” IM certification. However, this just isn’t true.
First, all diplomates—ABIM terminology for those enrolled in the board (re)certification process—in the FPHM are certified as internists. This is simply, as the name suggests, recognition of focused practice in HM—the core certification is still in IM. We are still internists—just internists who have focused our practice to hospital care. The formal board designation will read: ABIM Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine.
Will Hospital Credentialing Boards Recognize This Certification?
Yes. The FPHM is certification in IM by the ABIM. This carries the same weight and meaning as the regular IM MOC. All credentialing boards that recognize the ABIM MOC in IM will recognize the FPHM.
Is the FPHM MOC More Rigorous Than the Regular IM MOC?
Yes, and it was intentional. It is recognized that hospitalists do things that make them “special” by acquiring and refining skills learned experientially outside of a supervised training program. Thus, one can attain FPHM board designation only after three years of practice as a hospitalist. The problem is that this is largely unsupervised time (unlike a fellowship), so the threshold to ensure we have achieved a level of competency has to be established through the MOC process.
As such, the bar for the MOC for FPHM has been set higher. The upshot is that to maintain designation of FPHM, hospitalists are required to achieve 60 self-evaluation points every three years, compared with 100 points every 10 years for IM MOC. Forty of those 60 points must come in the form of Practice Improvement Modules, or PIMs. While more rigorous, it only makes sense that a group committed to the improvement of healthcare quality would commit to higher levels of quality assurance.
Will the FPHM Confer Subspecialty Status to Hospitalists?
No. This is where there has been the greatest deal of controversy surrounding the FPHM program. FPHM is not a subspecialty certification. Rather, it is MOC for IM physicians who focus their practice in the hospital setting. The American Board of Medical Specialties (ABMS), the group that oversees the ABIM, is very clear that only training-based subspecialties can be deemed board-certified subspecialties.
Still, the new FPHM will differentiate hospitalists from nonhospitalists. To me, this is semantics, and the recognition that comes with the FPHM is enough to recognize what I do as “special.”
Will the Examination for the FPHM Reflect What I Do?
Yes. I’ve had several colleagues tell me they’ve heard that the examination will contain elements not found on the standard MOC test. This is true, but it also is the major benefit of the new test. As reported on the ABIM website, the FPHM MOC exam will consist of roughly 45% inpatient medicine, 15% consultative and comanagement work, 15% transitions and ambulatory medicine, 15% patient safety/quality improvement, 5% epidemiology, and 5% ethics and end-of-life care. In this respect, it better reflects what most of us spend most of our time doing—inpatient care, consultative medicine, and transitions of care. Those three areas comprise nearly 75% of the examination. The one area that is new is the focus on patient safety and quality. However, for a field built on the promise of improving the quality, safety, and efficiency of healthcare, this is a welcome change.
Will I Be Able to Prepare for the FPHM Exam?
Yes. Because the FPHM utilizes a different exam than the standard IM MOC, some physicians are concerned that they there are no avenues for preparation, but this is not true. While the exam will weigh various portions of the test differently (e.g., less ambulatory and more inpatient content), the inpatient content will be similar to what is currently on the standard MOC test. After all, heart failure, cellulitis, and pulmonary embolism are the same, regardless of the test it shows up on.
The difference is that there will be more of it—a good thing for the practicing hospitalist. Many of the standard IM test preparation options will help you prepare for the FPHM exam. The ABIM also offers HM knowledge modules as part of the enrollment fee, which, while not meant to be preparation for the exam, can help you identify gaps in your knowledge. The blueprint for the exam is on the ABIM website and can give you clues to areas in which to prepare.
It is true that there will be patient safety and QI content on the HM test, which might not be available for study in typical board review books. However, much of this is the kind of information hospitalists live every day, such as handoffs, transitions of care, and infection control.
Should I Fear the Change?
Humans are intrinsically wired to dislike change. It’s that old saw about choosing the devil we know rather than the devil we don’t. My guess is that much of the concern around the new process stems from this human sentiment—it’s just easier to not do the FPHM and go down the standard IM MOC route. We must avoid this temptation.
The FPHM is a key step in solidifying HM’s status in the healthcare milieu. It gives us credibility in a way no other designation can. It also allows those of us who are serious about an HM career to differentiate ourselves from those who masquerade as hospitalists. And, most importantly, it allows us to demonstrate to our patients our sincere commitment to improving the quality of the inpatient systems that envelop them at their sickest moments.
For that reason alone, I’m enrolling in the FPHM MOC. TH
Dr. Glasheen is physician editor of The Hospitalist.
Registration for the Focused Practice in Hospital Medicine (FPHM) Maintenance of Certification (MOC) through the American Board of Internal Medicine (ABIM) opened March 15. Since then, hundreds of board-certified IM physicians have registered to complete their MOC through the FPHM. For those of you who haven’t gone through MOC yet, it is required every 10 years in order to maintain your board certification.
As a member of the committee tasked with helping ABIM develop the FPHM, as well as write the FPHM examination, I’m frequently asked questions about this process, especially since FPHM was featured on the May 2010 cover of this magazine. Some of the questions stem from the perplexity associated with this significant change to the MOC process. Others arise from misinformation and apprehension, and could rightly be called urban legends. Here is a sample of those questions, with their respective veracity.
Does This Certification Mean I’ll No Longer be an Internist?
