SHM Converge

After navigating a pandemic that turned the world – including the world of hospital medicine – upside down for so long, the very idea of returning to a “normal” career and way of life can seem strange.

Vineet Arora, MD, MAPP, MHM, assistant dean for scholarship and discovery and associate chief medical officer for clinical learning environment at the University of Chicago, offered guidance to hospitalists on the transition from pandemic life to postpandemic life on May 5 at SHM Converge, the annual conference of the Society of Hospital Medicine.

The pandemic, Dr. Arora said, showed how important it is to develop trust. When resources were scarce as dire COVID-19 cases flooded hospitals, a culture of trust was essential to getting through the crisis.

“My team expects me to speak up on their behalf – it’s how we do things. It’s so germane to safety,” Dr. Arora said. “This is what you’re looking for in your organization – a place of psychological safety and trust.”

Surveys show that patients do trust their physicians, and healthcare providers “got a big bump” in trust during the pandemic, she said, which offers a unique opportunity.

“Doctors are trusted messengers for the COVID vaccine,” she said. “It really does matter.” But clinicians should also advocate for social justice, she said. “We must speak up even louder to fight everyday racism.”

As hospitalists move into the postpandemic medical world, Dr. Arora encouraged them to “get rid of delusions of grandeur,” expecting incredible accomplishments around every corner.

“Amazing things do happen, but oftentimes they happen because we sustain the things we start,” Dr. Arora said. For instance, physicians should consider small changes in workflow, but then sustain those changes. Maintaining pushes for change is not necessarily the norm, she said, adding that all hospitalists are probably familiar with quality improvement projects that generate only 3 months of data, because of lost focus.

Hospitalists should also “seek out information brokers” in the postpandemic medical world, or those interacting with a variety of groups who are often good sources of ideas. Hospitalists, she said, are “natural information brokers,” communicating routinely with a wide variety of specialists and healthcare professionals.

“You’ve got to know what’s important to your organization and to your patients and to everybody else,” Dr. Arora said.

She suggested that hospitalists find “zero-gravity thinkers,” and even to be this type of thinker themselves – one who stays open to new ideas and has diverse interests and experiences.

It is easy to settle into the same ways we’ve always done things, Dr. Arora said.

“The truth is there are ways that it can be better,” she said. “But we sometimes have to seek out new ideas and maintain an open mind – and sometimes we need someone to do it for us.”

Often, those closest to us are the least valuable in this regard, she said, referring to them as “innovation killers.”

“They’re not going to give you the next breakthrough idea,” she said. “You have to get outside of your network to understand where the good ideas are coming from.”

With the trauma that hospitalists have experienced for more than a year, well-being might never have been a more vital topic than it is now, Dr. Arora said.

“We’re done with online wellness modules,” she said. “Fix the system and not the person because we all know the system is not working for us. As hospitalists, we actually are experts at fixing systems.”

Dr. Arora said that one way to think of how to improve hospitalist well-being is by emphasizing “the Four Ts” – teamwork (such as the use of scribes and good communication), time (consider new work schedule models), transitions (refining workflows) and tech (technology that works for clinicians rather than creating a burden).

As hospitalists attempt to move ahead in their post–COVID-19 careers, the key is finding new challenges and never stopping the learning process, Dr. Arora said. Referring to a concept described by career coach May Busch, she said physicians can consider successful careers as a “series of S curves” – at the beginning, there is a lot of work without much advancement, followed by a rapid rise, and then arrival at the destination, which brings you to a new plateau higher up the ladder. At the higher plateau, hospitalists should “jump to a new S curve,” learning a new skill and embarking on a new endeavor, which will lift them even higher.

“Success,” Dr. Arora said, “is defined by continuous growth and learning.”

Dr. Arora reported having no financial disclosures.

After navigating a pandemic that turned the world – including the world of hospital medicine – upside down for so long, the very idea of returning to a “normal” career and way of life can seem strange.

Vineet Arora, MD, MAPP, MHM, assistant dean for scholarship and discovery and associate chief medical officer for clinical learning environment at the University of Chicago, offered guidance to hospitalists on the transition from pandemic life to postpandemic life on May 5 at SHM Converge, the annual conference of the Society of Hospital Medicine.

The pandemic, Dr. Arora said, showed how important it is to develop trust. When resources were scarce as dire COVID-19 cases flooded hospitals, a culture of trust was essential to getting through the crisis.

“My team expects me to speak up on their behalf – it’s how we do things. It’s so germane to safety,” Dr. Arora said. “This is what you’re looking for in your organization – a place of psychological safety and trust.”

Surveys show that patients do trust their physicians, and healthcare providers “got a big bump” in trust during the pandemic, she said, which offers a unique opportunity.

“Doctors are trusted messengers for the COVID vaccine,” she said. “It really does matter.” But clinicians should also advocate for social justice, she said. “We must speak up even louder to fight everyday racism.”

As hospitalists move into the postpandemic medical world, Dr. Arora encouraged them to “get rid of delusions of grandeur,” expecting incredible accomplishments around every corner.

“Amazing things do happen, but oftentimes they happen because we sustain the things we start,” Dr. Arora said. For instance, physicians should consider small changes in workflow, but then sustain those changes. Maintaining pushes for change is not necessarily the norm, she said, adding that all hospitalists are probably familiar with quality improvement projects that generate only 3 months of data, because of lost focus.

Hospitalists should also “seek out information brokers” in the postpandemic medical world, or those interacting with a variety of groups who are often good sources of ideas. Hospitalists, she said, are “natural information brokers,” communicating routinely with a wide variety of specialists and healthcare professionals.

“You’ve got to know what’s important to your organization and to your patients and to everybody else,” Dr. Arora said.

She suggested that hospitalists find “zero-gravity thinkers,” and even to be this type of thinker themselves – one who stays open to new ideas and has diverse interests and experiences.

It is easy to settle into the same ways we’ve always done things, Dr. Arora said.

“The truth is there are ways that it can be better,” she said. “But we sometimes have to seek out new ideas and maintain an open mind – and sometimes we need someone to do it for us.”

Often, those closest to us are the least valuable in this regard, she said, referring to them as “innovation killers.”

“They’re not going to give you the next breakthrough idea,” she said. “You have to get outside of your network to understand where the good ideas are coming from.”

With the trauma that hospitalists have experienced for more than a year, well-being might never have been a more vital topic than it is now, Dr. Arora said.

“We’re done with online wellness modules,” she said. “Fix the system and not the person because we all know the system is not working for us. As hospitalists, we actually are experts at fixing systems.”

Dr. Arora said that one way to think of how to improve hospitalist well-being is by emphasizing “the Four Ts” – teamwork (such as the use of scribes and good communication), time (consider new work schedule models), transitions (refining workflows) and tech (technology that works for clinicians rather than creating a burden).

As hospitalists attempt to move ahead in their post–COVID-19 careers, the key is finding new challenges and never stopping the learning process, Dr. Arora said. Referring to a concept described by career coach May Busch, she said physicians can consider successful careers as a “series of S curves” – at the beginning, there is a lot of work without much advancement, followed by a rapid rise, and then arrival at the destination, which brings you to a new plateau higher up the ladder. At the higher plateau, hospitalists should “jump to a new S curve,” learning a new skill and embarking on a new endeavor, which will lift them even higher.

“Success,” Dr. Arora said, “is defined by continuous growth and learning.”

Dr. Arora reported having no financial disclosures.

After navigating a pandemic that turned the world – including the world of hospital medicine – upside down for so long, the very idea of returning to a “normal” career and way of life can seem strange.

Vineet Arora, MD, MAPP, MHM, assistant dean for scholarship and discovery and associate chief medical officer for clinical learning environment at the University of Chicago, offered guidance to hospitalists on the transition from pandemic life to postpandemic life on May 5 at SHM Converge, the annual conference of the Society of Hospital Medicine.

