Nice to meet

Recently, hospitalists around the country gathered together at Hospital Medicine 2013 to gain new and practical clinical insights we can use to optimize the medical care we provide to our patients, imbibe new research on the horizon, master clinical care guidelines, and sometimes, just relax and enjoy meeting new colleagues from around the country – naturally, comparing notes on how their practices stack up to our own. You could even pick up a book or two geared to hospitalists. I bought "Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine" and "Becoming a Consummate Clinician: What Every Student, House Office, and Hospital Practitioner Needs to Know." Learning just doesn’t get any better than this.

Information abounded, challenges were issued, and I think most of us learned how much we really need to learn more about. I believe we were thoroughly challenged to look at our current practice style, incorporate our new knowledge, and take our clinical acumen to the next level.

The first challenge began when I had to roll out of bed around 5 a.m. to prepare to make the hour-long drive down I-95 to the conference site at National Harbor, Md., to attend a 7:40 a.m. lecture: "Pain Management for the Hospitalist." I have not a single regret. It was well worth the bleary ride. I think many hospitalists share my concerns about overmedicating patients on the one hand, and being on guard for true drug seekers on the other.

My main takeaway was that when a patient is truly in pain, narcotic pain medication can be titrated up much more quickly than most of us currently feel comfortable with.

The lecture was presented by Dr. Eric Roeland of the University of Carolina, San Diego, who said that he sometimes doubles narcotic analgesics every 10 minutes under certain circumstances. Some participants were shocked (including me). He orders a dose of pain medication and then checks on the patient around the time of CMax (maximum concentration of the drug). For IV pain medications, this is approximately 10 minutes, for SC/IM it is 30 minutes, and for PO/PR it is 60 minutes. If his patient has not gotten pain relief by CMax, he orders twice the dose and checks back in again at the next CMax. If the patient still has no relief, Dr. Roeland will order four times the initial dose.

He stated that since sedation comes before respiratory depression, he feels comfortable increasing narcotics rapidly in patients who are "alert and playing Atari" or are otherwise highly functional. (I didn’t know Atari was still on the market.)

Click here for the presentation slides from this lecture and here for others.

Hope to see you next year when Hospital Medicine meets in Las Vegas!

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a mobile app for iOS.

Recently, hospitalists around the country gathered together at Hospital Medicine 2013 to gain new and practical clinical insights we can use to optimize the medical care we provide to our patients, imbibe new research on the horizon, master clinical care guidelines, and sometimes, just relax and enjoy meeting new colleagues from around the country – naturally, comparing notes on how their practices stack up to our own. You could even pick up a book or two geared to hospitalists. I bought "Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine" and "Becoming a Consummate Clinician: What Every Student, House Office, and Hospital Practitioner Needs to Know." Learning just doesn’t get any better than this.

Information abounded, challenges were issued, and I think most of us learned how much we really need to learn more about. I believe we were thoroughly challenged to look at our current practice style, incorporate our new knowledge, and take our clinical acumen to the next level.

The first challenge began when I had to roll out of bed around 5 a.m. to prepare to make the hour-long drive down I-95 to the conference site at National Harbor, Md., to attend a 7:40 a.m. lecture: "Pain Management for the Hospitalist." I have not a single regret. It was well worth the bleary ride. I think many hospitalists share my concerns about overmedicating patients on the one hand, and being on guard for true drug seekers on the other.

My main takeaway was that when a patient is truly in pain, narcotic pain medication can be titrated up much more quickly than most of us currently feel comfortable with.

The lecture was presented by Dr. Eric Roeland of the University of Carolina, San Diego, who said that he sometimes doubles narcotic analgesics every 10 minutes under certain circumstances. Some participants were shocked (including me). He orders a dose of pain medication and then checks on the patient around the time of CMax (maximum concentration of the drug). For IV pain medications, this is approximately 10 minutes, for SC/IM it is 30 minutes, and for PO/PR it is 60 minutes. If his patient has not gotten pain relief by CMax, he orders twice the dose and checks back in again at the next CMax. If the patient still has no relief, Dr. Roeland will order four times the initial dose.

He stated that since sedation comes before respiratory depression, he feels comfortable increasing narcotics rapidly in patients who are "alert and playing Atari" or are otherwise highly functional. (I didn’t know Atari was still on the market.)

Click here for the presentation slides from this lecture and here for others.

Hope to see you next year when Hospital Medicine meets in Las Vegas!

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a mobile app for iOS.

Recently, hospitalists around the country gathered together at Hospital Medicine 2013 to gain new and practical clinical insights we can use to optimize the medical care we provide to our patients, imbibe new research on the horizon, master clinical care guidelines, and sometimes, just relax and enjoy meeting new colleagues from around the country – naturally, comparing notes on how their practices stack up to our own. You could even pick up a book or two geared to hospitalists. I bought "Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine" and "Becoming a Consummate Clinician: What Every Student, House Office, and Hospital Practitioner Needs to Know." Learning just doesn’t get any better than this.

Information abounded, challenges were issued, and I think most of us learned how much we really need to learn more about. I believe we were thoroughly challenged to look at our current practice style, incorporate our new knowledge, and take our clinical acumen to the next level.

The first challenge began when I had to roll out of bed around 5 a.m. to prepare to make the hour-long drive down I-95 to the conference site at National Harbor, Md., to attend a 7:40 a.m. lecture: "Pain Management for the Hospitalist." I have not a single regret. It was well worth the bleary ride. I think many hospitalists share my concerns about overmedicating patients on the one hand, and being on guard for true drug seekers on the other.

My main takeaway was that when a patient is truly in pain, narcotic pain medication can be titrated up much more quickly than most of us currently feel comfortable with.

The lecture was presented by Dr. Eric Roeland of the University of Carolina, San Diego, who said that he sometimes doubles narcotic analgesics every 10 minutes under certain circumstances. Some participants were shocked (including me). He orders a dose of pain medication and then checks on the patient around the time of CMax (maximum concentration of the drug). For IV pain medications, this is approximately 10 minutes, for SC/IM it is 30 minutes, and for PO/PR it is 60 minutes. If his patient has not gotten pain relief by CMax, he orders twice the dose and checks back in again at the next CMax. If the patient still has no relief, Dr. Roeland will order four times the initial dose.

He stated that since sedation comes before respiratory depression, he feels comfortable increasing narcotics rapidly in patients who are "alert and playing Atari" or are otherwise highly functional. (I didn’t know Atari was still on the market.)

Click here for the presentation slides from this lecture and here for others.

Hope to see you next year when Hospital Medicine meets in Las Vegas!

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center, Glen Burnie, Md., who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a mobile app for iOS.