No. I clearly remember the day I found out I passed the ABIM certification exam; it represented the culmination of years of work, the pinnacle. All those long hours of study, late-night admissions, and exam preparation had finally paid off. I was a board-certified internist! I cherish my board certification and hold it out as recognition of my mastery of the field of IM. As such, I certainly understand the concern that entering the FPHM will somehow result in “losing” IM certification. However, this just isn’t true.
First, all diplomates—ABIM terminology for those enrolled in the board (re)certification process—in the FPHM are certified as internists. This is simply, as the name suggests, recognition of focused practice in HM—the core certification is still in IM. We are still internists—just internists who have focused our practice to hospital care. The formal board designation will read: ABIM Board Certified in Internal Medicine with a Focused Practice in Hospital Medicine.
Will Hospital Credentialing Boards Recognize This Certification?
Yes. The FPHM is certification in IM by the ABIM. This carries the same weight and meaning as the regular IM MOC. All credentialing boards that recognize the ABIM MOC in IM will recognize the FPHM.
Is the FPHM MOC More Rigorous Than the Regular IM MOC?
Yes, and it was intentional. It is recognized that hospitalists do things that make them “special” by acquiring and refining skills learned experientially outside of a supervised training program. Thus, one can attain FPHM board designation only after three years of practice as a hospitalist. The problem is that this is largely unsupervised time (unlike a fellowship), so the threshold to ensure we have achieved a level of competency has to be established through the MOC process.
As such, the bar for the MOC for FPHM has been set higher. The upshot is that to maintain designation of FPHM, hospitalists are required to achieve 60 self-evaluation points every three years, compared with 100 points every 10 years for IM MOC. Forty of those 60 points must come in the form of Practice Improvement Modules, or PIMs. While more rigorous, it only makes sense that a group committed to the improvement of healthcare quality would commit to higher levels of quality assurance.
Will the FPHM Confer Subspecialty Status to Hospitalists?
No. This is where there has been the greatest deal of controversy surrounding the FPHM program. FPHM is not a subspecialty certification. Rather, it is MOC for IM physicians who focus their practice in the hospital setting. The American Board of Medical Specialties (ABMS), the group that oversees the ABIM, is very clear that only training-based subspecialties can be deemed board-certified subspecialties.
Still, the new FPHM will differentiate hospitalists from nonhospitalists. To me, this is semantics, and the recognition that comes with the FPHM is enough to recognize what I do as “special.”
Will the Examination for the FPHM Reflect What I Do?
Yes. I’ve had several colleagues tell me they’ve heard that the examination will contain elements not found on the standard MOC test. This is true, but it also is the major benefit of the new test. As reported on the ABIM website, the FPHM MOC exam will consist of roughly 45% inpatient medicine, 15% consultative and comanagement work, 15% transitions and ambulatory medicine, 15% patient safety/quality improvement, 5% epidemiology, and 5% ethics and end-of-life care. In this respect, it better reflects what most of us spend most of our time doing—inpatient care, consultative medicine, and transitions of care. Those three areas comprise nearly 75% of the examination. The one area that is new is the focus on patient safety and quality. However, for a field built on the promise of improving the quality, safety, and efficiency of healthcare, this is a welcome change.
Will I Be Able to Prepare for the FPHM Exam?
Yes. Because the FPHM utilizes a different exam than the standard IM MOC, some physicians are concerned that they there are no avenues for preparation, but this is not true. While the exam will weigh various portions of the test differently (e.g., less ambulatory and more inpatient content), the inpatient content will be similar to what is currently on the standard MOC test. After all, heart failure, cellulitis, and pulmonary embolism are the same, regardless of the test it shows up on.
The difference is that there will be more of it—a good thing for the practicing hospitalist. Many of the standard IM test preparation options will help you prepare for the FPHM exam. The ABIM also offers HM knowledge modules as part of the enrollment fee, which, while not meant to be preparation for the exam, can help you identify gaps in your knowledge. The blueprint for the exam is on the ABIM website and can give you clues to areas in which to prepare.
It is true that there will be patient safety and QI content on the HM test, which might not be available for study in typical board review books. However, much of this is the kind of information hospitalists live every day, such as handoffs, transitions of care, and infection control.
Should I Fear the Change?
Humans are intrinsically wired to dislike change. It’s that old saw about choosing the devil we know rather than the devil we don’t. My guess is that much of the concern around the new process stems from this human sentiment—it’s just easier to not do the FPHM and go down the standard IM MOC route. We must avoid this temptation.
The FPHM is a key step in solidifying HM’s status in the healthcare milieu. It gives us credibility in a way no other designation can. It also allows those of us who are serious about an HM career to differentiate ourselves from those who masquerade as hospitalists. And, most importantly, it allows us to demonstrate to our patients our sincere commitment to improving the quality of the inpatient systems that envelop them at their sickest moments.
For that reason alone, I’m enrolling in the FPHM MOC. TH
Dr. Glasheen is physician editor of The Hospitalist.
Transitions Telethon
The headline was as biting as it was inciting. “Frustrations with hospitalist care: Need to improve transitions and communication,” it screamed from the cover of a recent issue of the Annals of Internal Medicine.1 Reading on the run, I thumbed to page 469 and glanced at the first few paragraphs, my mind spinning with the implications.