The pandemic, Dr. Arora said, showed how important it is to develop trust. When resources were scarce as dire COVID-19 cases flooded hospitals, a culture of trust was essential to getting through the crisis.

“My team expects me to speak up on their behalf – it’s how we do things. It’s so germane to safety,” Dr. Arora said. “This is what you’re looking for in your organization – a place of psychological safety and trust.”

Surveys show that patients do trust their physicians, and healthcare providers “got a big bump” in trust during the pandemic, she said, which offers a unique opportunity.

“Doctors are trusted messengers for the COVID vaccine,” she said. “It really does matter.” But clinicians should also advocate for social justice, she said. “We must speak up even louder to fight everyday racism.”

As hospitalists move into the postpandemic medical world, Dr. Arora encouraged them to “get rid of delusions of grandeur,” expecting incredible accomplishments around every corner.

“Amazing things do happen, but oftentimes they happen because we sustain the things we start,” Dr. Arora said. For instance, physicians should consider small changes in workflow, but then sustain those changes. Maintaining pushes for change is not necessarily the norm, she said, adding that all hospitalists are probably familiar with quality improvement projects that generate only 3 months of data, because of lost focus.

Hospitalists should also “seek out information brokers” in the postpandemic medical world, or those interacting with a variety of groups who are often good sources of ideas. Hospitalists, she said, are “natural information brokers,” communicating routinely with a wide variety of specialists and healthcare professionals.

“You’ve got to know what’s important to your organization and to your patients and to everybody else,” Dr. Arora said.

She suggested that hospitalists find “zero-gravity thinkers,” and even to be this type of thinker themselves – one who stays open to new ideas and has diverse interests and experiences.

It is easy to settle into the same ways we’ve always done things, Dr. Arora said.

“The truth is there are ways that it can be better,” she said. “But we sometimes have to seek out new ideas and maintain an open mind – and sometimes we need someone to do it for us.”

Often, those closest to us are the least valuable in this regard, she said, referring to them as “innovation killers.”

“They’re not going to give you the next breakthrough idea,” she said. “You have to get outside of your network to understand where the good ideas are coming from.”

With the trauma that hospitalists have experienced for more than a year, well-being might never have been a more vital topic than it is now, Dr. Arora said.

“We’re done with online wellness modules,” she said. “Fix the system and not the person because we all know the system is not working for us. As hospitalists, we actually are experts at fixing systems.”

Dr. Arora said that one way to think of how to improve hospitalist well-being is by emphasizing “the Four Ts” – teamwork (such as the use of scribes and good communication), time (consider new work schedule models), transitions (refining workflows) and tech (technology that works for clinicians rather than creating a burden).

As hospitalists attempt to move ahead in their post–COVID-19 careers, the key is finding new challenges and never stopping the learning process, Dr. Arora said. Referring to a concept described by career coach May Busch, she said physicians can consider successful careers as a “series of S curves” – at the beginning, there is a lot of work without much advancement, followed by a rapid rise, and then arrival at the destination, which brings you to a new plateau higher up the ladder. At the higher plateau, hospitalists should “jump to a new S curve,” learning a new skill and embarking on a new endeavor, which will lift them even higher.

“Success,” Dr. Arora said, “is defined by continuous growth and learning.”

Dr. Arora reported having no financial disclosures.

Click here for the Wednesday issue of the SHM Converge Daily News newsletter.

Click here for the Wednesday issue of the SHM Converge Daily News newsletter.

Click here for the Wednesday issue of the SHM Converge Daily News newsletter.

Earlier this spring, Kimberly D. Manning, MD, FACP, FAAP, was caring for an elderly Black man with multiple comorbidities at Grady Memorial Hospital in Atlanta, assembling an order for medications and a discharge plan.

“It was very challenging,” Dr. Manning, professor of medicine and associate vice chair of diversity, equity, and inclusion at Emory University, Atlanta, recalled during a May 4 session at SHM Converge, the annual conference of the Society of Hospital Medicine.

At one point, the patient glanced at her, shrugged, and said: “You know, Doc, we get in where we fit in.”

“He was talking about the idea that people who come from historically disadvantaged backgrounds just have to try to figure it out, have to try to make a dollar out of 15 cents,” Dr. Manning said. “This, to me, really underscores what we mean when we say health disparities, this idea that there are people who are working hard and doing the best that they can but who still are forced to ‘get in where they fit in.’”

The Centers for Disease Control and Prevention defines health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. “When we think about health disparities we often think about many diagnoses,” Dr. Manning continued. “We think about HIV and the disparate care and outcomes we’ve seen in populations of individuals who come from minority backgrounds. We see disparities in obesity, cancer, cardiovascular disease, infant mortality and maternal death, hospital readmissions, and COVID-19. We know that people who do not have access to health care or to healthy neighborhoods and environments or who are economically disadvantaged have poorer outcomes. It plays out with all of these diagnoses.”

In her opinion, health disparities in hospital medicine fall into in one of three buckets: diagnosis and triage, hospital stay and treatment, and sticking the landing – “that is, after a patient leaves the hospital,” Dr. Manning explained. “The hospital stay is the turn on the balance beam. You can do everything perfectly, but then you must dismount. To score a ‘10’ you have to stick the landing. That means being able to get your medications, being able to get to and from clinic appointments, being able to understand the directions you’ve been given. All of these things are intertwined, the inpatient and outpatient care.”

The roots of health disparities in hospitalized patients stem from centuries ago, she said, when America’s health care system was built to benefit white male landowners and their families. Health care for Blacks, on the other hand, “was focused on function, almost like veterinary care, or experimentation,” Dr. Manning said. “After slavery ended, many historically Black institutions of higher learning opened, including medical schools. In 1909, there were seven historically Black medical schools. Acknowledging the history that preceded disparities is essential.”

In her view, the path to improving health care disparities starts with conceding that structural racism exists in the practice of medicine. “This means that health disparities are connected to systemic and individual issues, including our biases,” Dr. Manning said. “Our system was built on this idea that there is greater value of one group of people above others. Access to care, physician workforce, and biases are impacted by system design. Health equity and health equality are not the same.”

She also underscored the importance of the social determinants of health, or “those things we need to be healthy,” including economic stability, neighborhood and physical environment, educational opportunities, access to good food, community and social context, and the idea of health care as a human right and understanding our health care system. “This is what is necessary,” she declared. “Without all of these together, we can’t have the health outcomes that we desire.”

As hospital leaders work to build a more diverse physician workforce, Dr. Manning emphasized the importance of forming antiracism policies by addressing questions such as what will we not stand for? How will we protect and create psychologically safe environments? What is our commitment to diversity in leadership and in trainees? What is our commitment to implicit bias training and bystander training?

“We have to get uncomfortable enough to advocate with urgency because all of these are necessary factors to mitigate health disparities,” she said. “Though the systemic issues are the most urgent, on an individual level, we must continue to disrupt the negative ideology and stereotypes that threaten our environment every day. When we see those negative things, we have to call them out. We need to continue to listen, to humanize those things that are happening around us, and to understand historical context.”

Dr. Manning reported having no financial disclosures.

Earlier this spring, Kimberly D. Manning, MD, FACP, FAAP, was caring for an elderly Black man with multiple comorbidities at Grady Memorial Hospital in Atlanta, assembling an order for medications and a discharge plan.

“It was very challenging,” Dr. Manning, professor of medicine and associate vice chair of diversity, equity, and inclusion at Emory University, Atlanta, recalled during a May 4 session at SHM Converge, the annual conference of the Society of Hospital Medicine.

At one point, the patient glanced at her, shrugged, and said: “You know, Doc, we get in where we fit in.”

“He was talking about the idea that people who come from historically disadvantaged backgrounds just have to try to figure it out, have to try to make a dollar out of 15 cents,” Dr. Manning said. “This, to me, really underscores what we mean when we say health disparities, this idea that there are people who are working hard and doing the best that they can but who still are forced to ‘get in where they fit in.’”