The article was an editorial following a recent thought piece by a primary-care physician (PCP) frustrated with his interactions with the HM model—mainly around the lack of communication from hospitalists about his patients, his marginalized role with his patients’ hospital care, and the lack of information transfer around transitions.2
Frustrations and Slapstick Comedy
Frustration with hospitalist care? Is this how PCPs see us? Are we really “frustrating” our outpatient colleagues? To an outsider, this presented a one-sided view of the issue—the side that sounds simplistically negative. What if someone important to our group should read this article, someone like my hospital CEO? I didn’t have to wonder for long as I looked up from my elevator reading to note my hospital CEO entering.
What followed eerily resembled one of those scenes from a slapstick comedy, as the boob, played perfectly by me, obviously fumbles something he intends to hide from his boss behind his back to escape the knowing eye of said boss. And, like a pornographic-magazine-sniffing parent, my CEO knowingly diagnosed the situation.
“Whatcha reading?” he sagely queried.
“Nothing,” I replied unconvincingly.
“Nothing? It sure looks like you hastily stuffed a magazine or something down the back of your pants as I walked in.”
“Oh, this?” I responded, unearthing a large medical journal from my pants, leaving an untucked shirt in its wake. “This is just a medical journal. You know, lots of medical stuff. It’s pretty complex. Probably hard for nonmedical types to understand,” I replied, employing a bit of professorial condescension to throw him off track.
“Annals of Internal Medicine,” he replied. “What a coincidence. I just received an e-mail from a friend with an Annals article about the issues of transitions of care with the hospitalist model. Sounds like a real problem. Maybe our new electronic health records will fix that. If not, you should fix it. Let’s chat about it soon.”
“Right,” I said as the elevator doors swished behind him, leaving me disheveled in both appearance and thoughts.
Testimonials?
The more recent Annals editorial summarized—and then printed—a few of the many online responses to the original thought piece.3 The responses ranged from outrage with the HM model of care to more measured discussions of the limitations of the “old” model it replaced. However, the tone and implications were clear: At least some, if not many, PCPs are displeased with the HM model.
One writer related a recent example in which his elderly patient was admitted unbeknownst to him. After receiving a query from a family member, he called the hospitalist on duty, who was uninformed about the patient details, had made questionable therapeutic changes, and was “unapologetic” about her team’s lack of communication, arguing that the ED physician “should have called.” That led this PCP to conclude that the system is “disjointed and isolating,” leaving “patients feeling abandoned.” Another writer commented that the current system of communication results in “potentially detrimental and demoralizing degrees of separation.” A response by a hospitalist detailed how they were able to put a system in place to contact PCPs with whom they are contracted 80% of the time.
The Annals editors concluded that the letters they received in response to the first article “reflect a schism that exists in internal medicine about the positive and negative effects of hospitalist care,” noting that “the evidence is still deficient about how to deliver care optimally when complex, seriously-ill patients must transition between multiple providers in diverse health care settings.” The authors go on to call for “intensive research and productive debates” about the HM model of care.
A Challenge to You
“Disjointed and isolating”? … “Detrimental and demoralizing”? … Lauding 80% PCP contact rates? … “Intensive research and debate”?
I get that this is a complex issue and that healthcare in the U.S. is fragmented to the point of fracture. To wit, it can be agonizingly time-consuming to track down PCPs and wade through their automated phone systems. And this assumes that your patient has a PCP, can identify that PCP, and has their phone number. If they don’t, you’re left to sift through online phone books, clinic websites, or Google searches with the hopes that you can summon the right Dr. Davis, Davies, or Daves—the patient’s not quite sure of the spelling but knows “she’s a nice lady doctor.” I know firsthand the tension between taking the time to make that PCP call and getting home in time for dinner with my family—I’m often guilty of choosing dinner.
However, I’m not sure “intensive research” is the answer. Nor is this a problem that can wait for technological solutions. I don’t want to diminish the great strides that have been made or understate the need to continue to innovate around transitions—this needs to be an area of ongoing study. But this is a problem that has at least one relatively simple, short-term solution: Just pick up the phone. As one Annals writer rightly questions: “How has inter-physician communication come to be regarded as an unexpected courtesy rather than an obligation?”
Good question.
So, I have a simple challenge for you: For one week, join me in committing to calling 100% of the available PCPs on patient discharge. I can guarantee you this will prove to be a hard, time-consuming, and, at times, migraine-inducing process. But it is an intervention that will make a difference, can be launched tomorrow, and does not require “intensive research and debate.”
We’ll no doubt gain some insight into our patients’ current therapeutic regimens, enlist PCPs’ help with the treatment decisions, and ensure that our patients’ transitions are as safe as possible. My guess is that we’ll also find it valuable to the point it becomes habit.
Start by committing with me to just one week.
Then go home and have dinner. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Frustrations with hospitalist care: need to improve transitions and communication. Ann Intern Med. 2010;152(7):469.
- Beckman H. Three degrees of separation. Ann Intern Med. 2009;151(12):890-891.
- The relationship between hospitalists and primary care physicians. Ann Intern Med. 2010;152(7):474-6.
The headline was as biting as it was inciting. “Frustrations with hospitalist care: Need to improve transitions and communication,” it screamed from the cover of a recent issue of the Annals of Internal Medicine.1 Reading on the run, I thumbed to page 469 and glanced at the first few paragraphs, my mind spinning with the implications.
The article was an editorial following a recent thought piece by a primary-care physician (PCP) frustrated with his interactions with the HM model—mainly around the lack of communication from hospitalists about his patients, his marginalized role with his patients’ hospital care, and the lack of information transfer around transitions.2
Frustrations and Slapstick Comedy
Frustration with hospitalist care? Is this how PCPs see us? Are we really “frustrating” our outpatient colleagues? To an outsider, this presented a one-sided view of the issue—the side that sounds simplistically negative. What if someone important to our group should read this article, someone like my hospital CEO? I didn’t have to wonder for long as I looked up from my elevator reading to note my hospital CEO entering.
What followed eerily resembled one of those scenes from a slapstick comedy, as the boob, played perfectly by me, obviously fumbles something he intends to hide from his boss behind his back to escape the knowing eye of said boss. And, like a pornographic-magazine-sniffing parent, my CEO knowingly diagnosed the situation.
“Whatcha reading?” he sagely queried.
“Nothing,” I replied unconvincingly.
“Nothing? It sure looks like you hastily stuffed a magazine or something down the back of your pants as I walked in.”
“Oh, this?” I responded, unearthing a large medical journal from my pants, leaving an untucked shirt in its wake. “This is just a medical journal. You know, lots of medical stuff. It’s pretty complex. Probably hard for nonmedical types to understand,” I replied, employing a bit of professorial condescension to throw him off track.
“Annals of Internal Medicine,” he replied. “What a coincidence. I just received an e-mail from a friend with an Annals article about the issues of transitions of care with the hospitalist model. Sounds like a real problem. Maybe our new electronic health records will fix that. If not, you should fix it. Let’s chat about it soon.”
“Right,” I said as the elevator doors swished behind him, leaving me disheveled in both appearance and thoughts.
Testimonials?
The more recent Annals editorial summarized—and then printed—a few of the many online responses to the original thought piece.3 The responses ranged from outrage with the HM model of care to more measured discussions of the limitations of the “old” model it replaced. However, the tone and implications were clear: At least some, if not many, PCPs are displeased with the HM model.
One writer related a recent example in which his elderly patient was admitted unbeknownst to him. After receiving a query from a family member, he called the hospitalist on duty, who was uninformed about the patient details, had made questionable therapeutic changes, and was “unapologetic” about her team’s lack of communication, arguing that the ED physician “should have called.” That led this PCP to conclude that the system is “disjointed and isolating,” leaving “patients feeling abandoned.” Another writer commented that the current system of communication results in “potentially detrimental and demoralizing degrees of separation.” A response by a hospitalist detailed how they were able to put a system in place to contact PCPs with whom they are contracted 80% of the time.
The Annals editors concluded that the letters they received in response to the first article “reflect a schism that exists in internal medicine about the positive and negative effects of hospitalist care,” noting that “the evidence is still deficient about how to deliver care optimally when complex, seriously-ill patients must transition between multiple providers in diverse health care settings.” The authors go on to call for “intensive research and productive debates” about the HM model of care.
A Challenge to You
“Disjointed and isolating”? … “Detrimental and demoralizing”? … Lauding 80% PCP contact rates? … “Intensive research and debate”?
I get that this is a complex issue and that healthcare in the U.S. is fragmented to the point of fracture. To wit, it can be agonizingly time-consuming to track down PCPs and wade through their automated phone systems. And this assumes that your patient has a PCP, can identify that PCP, and has their phone number. If they don’t, you’re left to sift through online phone books, clinic websites, or Google searches with the hopes that you can summon the right Dr. Davis, Davies, or Daves—the patient’s not quite sure of the spelling but knows “she’s a nice lady doctor.” I know firsthand the tension between taking the time to make that PCP call and getting home in time for dinner with my family—I’m often guilty of choosing dinner.
However, I’m not sure “intensive research” is the answer. Nor is this a problem that can wait for technological solutions. I don’t want to diminish the great strides that have been made or understate the need to continue to innovate around transitions—this needs to be an area of ongoing study. But this is a problem that has at least one relatively simple, short-term solution: Just pick up the phone. As one Annals writer rightly questions: “How has inter-physician communication come to be regarded as an unexpected courtesy rather than an obligation?”
Good question.
So, I have a simple challenge for you: For one week, join me in committing to calling 100% of the available PCPs on patient discharge. I can guarantee you this will prove to be a hard, time-consuming, and, at times, migraine-inducing process. But it is an intervention that will make a difference, can be launched tomorrow, and does not require “intensive research and debate.”
We’ll no doubt gain some insight into our patients’ current therapeutic regimens, enlist PCPs’ help with the treatment decisions, and ensure that our patients’ transitions are as safe as possible. My guess is that we’ll also find it valuable to the point it becomes habit.
Start by committing with me to just one week.
Then go home and have dinner. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Frustrations with hospitalist care: need to improve transitions and communication. Ann Intern Med. 2010;152(7):469.
- Beckman H. Three degrees of separation. Ann Intern Med. 2009;151(12):890-891.
- The relationship between hospitalists and primary care physicians. Ann Intern Med. 2010;152(7):474-6.
The headline was as biting as it was inciting. “Frustrations with hospitalist care: Need to improve transitions and communication,” it screamed from the cover of a recent issue of the Annals of Internal Medicine.1 Reading on the run, I thumbed to page 469 and glanced at the first few paragraphs, my mind spinning with the implications.
The article was an editorial following a recent thought piece by a primary-care physician (PCP) frustrated with his interactions with the HM model—mainly around the lack of communication from hospitalists about his patients, his marginalized role with his patients’ hospital care, and the lack of information transfer around transitions.2
Frustrations and Slapstick Comedy
Frustration with hospitalist care? Is this how PCPs see us? Are we really “frustrating” our outpatient colleagues? To an outsider, this presented a one-sided view of the issue—the side that sounds simplistically negative. What if someone important to our group should read this article, someone like my hospital CEO? I didn’t have to wonder for long as I looked up from my elevator reading to note my hospital CEO entering.