The Centers for Disease Control and Prevention defines health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. “When we think about health disparities we often think about many diagnoses,” Dr. Manning continued. “We think about HIV and the disparate care and outcomes we’ve seen in populations of individuals who come from minority backgrounds. We see disparities in obesity, cancer, cardiovascular disease, infant mortality and maternal death, hospital readmissions, and COVID-19. We know that people who do not have access to health care or to healthy neighborhoods and environments or who are economically disadvantaged have poorer outcomes. It plays out with all of these diagnoses.”

In her opinion, health disparities in hospital medicine fall into in one of three buckets: diagnosis and triage, hospital stay and treatment, and sticking the landing – “that is, after a patient leaves the hospital,” Dr. Manning explained. “The hospital stay is the turn on the balance beam. You can do everything perfectly, but then you must dismount. To score a ‘10’ you have to stick the landing. That means being able to get your medications, being able to get to and from clinic appointments, being able to understand the directions you’ve been given. All of these things are intertwined, the inpatient and outpatient care.”

The roots of health disparities in hospitalized patients stem from centuries ago, she said, when America’s health care system was built to benefit white male landowners and their families. Health care for Blacks, on the other hand, “was focused on function, almost like veterinary care, or experimentation,” Dr. Manning said. “After slavery ended, many historically Black institutions of higher learning opened, including medical schools. In 1909, there were seven historically Black medical schools. Acknowledging the history that preceded disparities is essential.”

In her view, the path to improving health care disparities starts with conceding that structural racism exists in the practice of medicine. “This means that health disparities are connected to systemic and individual issues, including our biases,” Dr. Manning said. “Our system was built on this idea that there is greater value of one group of people above others. Access to care, physician workforce, and biases are impacted by system design. Health equity and health equality are not the same.”

She also underscored the importance of the social determinants of health, or “those things we need to be healthy,” including economic stability, neighborhood and physical environment, educational opportunities, access to good food, community and social context, and the idea of health care as a human right and understanding our health care system. “This is what is necessary,” she declared. “Without all of these together, we can’t have the health outcomes that we desire.”

As hospital leaders work to build a more diverse physician workforce, Dr. Manning emphasized the importance of forming antiracism policies by addressing questions such as what will we not stand for? How will we protect and create psychologically safe environments? What is our commitment to diversity in leadership and in trainees? What is our commitment to implicit bias training and bystander training?

“We have to get uncomfortable enough to advocate with urgency because all of these are necessary factors to mitigate health disparities,” she said. “Though the systemic issues are the most urgent, on an individual level, we must continue to disrupt the negative ideology and stereotypes that threaten our environment every day. When we see those negative things, we have to call them out. We need to continue to listen, to humanize those things that are happening around us, and to understand historical context.”

Dr. Manning reported having no financial disclosures.

Earlier this spring, Kimberly D. Manning, MD, FACP, FAAP, was caring for an elderly Black man with multiple comorbidities at Grady Memorial Hospital in Atlanta, assembling an order for medications and a discharge plan.

“It was very challenging,” Dr. Manning, professor of medicine and associate vice chair of diversity, equity, and inclusion at Emory University, Atlanta, recalled during a May 4 session at SHM Converge, the annual conference of the Society of Hospital Medicine.

At one point, the patient glanced at her, shrugged, and said: “You know, Doc, we get in where we fit in.”

“He was talking about the idea that people who come from historically disadvantaged backgrounds just have to try to figure it out, have to try to make a dollar out of 15 cents,” Dr. Manning said. “This, to me, really underscores what we mean when we say health disparities, this idea that there are people who are working hard and doing the best that they can but who still are forced to ‘get in where they fit in.’”

The Centers for Disease Control and Prevention defines health disparities as preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. “When we think about health disparities we often think about many diagnoses,” Dr. Manning continued. “We think about HIV and the disparate care and outcomes we’ve seen in populations of individuals who come from minority backgrounds. We see disparities in obesity, cancer, cardiovascular disease, infant mortality and maternal death, hospital readmissions, and COVID-19. We know that people who do not have access to health care or to healthy neighborhoods and environments or who are economically disadvantaged have poorer outcomes. It plays out with all of these diagnoses.”

In her opinion, health disparities in hospital medicine fall into in one of three buckets: diagnosis and triage, hospital stay and treatment, and sticking the landing – “that is, after a patient leaves the hospital,” Dr. Manning explained. “The hospital stay is the turn on the balance beam. You can do everything perfectly, but then you must dismount. To score a ‘10’ you have to stick the landing. That means being able to get your medications, being able to get to and from clinic appointments, being able to understand the directions you’ve been given. All of these things are intertwined, the inpatient and outpatient care.”

The roots of health disparities in hospitalized patients stem from centuries ago, she said, when America’s health care system was built to benefit white male landowners and their families. Health care for Blacks, on the other hand, “was focused on function, almost like veterinary care, or experimentation,” Dr. Manning said. “After slavery ended, many historically Black institutions of higher learning opened, including medical schools. In 1909, there were seven historically Black medical schools. Acknowledging the history that preceded disparities is essential.”

In her view, the path to improving health care disparities starts with conceding that structural racism exists in the practice of medicine. “This means that health disparities are connected to systemic and individual issues, including our biases,” Dr. Manning said. “Our system was built on this idea that there is greater value of one group of people above others. Access to care, physician workforce, and biases are impacted by system design. Health equity and health equality are not the same.”

She also underscored the importance of the social determinants of health, or “those things we need to be healthy,” including economic stability, neighborhood and physical environment, educational opportunities, access to good food, community and social context, and the idea of health care as a human right and understanding our health care system. “This is what is necessary,” she declared. “Without all of these together, we can’t have the health outcomes that we desire.”

As hospital leaders work to build a more diverse physician workforce, Dr. Manning emphasized the importance of forming antiracism policies by addressing questions such as what will we not stand for? How will we protect and create psychologically safe environments? What is our commitment to diversity in leadership and in trainees? What is our commitment to implicit bias training and bystander training?

“We have to get uncomfortable enough to advocate with urgency because all of these are necessary factors to mitigate health disparities,” she said. “Though the systemic issues are the most urgent, on an individual level, we must continue to disrupt the negative ideology and stereotypes that threaten our environment every day. When we see those negative things, we have to call them out. We need to continue to listen, to humanize those things that are happening around us, and to understand historical context.”

Dr. Manning reported having no financial disclosures.

A year into the COVID-19 pandemic, it is fair to say that children do transmit the virus, but at lower rates, Philip Zachariah, MD, of Columbia University, New York, said in a presentation at SHM Converge, the annual conference of the Society of Hospital Medicine.

Supportive care remains a key element in treating children with COVID-19, Dr. Zachariah emphasized. His presentation on pediatric hot topics in COVID-19 addressed several issues including the importance of risk stratification, current therapeutic options, and the latest on multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
 

Recognize the high-risk patient

When it comes to identifying risk factors for COVID-19 in children, remember that the trajectory of disease is diverse, Dr. Zachariah said.

The presentations of COVID-19 in children include those who are older and/or have comorbidities and present with mainly respiratory issues, those who are younger with symptoms that might overlap with Kawasaki disease, and those who are older with symptoms of cardiac involvement and MIS-C.

The overall hospitalization rate for children with COVID-19 is approximately 5%, but once hospitalized, the rates of ICU admission are approximately 30% and reflect rates seen in adult patients, Dr. Zachariah noted.

In general, data show that underlying conditions are more common in acute COVID-19 cases, and laboratory anomalies are more pronounced in patients with MIS-C, he said.

Based on the most recent studies, independent risk factors for acute COVID-19 in children include extremes of age (infancy or adolescence), minority populations, obesity, medical complexity, immune compromise, and asthma.