What followed eerily resembled one of those scenes from a slapstick comedy, as the boob, played perfectly by me, obviously fumbles something he intends to hide from his boss behind his back to escape the knowing eye of said boss. And, like a pornographic-magazine-sniffing parent, my CEO knowingly diagnosed the situation.
“Whatcha reading?” he sagely queried.
“Nothing,” I replied unconvincingly.
“Nothing? It sure looks like you hastily stuffed a magazine or something down the back of your pants as I walked in.”
“Oh, this?” I responded, unearthing a large medical journal from my pants, leaving an untucked shirt in its wake. “This is just a medical journal. You know, lots of medical stuff. It’s pretty complex. Probably hard for nonmedical types to understand,” I replied, employing a bit of professorial condescension to throw him off track.
“Annals of Internal Medicine,” he replied. “What a coincidence. I just received an e-mail from a friend with an Annals article about the issues of transitions of care with the hospitalist model. Sounds like a real problem. Maybe our new electronic health records will fix that. If not, you should fix it. Let’s chat about it soon.”
“Right,” I said as the elevator doors swished behind him, leaving me disheveled in both appearance and thoughts.
Testimonials?
The more recent Annals editorial summarized—and then printed—a few of the many online responses to the original thought piece.3 The responses ranged from outrage with the HM model of care to more measured discussions of the limitations of the “old” model it replaced. However, the tone and implications were clear: At least some, if not many, PCPs are displeased with the HM model.
One writer related a recent example in which his elderly patient was admitted unbeknownst to him. After receiving a query from a family member, he called the hospitalist on duty, who was uninformed about the patient details, had made questionable therapeutic changes, and was “unapologetic” about her team’s lack of communication, arguing that the ED physician “should have called.” That led this PCP to conclude that the system is “disjointed and isolating,” leaving “patients feeling abandoned.” Another writer commented that the current system of communication results in “potentially detrimental and demoralizing degrees of separation.” A response by a hospitalist detailed how they were able to put a system in place to contact PCPs with whom they are contracted 80% of the time.
The Annals editors concluded that the letters they received in response to the first article “reflect a schism that exists in internal medicine about the positive and negative effects of hospitalist care,” noting that “the evidence is still deficient about how to deliver care optimally when complex, seriously-ill patients must transition between multiple providers in diverse health care settings.” The authors go on to call for “intensive research and productive debates” about the HM model of care.
A Challenge to You
“Disjointed and isolating”? … “Detrimental and demoralizing”? … Lauding 80% PCP contact rates? … “Intensive research and debate”?
I get that this is a complex issue and that healthcare in the U.S. is fragmented to the point of fracture. To wit, it can be agonizingly time-consuming to track down PCPs and wade through their automated phone systems. And this assumes that your patient has a PCP, can identify that PCP, and has their phone number. If they don’t, you’re left to sift through online phone books, clinic websites, or Google searches with the hopes that you can summon the right Dr. Davis, Davies, or Daves—the patient’s not quite sure of the spelling but knows “she’s a nice lady doctor.” I know firsthand the tension between taking the time to make that PCP call and getting home in time for dinner with my family—I’m often guilty of choosing dinner.
However, I’m not sure “intensive research” is the answer. Nor is this a problem that can wait for technological solutions. I don’t want to diminish the great strides that have been made or understate the need to continue to innovate around transitions—this needs to be an area of ongoing study. But this is a problem that has at least one relatively simple, short-term solution: Just pick up the phone. As one Annals writer rightly questions: “How has inter-physician communication come to be regarded as an unexpected courtesy rather than an obligation?”
Good question.
So, I have a simple challenge for you: For one week, join me in committing to calling 100% of the available PCPs on patient discharge. I can guarantee you this will prove to be a hard, time-consuming, and, at times, migraine-inducing process. But it is an intervention that will make a difference, can be launched tomorrow, and does not require “intensive research and debate.”
We’ll no doubt gain some insight into our patients’ current therapeutic regimens, enlist PCPs’ help with the treatment decisions, and ensure that our patients’ transitions are as safe as possible. My guess is that we’ll also find it valuable to the point it becomes habit.
Start by committing with me to just one week.
Then go home and have dinner. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
References
- Frustrations with hospitalist care: need to improve transitions and communication. Ann Intern Med. 2010;152(7):469.
- Beckman H. Three degrees of separation. Ann Intern Med. 2009;151(12):890-891.
- The relationship between hospitalists and primary care physicians. Ann Intern Med. 2010;152(7):474-6.
What I Learned
As I write, I’m fighting the jet stream from Washington, D.C., to Denver, midflight on my return from HM10. I’m 30,000 feet above the ground—literally and figuratively—my mind spinning with the thoughts, ideas, and memories from the largest gathering of hospitalists ever. In the end, 2,500 hospitalists descended on our nation’s capital. Shrouded by the din of healthcare reform, we discussed, deliberated, and discovered what’s new in the clinical, political, and programmatic world of HM. Out of this churn, I learned a lot. Here’s but a small sample.
Smart People = Smart Solutions
I learned that if you put really smart people in a room and give them a problem to grapple with, they come up with really smart solutions. At the inaugural Academic Hospital Medicine Leadership Summit, 100 of the brightest, most influential academic hospitalists convened to tackle the problems facing our field.
The output was an amazing crop of inventive ideas aimed at taming the vexing issues surrounding clinical sustainability, academic viability, and career satisfaction. SHM leadership has heard the cry and promises to work closely with the academic community to transform these smart solutions into future initiatives.
Hospitalists Support Healthcare Reform, Should Collude with Hospitals
I learned that most of us support the recently passed healthcare reform legislation, with a few notable dissenters. In response to a question from the chair of SHM’s Public Policy Committee, the vast majority of attendees at the opening plenary session raised their hands affirmatively in response to the question of whether they support the reform bill. Meanwhile, nearly everyone in the crowd felt it is important that SHM have an opinion regarding the legislation and continue to work closely with Congress to ensure its implementation helps our most important constituent—our patients.
Finally, I learned that Ron Greeno, CMO of Brentwood, Tenn.-based Cogent Healthcare, believes that the development of accountable-care organizations might lead hospitalists to align with hospitals to keep costs down. In fact, he saw this as a welcome, intended consequence. In his opinion, this “collusion” promises to raise the quality of care and reduce waste in the system—a statement that was met with applause from the plenary crowd.
The Healthcare Paradox
I learned that blogs save lives. Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, roused the crowd during his keynote address by relating the power of transparency. Bothered by the paradox that the medical profession, comprising the most well-intentioned people in the world, could kill so many people through errors (ranked the No. 4 public health hazard in the U.S.), Levy decided to make his hospital’s struggles public.
On his blog, Running a Hospital (runningahospital.blogspot.com), he took the extraordinary step of publically documenting the rates of harm caused at his medical center for the world to see. Additionally, he set audacious goals to reduce the amount of harm to zero. He encouraged hospital staff to raise issues of safety and efficiency as a way to avoid the workarounds—shortcuts—that ultimately increase variability and reduce quality without addressing the core problem.
In response, the staff swarms the problem to rapidly improve the process and ultimately return the system back to homeostasis. The results of this effort can be viewed at Levy’s hospital’s website (www.bidmc.org/QualityandSafety.aspx).
Which Hill Will You Climb?
I learned that leadership is the ability to help people address problems that make the world better. At a much-anticipated presentation, Peter Pronovost, MD, of Johns Hopkins Hospital in Baltimore related a transformative story from his youth. At a summer camp, each boy was assigned to one of three groups and tasked with climbing a seemingly insurmountable hill. The first camp counselor pummeled the group with overbearing directions, directives, and derision, and in the end the group failed to conquer the hill. The second counselor took a more relaxed approach, giving the group essentially no direction. They, too, failed.
The final counselor offered nothing but the inspiration of how marvelous the view from the top of the hill would be and how they’d all have to pull together and work as a team if they wanted to attain that greatness. Dr. Pronovost was in this last group, and has been summiting insurmountable peaks ever since.
You likely are familiar with Dr. Pronovost’s work on ICU line infections. He elaborated on how he accomplished a rate of zero line infections, first at his hospital and then throughout the entire state of Michigan. The key was an inspiring vision and, once again, removal of workarounds. After compiling a checklist of the five most crucial components of line placement and management, Hopkins personnel discovered they were only compliant with the checklist 30% of the time—mostly due to shortcuts caused by inefficient systems that placed supplies too far from the clinical-care setting. After removing those barriers, the compliance rate went to 70%. It was only after empowering the nursing staff to stop physicians from proceeding with line placement unless the checklist was followed that the team was able to achieve 100% compliance.
Today, patients in the Johns Hopkins cardiovascular unit have not suffered a line infection for 87 consecutive weeks. That’s a hill worth climbing.
Saving Lives and Canine Castaways
I learned that the SHM annual meeting is attracting the highest echelon of clinical speakers. Whether it was Dr. Pronovost speaking about line infections, Dr. Greg Fonarow discussing congestive heart failure, or Dr. John Bartlett presenting on Clostrium difficile infections, HM10 featured world-class speakers.
For example, Dr. Bartlett’s work has defined the C. diff field, and the opportunity to hear him was incredible. I learned from him that severe C. diff infections are on the rise and that recurrences are tougher than ever to treat. I also learned that there are mixed data on whether nurses can detect C. diff based on stool smell alone; that up to 10% of dogs carry C. diff (out of the bed, Hogan and Grady!); and that stool transplants are becoming a quality- and quantity-of-life-saving treatment for those with severe bouts of recurrent C. diff.
To quote Dr. Bartlett, “pathophysiologically, it’s a dream; aesthetically, it sucks.”
Homeward Bound
Finally, I learned that every year, SHM feels more and more like my second family, with the annual meeting its family reunion. I saw tons of friends, made dozens more, and look forward to next year in Dallas.
Mostly, however, I was reminded of the emotional tug of being away from home, the emotive power of a few e-mailed photos of your kids, and how great if feels to turn off your electronic devices and return your folding tray and seat back to the upright and locked position. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
As I write, I’m fighting the jet stream from Washington, D.C., to Denver, midflight on my return from HM10. I’m 30,000 feet above the ground—literally and figuratively—my mind spinning with the thoughts, ideas, and memories from the largest gathering of hospitalists ever. In the end, 2,500 hospitalists descended on our nation’s capital. Shrouded by the din of healthcare reform, we discussed, deliberated, and discovered what’s new in the clinical, political, and programmatic world of HM. Out of this churn, I learned a lot. Here’s but a small sample.