However, data are limited on specific issues of medical complexity, and risk depends on the level and type of immunosuppression, as morbidity and mortality have been relatively low in transplant patients, Dr. Zachariah noted.

Another dilemma lies in recognizing MIS-C in a febrile child, Dr. Zachariah noted. A complex question, “but persistent high fever in the setting of known recent COVID-19 infections (within 3 to 6 weeks) seems key,” he said. “If given the chance to do one blood test, I would suggest doing a CRP [C-reactive protein] as a screening test,” Dr. Zachariah said. The best laboratory prognosticators appear to be lymphopenia and brain natriuretic peptide (BNP) he added.

A final risk factor is innate immune defects that might predispose previously healthy children to severe acute COVID-19, such as differences in cytokine expression, said Dr. Zachariah.

“For example, autoantibodies against type 1 interferon production may dispose to severe disease,” he noted. Patients with MIS-C have shown patterns of T-cell activation similar to those seen in severely ill adults, and activation of vascular patrolling CX3CR1+ CD8 + T cells appears as a distinguishing feature in MIS-C, he explained.
 

Prevention plans with monoclonal antibodies

Another hot topic in pediatric COVID-19 is the prevention of severe disease and hospitalization using the currently available therapies, Dr. Zachariah said. However, when interpreting efficacy data, clinicians are almost always extrapolating relative risk to absolute risk in children, he noted.

“Convalescent plasma was promising, but the data on efficacy are increasingly negative,” he noted. Instead, a more exciting development is the use of monoclonal antibodies, which, ideally, “will deliver protection to ‘high risk’ populations in the very early stages of infection,” he said.

Bamlanivimab/etesevimab is “a neutralizing IgG1 monoclonal antibody that binds to overlapping domains of the receptor binding domain of the spike protein of SARS-CoV-2,” said Dr. Zachariah. In a study of 1,035 patients with a median age of 56 years, a single intravenous infusion of bamlanivimab plus etesevimab within 3 days of a positive COVID-19 test showed a 70% reduction in risk of COVID-19 hospitalizations or death.

For children, the current Food and Drug Administration Emergency Use Authorization for monoclonal antibody use covers patients aged 12-17 years, who weigh 40 kg or more, and meet any of several other criteria: a body mass index at the 85th percentile or higher, sickle cell disease, congenital or acquired heart disease, neurodevelopmental disorders such as cerebral palsy, chronic respiratory disease requiring daily control, diabetes, or chronic kidney disease, Dr. Zachariah said.

In addition, pediatric patients aged 12-17 years could be considered for monoclonal antibody treatment in consultation with a pediatric infectious disease specialist if they are symptomatic with COVID-19, weigh at least 40 kg, are not hospitalized for COVID-19 symptoms, and have no new oxygen requirements, he said.
 

More on MIS-C

Currently, IVIG is the most common treatment for MIS-C in the United States, Dr. Zachariah said. In addition, a study published in JAMA Feb. 1, 2021, showed that IVIG in combination with methylprednisolone was associated with a lower risk of treatment failure compared to IVIG alone in 111 children with a median age of 8.6 years.

Although comparative effectiveness data are lacking, in long-term follow-up, all the patients seemed to be doing fine, Dr. Zachariah said. Potential second-line therapies for atypical MIS-C include anakinra and tocilizumab, he added.

Dr. Zachariah concluded by emphasizing the potential of COVID-19 vaccines, with studies underway for both Moderna and Pfizer vaccines in children younger than 16 years.

Dr. Zachariah had no relevant financial conflicts to disclose.

A year into the COVID-19 pandemic, it is fair to say that children do transmit the virus, but at lower rates, Philip Zachariah, MD, of Columbia University, New York, said in a presentation at SHM Converge, the annual conference of the Society of Hospital Medicine.

Supportive care remains a key element in treating children with COVID-19, Dr. Zachariah emphasized. His presentation on pediatric hot topics in COVID-19 addressed several issues including the importance of risk stratification, current therapeutic options, and the latest on multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
 

Recognize the high-risk patient

When it comes to identifying risk factors for COVID-19 in children, remember that the trajectory of disease is diverse, Dr. Zachariah said.

The presentations of COVID-19 in children include those who are older and/or have comorbidities and present with mainly respiratory issues, those who are younger with symptoms that might overlap with Kawasaki disease, and those who are older with symptoms of cardiac involvement and MIS-C.

The overall hospitalization rate for children with COVID-19 is approximately 5%, but once hospitalized, the rates of ICU admission are approximately 30% and reflect rates seen in adult patients, Dr. Zachariah noted.

In general, data show that underlying conditions are more common in acute COVID-19 cases, and laboratory anomalies are more pronounced in patients with MIS-C, he said.

Based on the most recent studies, independent risk factors for acute COVID-19 in children include extremes of age (infancy or adolescence), minority populations, obesity, medical complexity, immune compromise, and asthma.

However, data are limited on specific issues of medical complexity, and risk depends on the level and type of immunosuppression, as morbidity and mortality have been relatively low in transplant patients, Dr. Zachariah noted.

Another dilemma lies in recognizing MIS-C in a febrile child, Dr. Zachariah noted. A complex question, “but persistent high fever in the setting of known recent COVID-19 infections (within 3 to 6 weeks) seems key,” he said. “If given the chance to do one blood test, I would suggest doing a CRP [C-reactive protein] as a screening test,” Dr. Zachariah said. The best laboratory prognosticators appear to be lymphopenia and brain natriuretic peptide (BNP) he added.

A final risk factor is innate immune defects that might predispose previously healthy children to severe acute COVID-19, such as differences in cytokine expression, said Dr. Zachariah.

“For example, autoantibodies against type 1 interferon production may dispose to severe disease,” he noted. Patients with MIS-C have shown patterns of T-cell activation similar to those seen in severely ill adults, and activation of vascular patrolling CX3CR1+ CD8 + T cells appears as a distinguishing feature in MIS-C, he explained.
 

Prevention plans with monoclonal antibodies

Another hot topic in pediatric COVID-19 is the prevention of severe disease and hospitalization using the currently available therapies, Dr. Zachariah said. However, when interpreting efficacy data, clinicians are almost always extrapolating relative risk to absolute risk in children, he noted.

“Convalescent plasma was promising, but the data on efficacy are increasingly negative,” he noted. Instead, a more exciting development is the use of monoclonal antibodies, which, ideally, “will deliver protection to ‘high risk’ populations in the very early stages of infection,” he said.

Bamlanivimab/etesevimab is “a neutralizing IgG1 monoclonal antibody that binds to overlapping domains of the receptor binding domain of the spike protein of SARS-CoV-2,” said Dr. Zachariah. In a study of 1,035 patients with a median age of 56 years, a single intravenous infusion of bamlanivimab plus etesevimab within 3 days of a positive COVID-19 test showed a 70% reduction in risk of COVID-19 hospitalizations or death.

For children, the current Food and Drug Administration Emergency Use Authorization for monoclonal antibody use covers patients aged 12-17 years, who weigh 40 kg or more, and meet any of several other criteria: a body mass index at the 85th percentile or higher, sickle cell disease, congenital or acquired heart disease, neurodevelopmental disorders such as cerebral palsy, chronic respiratory disease requiring daily control, diabetes, or chronic kidney disease, Dr. Zachariah said.

In addition, pediatric patients aged 12-17 years could be considered for monoclonal antibody treatment in consultation with a pediatric infectious disease specialist if they are symptomatic with COVID-19, weigh at least 40 kg, are not hospitalized for COVID-19 symptoms, and have no new oxygen requirements, he said.
 

More on MIS-C

Currently, IVIG is the most common treatment for MIS-C in the United States, Dr. Zachariah said. In addition, a study published in JAMA Feb. 1, 2021, showed that IVIG in combination with methylprednisolone was associated with a lower risk of treatment failure compared to IVIG alone in 111 children with a median age of 8.6 years.