Smart People = Smart Solutions
I learned that if you put really smart people in a room and give them a problem to grapple with, they come up with really smart solutions. At the inaugural Academic Hospital Medicine Leadership Summit, 100 of the brightest, most influential academic hospitalists convened to tackle the problems facing our field.
The output was an amazing crop of inventive ideas aimed at taming the vexing issues surrounding clinical sustainability, academic viability, and career satisfaction. SHM leadership has heard the cry and promises to work closely with the academic community to transform these smart solutions into future initiatives.
Hospitalists Support Healthcare Reform, Should Collude with Hospitals
I learned that most of us support the recently passed healthcare reform legislation, with a few notable dissenters. In response to a question from the chair of SHM’s Public Policy Committee, the vast majority of attendees at the opening plenary session raised their hands affirmatively in response to the question of whether they support the reform bill. Meanwhile, nearly everyone in the crowd felt it is important that SHM have an opinion regarding the legislation and continue to work closely with Congress to ensure its implementation helps our most important constituent—our patients.
Finally, I learned that Ron Greeno, CMO of Brentwood, Tenn.-based Cogent Healthcare, believes that the development of accountable-care organizations might lead hospitalists to align with hospitals to keep costs down. In fact, he saw this as a welcome, intended consequence. In his opinion, this “collusion” promises to raise the quality of care and reduce waste in the system—a statement that was met with applause from the plenary crowd.
The Healthcare Paradox
I learned that blogs save lives. Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, roused the crowd during his keynote address by relating the power of transparency. Bothered by the paradox that the medical profession, comprising the most well-intentioned people in the world, could kill so many people through errors (ranked the No. 4 public health hazard in the U.S.), Levy decided to make his hospital’s struggles public.
On his blog, Running a Hospital (runningahospital.blogspot.com), he took the extraordinary step of publically documenting the rates of harm caused at his medical center for the world to see. Additionally, he set audacious goals to reduce the amount of harm to zero. He encouraged hospital staff to raise issues of safety and efficiency as a way to avoid the workarounds—shortcuts—that ultimately increase variability and reduce quality without addressing the core problem.
In response, the staff swarms the problem to rapidly improve the process and ultimately return the system back to homeostasis. The results of this effort can be viewed at Levy’s hospital’s website (www.bidmc.org/QualityandSafety.aspx).
Which Hill Will You Climb?
I learned that leadership is the ability to help people address problems that make the world better. At a much-anticipated presentation, Peter Pronovost, MD, of Johns Hopkins Hospital in Baltimore related a transformative story from his youth. At a summer camp, each boy was assigned to one of three groups and tasked with climbing a seemingly insurmountable hill. The first camp counselor pummeled the group with overbearing directions, directives, and derision, and in the end the group failed to conquer the hill. The second counselor took a more relaxed approach, giving the group essentially no direction. They, too, failed.
The final counselor offered nothing but the inspiration of how marvelous the view from the top of the hill would be and how they’d all have to pull together and work as a team if they wanted to attain that greatness. Dr. Pronovost was in this last group, and has been summiting insurmountable peaks ever since.
You likely are familiar with Dr. Pronovost’s work on ICU line infections. He elaborated on how he accomplished a rate of zero line infections, first at his hospital and then throughout the entire state of Michigan. The key was an inspiring vision and, once again, removal of workarounds. After compiling a checklist of the five most crucial components of line placement and management, Hopkins personnel discovered they were only compliant with the checklist 30% of the time—mostly due to shortcuts caused by inefficient systems that placed supplies too far from the clinical-care setting. After removing those barriers, the compliance rate went to 70%. It was only after empowering the nursing staff to stop physicians from proceeding with line placement unless the checklist was followed that the team was able to achieve 100% compliance.
Today, patients in the Johns Hopkins cardiovascular unit have not suffered a line infection for 87 consecutive weeks. That’s a hill worth climbing.
Saving Lives and Canine Castaways
I learned that the SHM annual meeting is attracting the highest echelon of clinical speakers. Whether it was Dr. Pronovost speaking about line infections, Dr. Greg Fonarow discussing congestive heart failure, or Dr. John Bartlett presenting on Clostrium difficile infections, HM10 featured world-class speakers.
For example, Dr. Bartlett’s work has defined the C. diff field, and the opportunity to hear him was incredible. I learned from him that severe C. diff infections are on the rise and that recurrences are tougher than ever to treat. I also learned that there are mixed data on whether nurses can detect C. diff based on stool smell alone; that up to 10% of dogs carry C. diff (out of the bed, Hogan and Grady!); and that stool transplants are becoming a quality- and quantity-of-life-saving treatment for those with severe bouts of recurrent C. diff.
To quote Dr. Bartlett, “pathophysiologically, it’s a dream; aesthetically, it sucks.”
Homeward Bound
Finally, I learned that every year, SHM feels more and more like my second family, with the annual meeting its family reunion. I saw tons of friends, made dozens more, and look forward to next year in Dallas.
Mostly, however, I was reminded of the emotional tug of being away from home, the emotive power of a few e-mailed photos of your kids, and how great if feels to turn off your electronic devices and return your folding tray and seat back to the upright and locked position. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.
As I write, I’m fighting the jet stream from Washington, D.C., to Denver, midflight on my return from HM10. I’m 30,000 feet above the ground—literally and figuratively—my mind spinning with the thoughts, ideas, and memories from the largest gathering of hospitalists ever. In the end, 2,500 hospitalists descended on our nation’s capital. Shrouded by the din of healthcare reform, we discussed, deliberated, and discovered what’s new in the clinical, political, and programmatic world of HM. Out of this churn, I learned a lot. Here’s but a small sample.
Smart People = Smart Solutions
I learned that if you put really smart people in a room and give them a problem to grapple with, they come up with really smart solutions. At the inaugural Academic Hospital Medicine Leadership Summit, 100 of the brightest, most influential academic hospitalists convened to tackle the problems facing our field.
The output was an amazing crop of inventive ideas aimed at taming the vexing issues surrounding clinical sustainability, academic viability, and career satisfaction. SHM leadership has heard the cry and promises to work closely with the academic community to transform these smart solutions into future initiatives.
Hospitalists Support Healthcare Reform, Should Collude with Hospitals
I learned that most of us support the recently passed healthcare reform legislation, with a few notable dissenters. In response to a question from the chair of SHM’s Public Policy Committee, the vast majority of attendees at the opening plenary session raised their hands affirmatively in response to the question of whether they support the reform bill. Meanwhile, nearly everyone in the crowd felt it is important that SHM have an opinion regarding the legislation and continue to work closely with Congress to ensure its implementation helps our most important constituent—our patients.
Finally, I learned that Ron Greeno, CMO of Brentwood, Tenn.-based Cogent Healthcare, believes that the development of accountable-care organizations might lead hospitalists to align with hospitals to keep costs down. In fact, he saw this as a welcome, intended consequence. In his opinion, this “collusion” promises to raise the quality of care and reduce waste in the system—a statement that was met with applause from the plenary crowd.
The Healthcare Paradox
I learned that blogs save lives. Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, roused the crowd during his keynote address by relating the power of transparency. Bothered by the paradox that the medical profession, comprising the most well-intentioned people in the world, could kill so many people through errors (ranked the No. 4 public health hazard in the U.S.), Levy decided to make his hospital’s struggles public.
On his blog, Running a Hospital (runningahospital.blogspot.com), he took the extraordinary step of publically documenting the rates of harm caused at his medical center for the world to see. Additionally, he set audacious goals to reduce the amount of harm to zero. He encouraged hospital staff to raise issues of safety and efficiency as a way to avoid the workarounds—shortcuts—that ultimately increase variability and reduce quality without addressing the core problem.
In response, the staff swarms the problem to rapidly improve the process and ultimately return the system back to homeostasis. The results of this effort can be viewed at Levy’s hospital’s website (www.bidmc.org/QualityandSafety.aspx).
Which Hill Will You Climb?
I learned that leadership is the ability to help people address problems that make the world better. At a much-anticipated presentation, Peter Pronovost, MD, of Johns Hopkins Hospital in Baltimore related a transformative story from his youth. At a summer camp, each boy was assigned to one of three groups and tasked with climbing a seemingly insurmountable hill. The first camp counselor pummeled the group with overbearing directions, directives, and derision, and in the end the group failed to conquer the hill. The second counselor took a more relaxed approach, giving the group essentially no direction. They, too, failed.
The final counselor offered nothing but the inspiration of how marvelous the view from the top of the hill would be and how they’d all have to pull together and work as a team if they wanted to attain that greatness. Dr. Pronovost was in this last group, and has been summiting insurmountable peaks ever since.
You likely are familiar with Dr. Pronovost’s work on ICU line infections. He elaborated on how he accomplished a rate of zero line infections, first at his hospital and then throughout the entire state of Michigan. The key was an inspiring vision and, once again, removal of workarounds. After compiling a checklist of the five most crucial components of line placement and management, Hopkins personnel discovered they were only compliant with the checklist 30% of the time—mostly due to shortcuts caused by inefficient systems that placed supplies too far from the clinical-care setting. After removing those barriers, the compliance rate went to 70%. It was only after empowering the nursing staff to stop physicians from proceeding with line placement unless the checklist was followed that the team was able to achieve 100% compliance.
Today, patients in the Johns Hopkins cardiovascular unit have not suffered a line infection for 87 consecutive weeks. That’s a hill worth climbing.
Saving Lives and Canine Castaways
I learned that the SHM annual meeting is attracting the highest echelon of clinical speakers. Whether it was Dr. Pronovost speaking about line infections, Dr. Greg Fonarow discussing congestive heart failure, or Dr. John Bartlett presenting on Clostrium difficile infections, HM10 featured world-class speakers.
For example, Dr. Bartlett’s work has defined the C. diff field, and the opportunity to hear him was incredible. I learned from him that severe C. diff infections are on the rise and that recurrences are tougher than ever to treat. I also learned that there are mixed data on whether nurses can detect C. diff based on stool smell alone; that up to 10% of dogs carry C. diff (out of the bed, Hogan and Grady!); and that stool transplants are becoming a quality- and quantity-of-life-saving treatment for those with severe bouts of recurrent C. diff.
To quote Dr. Bartlett, “pathophysiologically, it’s a dream; aesthetically, it sucks.”
Homeward Bound
Finally, I learned that every year, SHM feels more and more like my second family, with the annual meeting its family reunion. I saw tons of friends, made dozens more, and look forward to next year in Dallas.
Mostly, however, I was reminded of the emotional tug of being away from home, the emotive power of a few e-mailed photos of your kids, and how great if feels to turn off your electronic devices and return your folding tray and seat back to the upright and locked position. TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.