Although comparative effectiveness data are lacking, in long-term follow-up, all the patients seemed to be doing fine, Dr. Zachariah said. Potential second-line therapies for atypical MIS-C include anakinra and tocilizumab, he added.

Dr. Zachariah concluded by emphasizing the potential of COVID-19 vaccines, with studies underway for both Moderna and Pfizer vaccines in children younger than 16 years.

Dr. Zachariah had no relevant financial conflicts to disclose.

A year into the COVID-19 pandemic, it is fair to say that children do transmit the virus, but at lower rates, Philip Zachariah, MD, of Columbia University, New York, said in a presentation at SHM Converge, the annual conference of the Society of Hospital Medicine.

Supportive care remains a key element in treating children with COVID-19, Dr. Zachariah emphasized. His presentation on pediatric hot topics in COVID-19 addressed several issues including the importance of risk stratification, current therapeutic options, and the latest on multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.
 

Recognize the high-risk patient

When it comes to identifying risk factors for COVID-19 in children, remember that the trajectory of disease is diverse, Dr. Zachariah said.

The presentations of COVID-19 in children include those who are older and/or have comorbidities and present with mainly respiratory issues, those who are younger with symptoms that might overlap with Kawasaki disease, and those who are older with symptoms of cardiac involvement and MIS-C.

The overall hospitalization rate for children with COVID-19 is approximately 5%, but once hospitalized, the rates of ICU admission are approximately 30% and reflect rates seen in adult patients, Dr. Zachariah noted.

In general, data show that underlying conditions are more common in acute COVID-19 cases, and laboratory anomalies are more pronounced in patients with MIS-C, he said.

Based on the most recent studies, independent risk factors for acute COVID-19 in children include extremes of age (infancy or adolescence), minority populations, obesity, medical complexity, immune compromise, and asthma.

However, data are limited on specific issues of medical complexity, and risk depends on the level and type of immunosuppression, as morbidity and mortality have been relatively low in transplant patients, Dr. Zachariah noted.

Another dilemma lies in recognizing MIS-C in a febrile child, Dr. Zachariah noted. A complex question, “but persistent high fever in the setting of known recent COVID-19 infections (within 3 to 6 weeks) seems key,” he said. “If given the chance to do one blood test, I would suggest doing a CRP [C-reactive protein] as a screening test,” Dr. Zachariah said. The best laboratory prognosticators appear to be lymphopenia and brain natriuretic peptide (BNP) he added.

A final risk factor is innate immune defects that might predispose previously healthy children to severe acute COVID-19, such as differences in cytokine expression, said Dr. Zachariah.

“For example, autoantibodies against type 1 interferon production may dispose to severe disease,” he noted. Patients with MIS-C have shown patterns of T-cell activation similar to those seen in severely ill adults, and activation of vascular patrolling CX3CR1+ CD8 + T cells appears as a distinguishing feature in MIS-C, he explained.
 

Prevention plans with monoclonal antibodies

Another hot topic in pediatric COVID-19 is the prevention of severe disease and hospitalization using the currently available therapies, Dr. Zachariah said. However, when interpreting efficacy data, clinicians are almost always extrapolating relative risk to absolute risk in children, he noted.

“Convalescent plasma was promising, but the data on efficacy are increasingly negative,” he noted. Instead, a more exciting development is the use of monoclonal antibodies, which, ideally, “will deliver protection to ‘high risk’ populations in the very early stages of infection,” he said.

Bamlanivimab/etesevimab is “a neutralizing IgG1 monoclonal antibody that binds to overlapping domains of the receptor binding domain of the spike protein of SARS-CoV-2,” said Dr. Zachariah. In a study of 1,035 patients with a median age of 56 years, a single intravenous infusion of bamlanivimab plus etesevimab within 3 days of a positive COVID-19 test showed a 70% reduction in risk of COVID-19 hospitalizations or death.

For children, the current Food and Drug Administration Emergency Use Authorization for monoclonal antibody use covers patients aged 12-17 years, who weigh 40 kg or more, and meet any of several other criteria: a body mass index at the 85th percentile or higher, sickle cell disease, congenital or acquired heart disease, neurodevelopmental disorders such as cerebral palsy, chronic respiratory disease requiring daily control, diabetes, or chronic kidney disease, Dr. Zachariah said.

In addition, pediatric patients aged 12-17 years could be considered for monoclonal antibody treatment in consultation with a pediatric infectious disease specialist if they are symptomatic with COVID-19, weigh at least 40 kg, are not hospitalized for COVID-19 symptoms, and have no new oxygen requirements, he said.
 

More on MIS-C

Currently, IVIG is the most common treatment for MIS-C in the United States, Dr. Zachariah said. In addition, a study published in JAMA Feb. 1, 2021, showed that IVIG in combination with methylprednisolone was associated with a lower risk of treatment failure compared to IVIG alone in 111 children with a median age of 8.6 years.

Although comparative effectiveness data are lacking, in long-term follow-up, all the patients seemed to be doing fine, Dr. Zachariah said. Potential second-line therapies for atypical MIS-C include anakinra and tocilizumab, he added.

Dr. Zachariah concluded by emphasizing the potential of COVID-19 vaccines, with studies underway for both Moderna and Pfizer vaccines in children younger than 16 years.

Dr. Zachariah had no relevant financial conflicts to disclose.

As the COVID-19 pandemic continues and evidence evolves, clinical judgment is the bottom line for clinical care, according to Adarsh Bhimraj, MD, of the Cleveland Clinic, and James Walter, MD, of Northwestern Medicine, Chicago.

In a debate/discussion presented at SHM Converge, the annual conference of the Society of Hospital Medicine, Dr. Bhimraj and Dr. Walter took sides in a friendly debate on the value of remdesivir and tocilizumab for hospitalized COVID-19 patients.

Dr. Bhimraj argued for the use of remdesivir or tocilizumab in patients hospitalized with COVID-19 pneumonia, and Dr. Walter presented the case against their use.
 

Referendum on remdesivir

The main sources referenced by the presenters regarding remdesivir were the WHO Solidarity Trial (N Engl J Med. 2021 Feb 11. doi: 10.1056/NEJMoa2023184) and the Adaptive Covid-19 Treatment Trial (ACCT) final report (N Engl J Med. 2020 Nov 5. doi: 10.1056/NEJMoa2007764).

“The ‘debate’ is partly artificial,” and meant to illustrate how clinicians can use their own clinical faculties and reasoning to make an informed decision when treating COVID-19 patients, Dr. Bhimraj said.

The ACCT trial compared remdesivir with placebo in patients with severe enough COVID-19 to require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation. The primary outcome in the study was time to recovery, and “the devil is in the details,” Dr. Bhimraj said. The outcomes clinicians should look for in studies are those that matter to patients, such as death, disability, and discomfort, he noted. Disease-oriented endpoints are easier to measure, but not always meaningful for patients, he said. The study showed an average 5-day decrease in illness, “but the fact is that it did not show a mortality benefit,” he noted.

Another large, open-label study of remdesivir across 30 countries showed no survival benefit associated with the drug, compared with standard of care, said Dr. Bhimraj. Patients treated with remdesivir remained in the hospital longer, but Dr. Bhimraj said he believed that was a bias. “I think the physicians kept the patients in the hospital longer to give the treatment rather than the treatments themselves prolonging the treatment duration,” he said.

In conclusion for remdesivir, “the solid data show that there is an early recovery,” he said. “At least for severe disease, even if there is no mortality benefit, there is a role. I argue that, if someone asks if you want to use remdesivir in severe COVID-19 patients, say yes, especially if you value people getting out of the hospital sooner. In a crisis situation, there is a role for remdesivir.”

Dr. Walter discussed the “con” side of using remdesivir. “We can start with a predata hypothesis, but integrate new data about the efficacy into a postdata hypothesis,” he said.

Dr. Walter made several points against the use of remdesivir in hospitalized COVID-19 patients. First, it has not shown any improvement in mortality and may increase the length of hospital stay, he noted.

Data from the ACCT-1 trial and the WHO solidarity trial, showed “no signal of mortality benefit at all,” he said. In addition, the World Health Organization, American College of Physicians, and National Institutes of Health all recommend against remdesivir for patients who require mechanical ventilation or extracorporeal membrane oxygenation, he said. The efficacy when used with steroids remains unclear, and long-term safety data are lacking, he added.
 

Taking on tocilizumab

Tocilizumab, an anti-inflammatory agent, has demonstrated an impact on several surrogate markers, notably C-reactive protein, temperature, and oxygenation. Dr. Bhimraj said. He reviewed data from eight published studies on the use of tocilizumab in COVID-19 patients.

Arguably, some trials may not have been powered adequately, and in combination, some trials show an effect on clinical deterioration, if not a mortality benefit, he said.

Consequently, in the context of COVID-19, tocilizumab “should be used early in the disease process, especially if steroids are not working,” said Dr. Bhimraj. Despite the limited evidence, “there is a niche population where this might be beneficial,” he said.

By contrast, Dr. Walter took the position of skepticism about the value of tocilizumab for COVID-19 patients.

Notably, decades of research show that tocilizumab has shown no benefit in patients with sepsis or septic shock, or those with acute respiratory distress syndrome, which have similarities to COVID-19 (JAMA. 2020 Sep 3. doi: 10.1001/jama.2020.17052).

He cited a research letter published in JAMA in September 2020, which showed that cytokine levels were in fact lower in critically ill patients with COVID-19, compared with those who had conditions including sepsis with and without ARDS.

Dr. Walter also cited data on the questionable benefit of tocilizumab when used with steroids and the negligible impact on mortality in hospitalized COVID-19 patients seen in the RECOVERY trial.

Limited data mean that therapeutic decisions related to COVID-19 are more nuanced, but they can be made, the presenters agreed.

Ultimately, when trying to decide whether a drug is efficacious, futile, or harmful, “What we have to do is consider the grand totality of the evidence,” Dr. Bhimraj emphasized.

Dr. Bhimraj and Dr. Walter had no relevant financial conflicts to disclose.

As the COVID-19 pandemic continues and evidence evolves, clinical judgment is the bottom line for clinical care, according to Adarsh Bhimraj, MD, of the Cleveland Clinic, and James Walter, MD, of Northwestern Medicine, Chicago.

In a debate/discussion presented at SHM Converge, the annual conference of the Society of Hospital Medicine, Dr. Bhimraj and Dr. Walter took sides in a friendly debate on the value of remdesivir and tocilizumab for hospitalized COVID-19 patients.

Dr. Bhimraj argued for the use of remdesivir or tocilizumab in patients hospitalized with COVID-19 pneumonia, and Dr. Walter presented the case against their use.
 

Referendum on remdesivir

The main sources referenced by the presenters regarding remdesivir were the WHO Solidarity Trial (N Engl J Med. 2021 Feb 11. doi: 10.1056/NEJMoa2023184) and the Adaptive Covid-19 Treatment Trial (ACCT) final report (N Engl J Med. 2020 Nov 5. doi: 10.1056/NEJMoa2007764).

“The ‘debate’ is partly artificial,” and meant to illustrate how clinicians can use their own clinical faculties and reasoning to make an informed decision when treating COVID-19 patients, Dr. Bhimraj said.

The ACCT trial compared remdesivir with placebo in patients with severe enough COVID-19 to require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation. The primary outcome in the study was time to recovery, and “the devil is in the details,” Dr. Bhimraj said. The outcomes clinicians should look for in studies are those that matter to patients, such as death, disability, and discomfort, he noted. Disease-oriented endpoints are easier to measure, but not always meaningful for patients, he said. The study showed an average 5-day decrease in illness, “but the fact is that it did not show a mortality benefit,” he noted.

Another large, open-label study of remdesivir across 30 countries showed no survival benefit associated with the drug, compared with standard of care, said Dr. Bhimraj. Patients treated with remdesivir remained in the hospital longer, but Dr. Bhimraj said he believed that was a bias. “I think the physicians kept the patients in the hospital longer to give the treatment rather than the treatments themselves prolonging the treatment duration,” he said.

In conclusion for remdesivir, “the solid data show that there is an early recovery,” he said. “At least for severe disease, even if there is no mortality benefit, there is a role. I argue that, if someone asks if you want to use remdesivir in severe COVID-19 patients, say yes, especially if you value people getting out of the hospital sooner. In a crisis situation, there is a role for remdesivir.”

Dr. Walter discussed the “con” side of using remdesivir. “We can start with a predata hypothesis, but integrate new data about the efficacy into a postdata hypothesis,” he said.

Dr. Walter made several points against the use of remdesivir in hospitalized COVID-19 patients. First, it has not shown any improvement in mortality and may increase the length of hospital stay, he noted.

Data from the ACCT-1 trial and the WHO solidarity trial, showed “no signal of mortality benefit at all,” he said. In addition, the World Health Organization, American College of Physicians, and National Institutes of Health all recommend against remdesivir for patients who require mechanical ventilation or extracorporeal membrane oxygenation, he said. The efficacy when used with steroids remains unclear, and long-term safety data are lacking, he added.
 

Taking on tocilizumab

Tocilizumab, an anti-inflammatory agent, has demonstrated an impact on several surrogate markers, notably C-reactive protein, temperature, and oxygenation. Dr. Bhimraj said. He reviewed data from eight published studies on the use of tocilizumab in COVID-19 patients.

Arguably, some trials may not have been powered adequately, and in combination, some trials show an effect on clinical deterioration, if not a mortality benefit, he said.

Consequently, in the context of COVID-19, tocilizumab “should be used early in the disease process, especially if steroids are not working,” said Dr. Bhimraj. Despite the limited evidence, “there is a niche population where this might be beneficial,” he said.

By contrast, Dr. Walter took the position of skepticism about the value of tocilizumab for COVID-19 patients.

Notably, decades of research show that tocilizumab has shown no benefit in patients with sepsis or septic shock, or those with acute respiratory distress syndrome, which have similarities to COVID-19 (JAMA. 2020 Sep 3. doi: 10.1001/jama.2020.17052).

He cited a research letter published in JAMA in September 2020, which showed that cytokine levels were in fact lower in critically ill patients with COVID-19, compared with those who had conditions including sepsis with and without ARDS.

Dr. Walter also cited data on the questionable benefit of tocilizumab when used with steroids and the negligible impact on mortality in hospitalized COVID-19 patients seen in the RECOVERY trial.

Limited data mean that therapeutic decisions related to COVID-19 are more nuanced, but they can be made, the presenters agreed.

Ultimately, when trying to decide whether a drug is efficacious, futile, or harmful, “What we have to do is consider the grand totality of the evidence,” Dr. Bhimraj emphasized.

Dr. Bhimraj and Dr. Walter had no relevant financial conflicts to disclose.

As the COVID-19 pandemic continues and evidence evolves, clinical judgment is the bottom line for clinical care, according to Adarsh Bhimraj, MD, of the Cleveland Clinic, and James Walter, MD, of Northwestern Medicine, Chicago.

In a debate/discussion presented at SHM Converge, the annual conference of the Society of Hospital Medicine, Dr. Bhimraj and Dr. Walter took sides in a friendly debate on the value of remdesivir and tocilizumab for hospitalized COVID-19 patients.

Dr. Bhimraj argued for the use of remdesivir or tocilizumab in patients hospitalized with COVID-19 pneumonia, and Dr. Walter presented the case against their use.
 

Referendum on remdesivir

The main sources referenced by the presenters regarding remdesivir were the WHO Solidarity Trial (N Engl J Med. 2021 Feb 11. doi: 10.1056/NEJMoa2023184) and the Adaptive Covid-19 Treatment Trial (ACCT) final report (N Engl J Med. 2020 Nov 5. doi: 10.1056/NEJMoa2007764).

“The ‘debate’ is partly artificial,” and meant to illustrate how clinicians can use their own clinical faculties and reasoning to make an informed decision when treating COVID-19 patients, Dr. Bhimraj said.

The ACCT trial compared remdesivir with placebo in patients with severe enough COVID-19 to require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation. The primary outcome in the study was time to recovery, and “the devil is in the details,” Dr. Bhimraj said. The outcomes clinicians should look for in studies are those that matter to patients, such as death, disability, and discomfort, he noted. Disease-oriented endpoints are easier to measure, but not always meaningful for patients, he said. The study showed an average 5-day decrease in illness, “but the fact is that it did not show a mortality benefit,” he noted.

Another large, open-label study of remdesivir across 30 countries showed no survival benefit associated with the drug, compared with standard of care, said Dr. Bhimraj. Patients treated with remdesivir remained in the hospital longer, but Dr. Bhimraj said he believed that was a bias. “I think the physicians kept the patients in the hospital longer to give the treatment rather than the treatments themselves prolonging the treatment duration,” he said.

In conclusion for remdesivir, “the solid data show that there is an early recovery,” he said. “At least for severe disease, even if there is no mortality benefit, there is a role. I argue that, if someone asks if you want to use remdesivir in severe COVID-19 patients, say yes, especially if you value people getting out of the hospital sooner. In a crisis situation, there is a role for remdesivir.”

Dr. Walter discussed the “con” side of using remdesivir. “We can start with a predata hypothesis, but integrate new data about the efficacy into a postdata hypothesis,” he said.

Dr. Walter made several points against the use of remdesivir in hospitalized COVID-19 patients. First, it has not shown any improvement in mortality and may increase the length of hospital stay, he noted.

Data from the ACCT-1 trial and the WHO solidarity trial, showed “no signal of mortality benefit at all,” he said. In addition, the World Health Organization, American College of Physicians, and National Institutes of Health all recommend against remdesivir for patients who require mechanical ventilation or extracorporeal membrane oxygenation, he said. The efficacy when used with steroids remains unclear, and long-term safety data are lacking, he added.
 

Taking on tocilizumab

Tocilizumab, an anti-inflammatory agent, has demonstrated an impact on several surrogate markers, notably C-reactive protein, temperature, and oxygenation. Dr. Bhimraj said. He reviewed data from eight published studies on the use of tocilizumab in COVID-19 patients.

Arguably, some trials may not have been powered adequately, and in combination, some trials show an effect on clinical deterioration, if not a mortality benefit, he said.

Consequently, in the context of COVID-19, tocilizumab “should be used early in the disease process, especially if steroids are not working,” said Dr. Bhimraj. Despite the limited evidence, “there is a niche population where this might be beneficial,” he said.

By contrast, Dr. Walter took the position of skepticism about the value of tocilizumab for COVID-19 patients.

Notably, decades of research show that tocilizumab has shown no benefit in patients with sepsis or septic shock, or those with acute respiratory distress syndrome, which have similarities to COVID-19 (JAMA. 2020 Sep 3. doi: 10.1001/jama.2020.17052).

He cited a research letter published in JAMA in September 2020, which showed that cytokine levels were in fact lower in critically ill patients with COVID-19, compared with those who had conditions including sepsis with and without ARDS.

Dr. Walter also cited data on the questionable benefit of tocilizumab when used with steroids and the negligible impact on mortality in hospitalized COVID-19 patients seen in the RECOVERY trial.

Limited data mean that therapeutic decisions related to COVID-19 are more nuanced, but they can be made, the presenters agreed.

Ultimately, when trying to decide whether a drug is efficacious, futile, or harmful, “What we have to do is consider the grand totality of the evidence,” Dr. Bhimraj emphasized.

Dr. Bhimraj and Dr. Walter had no relevant financial conflicts to disclose.

Whether they realize it or not, hospitalists treating patients during the COVID-19 pandemic have been in a combat-like situation, with challenges and stresses similar to those faced by soldiers in a war zone.

And now, as the pandemic shows signs of subsiding, they’re about to emerge from this fight, which poses a whole new set of challenges, according a retired U.S. Army general who spoke May 4 at SHM Converge, the annual conference of the Society of Hospital Medicine.

Lt. Gen. (Ret.) Mark Hertling, DBA, said during his keynote speech that clinicians and soldiers – the only two professions that routinely have to navigate through life and death situations – must lead during all phases of combat.

“This is a period where you’re going to experience some things that you may or may not be ready for,” he said. “These are the same kind of issues soldiers face when redeploying from a combat zone.”

To help draw the comparison between hospitalists during the COVID-19 era and troops during a war, Lt. Gen. Hertling showed a photo of a U.S. paratrooper who’d just dropped into northern Iraq, carrying a backpack engorged with gear. He was on one knee with his face downcast as he seemed to be taking a moment to reflect on the enormity, complexity, and danger of the crisis into which he was about to plunge. He was, Lt. Gen. Hertling said, likely pondering the mission, his family he left behind, and concerns about making mistakes in front of his comrades.

Then he showed a picture of a health care worker in a hospital corridor slumped on the floor with his or her back against the wall, knees up, and hands loosely clasped, looking exhausted and dazed. Health care workers also have carried a load that has seemed unbearable.

“You can certainly see that they are experiencing an emotional trauma at the very start of the pandemic,” he said. “The things you have carried over the last year-plus as the pandemic has raged will be with you in good and sometimes bad ways, and you need to address those things.”

Lt. Gen. Hertling described several issues – mirroring those seen in combat – that clinicians will take away from the COVID-19 experience and must grapple with as the closing chapters of the pandemic play out:
 

A sense of teamwork in a crisis

While it’s not unusual, he said, for physicians not to get along well with administrators, and for nurses sometimes not to trust doctors, the COVID-19 crisis created a sense of effective teamwork.

“They have built trust because they see a common mission and a common requirement,” he said.
 

A sense of loss

“You have lost patients, you probably have lost comrades, and some of you are having this associated survivor’s guilt – why did you survive and so many of your patients, perhaps a lot of your friends, did not?”

At memorial services for fallen soldiers, Lt. Gen. Hertling would bring a laminated card with the soldier’s picture and put it in a box with the words “Make It Matter” on it.

“That was our code for ensuring that every one of these individual soldiers who sacrificed their lives for the organization, we would carry on their legacy and make their sacrifice matter,” he said. “That’s one of the few ways you can overcome survivor’s guilt.”
 

Sense of accomplishment

Lt. Gen. Hertling said hospitalists, pushed to the extreme, were able to do things they never thought they were capable of.

“You have to relish in that, and you have to write those things down so you can go back and think about the things you did in a crisis environment to help,” he said.

In the post-pandemic era, health care workers should reflect on what they have seen, learned, and experienced, to help set a new standard and to establish ways to eliminate “bureaucratic morasses,” which seemed more possible than ever because the urgency of the moment demanded it.

Lt. Gen. Hertling also said hospitalists should take time to make a plan to handle personal, professional, team, and organizational requirements. For instance, health care workers should get a physical to take stock of how their bodies reacted to the stress of the pandemic. He said they should also recognize the difference between posttraumatic stress, which is to be expected, and posttraumatic stress disorder (PTSD), which is less common.

“It’s only at the extreme that it becomes a dysfunction and you have to address it with the help of others,” he said. Hospitalists should examine the state of their emotional and spiritual relationships – with family and friends as well as with God or other figures important to them spiritually.

Professionally, hospitalists should review professional accomplishments and shortcomings and make changes based on those assessments, he said. It’s also a good time to assess leadership issues – recall who the contributors were and who could have done more. Hospitalists should also consider contributing post-pandemic articles to the Journal of Hospital Medicine, he said.

Lt. Gen. Hertling concluded by suggesting that hospitalists seek feedback on themselves and their own leadership qualities, from their team members.

“Really press the issue,” he said, “and get a good critique on how you can improve personally and professionally in terms of your leadership approach.”

Whether they realize it or not, hospitalists treating patients during the COVID-19 pandemic have been in a combat-like situation, with challenges and stresses similar to those faced by soldiers in a war zone.

And now, as the pandemic shows signs of subsiding, they’re about to emerge from this fight, which poses a whole new set of challenges, according a retired U.S. Army general who spoke May 4 at SHM Converge, the annual conference of the Society of Hospital Medicine.

Lt. Gen. (Ret.) Mark Hertling, DBA, said during his keynote speech that clinicians and soldiers – the only two professions that routinely have to navigate through life and death situations – must lead during all phases of combat.

“This is a period where you’re going to experience some things that you may or may not be ready for,” he said. “These are the same kind of issues soldiers face when redeploying from a combat zone.”

To help draw the comparison between hospitalists during the COVID-19 era and troops during a war, Lt. Gen. Hertling showed a photo of a U.S. paratrooper who’d just dropped into northern Iraq, carrying a backpack engorged with gear. He was on one knee with his face downcast as he seemed to be taking a moment to reflect on the enormity, complexity, and danger of the crisis into which he was about to plunge. He was, Lt. Gen. Hertling said, likely pondering the mission, his family he left behind, and concerns about making mistakes in front of his comrades.

Then he showed a picture of a health care worker in a hospital corridor slumped on the floor with his or her back against the wall, knees up, and hands loosely clasped, looking exhausted and dazed. Health care workers also have carried a load that has seemed unbearable.

“You can certainly see that they are experiencing an emotional trauma at the very start of the pandemic,” he said. “The things you have carried over the last year-plus as the pandemic has raged will be with you in good and sometimes bad ways, and you need to address those things.”

Lt. Gen. Hertling described several issues – mirroring those seen in combat – that clinicians will take away from the COVID-19 experience and must grapple with as the closing chapters of the pandemic play out:
 

A sense of teamwork in a crisis

While it’s not unusual, he said, for physicians not to get along well with administrators, and for nurses sometimes not to trust doctors, the COVID-19 crisis created a sense of effective teamwork.

“They have built trust because they see a common mission and a common requirement,” he said.
 

A sense of loss

“You have lost patients, you probably have lost comrades, and some of you are having this associated survivor’s guilt – why did you survive and so many of your patients, perhaps a lot of your friends, did not?”

At memorial services for fallen soldiers, Lt. Gen. Hertling would bring a laminated card with the soldier’s picture and put it in a box with the words “Make It Matter” on it.

“That was our code for ensuring that every one of these individual soldiers who sacrificed their lives for the organization, we would carry on their legacy and make their sacrifice matter,” he said. “That’s one of the few ways you can overcome survivor’s guilt.”
 

Sense of accomplishment

Lt. Gen. Hertling said hospitalists, pushed to the extreme, were able to do things they never thought they were capable of.

“You have to relish in that, and you have to write those things down so you can go back and think about the things you did in a crisis environment to help,” he said.

In the post-pandemic era, health care workers should reflect on what they have seen, learned, and experienced, to help set a new standard and to establish ways to eliminate “bureaucratic morasses,” which seemed more possible than ever because the urgency of the moment demanded it.

Lt. Gen. Hertling also said hospitalists should take time to make a plan to handle personal, professional, team, and organizational requirements. For instance, health care workers should get a physical to take stock of how their bodies reacted to the stress of the pandemic. He said they should also recognize the difference between posttraumatic stress, which is to be expected, and posttraumatic stress disorder (PTSD), which is less common.

“It’s only at the extreme that it becomes a dysfunction and you have to address it with the help of others,” he said. Hospitalists should examine the state of their emotional and spiritual relationships – with family and friends as well as with God or other figures important to them spiritually.

Professionally, hospitalists should review professional accomplishments and shortcomings and make changes based on those assessments, he said. It’s also a good time to assess leadership issues – recall who the contributors were and who could have done more. Hospitalists should also consider contributing post-pandemic articles to the Journal of Hospital Medicine, he said.

Lt. Gen. Hertling concluded by suggesting that hospitalists seek feedback on themselves and their own leadership qualities, from their team members.

“Really press the issue,” he said, “and get a good critique on how you can improve personally and professionally in terms of your leadership approach.”

Whether they realize it or not, hospitalists treating patients during the COVID-19 pandemic have been in a combat-like situation, with challenges and stresses similar to those faced by soldiers in a war zone.

And now, as the pandemic shows signs of subsiding, they’re about to emerge from this fight, which poses a whole new set of challenges, according a retired U.S. Army general who spoke May 4 at SHM Converge, the annual conference of the Society of Hospital Medicine.

Lt. Gen. (Ret.) Mark Hertling, DBA, said during his keynote speech that clinicians and soldiers – the only two professions that routinely have to navigate through life and death situations – must lead during all phases of combat.

“This is a period where you’re going to experience some things that you may or may not be ready for,” he said. “These are the same kind of issues soldiers face when redeploying from a combat zone.”

To help draw the comparison between hospitalists during the COVID-19 era and troops during a war, Lt. Gen. Hertling showed a photo of a U.S. paratrooper who’d just dropped into northern Iraq, carrying a backpack engorged with gear. He was on one knee with his face downcast as he seemed to be taking a moment to reflect on the enormity, complexity, and danger of the crisis into which he was about to plunge. He was, Lt. Gen. Hertling said, likely pondering the mission, his family he left behind, and concerns about making mistakes in front of his comrades.

Then he showed a picture of a health care worker in a hospital corridor slumped on the floor with his or her back against the wall, knees up, and hands loosely clasped, looking exhausted and dazed. Health care workers also have carried a load that has seemed unbearable.

“You can certainly see that they are experiencing an emotional trauma at the very start of the pandemic,” he said. “The things you have carried over the last year-plus as the pandemic has raged will be with you in good and sometimes bad ways, and you need to address those things.”

Lt. Gen. Hertling described several issues – mirroring those seen in combat – that clinicians will take away from the COVID-19 experience and must grapple with as the closing chapters of the pandemic play out:
 

A sense of teamwork in a crisis

While it’s not unusual, he said, for physicians not to get along well with administrators, and for nurses sometimes not to trust doctors, the COVID-19 crisis created a sense of effective teamwork.

“They have built trust because they see a common mission and a common requirement,” he said.
 

A sense of loss

“You have lost patients, you probably have lost comrades, and some of you are having this associated survivor’s guilt – why did you survive and so many of your patients, perhaps a lot of your friends, did not?”

At memorial services for fallen soldiers, Lt. Gen. Hertling would bring a laminated card with the soldier’s picture and put it in a box with the words “Make It Matter” on it.

“That was our code for ensuring that every one of these individual soldiers who sacrificed their lives for the organization, we would carry on their legacy and make their sacrifice matter,” he said. “That’s one of the few ways you can overcome survivor’s guilt.”
 

Sense of accomplishment

Lt. Gen. Hertling said hospitalists, pushed to the extreme, were able to do things they never thought they were capable of.

“You have to relish in that, and you have to write those things down so you can go back and think about the things you did in a crisis environment to help,” he said.

In the post-pandemic era, health care workers should reflect on what they have seen, learned, and experienced, to help set a new standard and to establish ways to eliminate “bureaucratic morasses,” which seemed more possible than ever because the urgency of the moment demanded it.

Lt. Gen. Hertling also said hospitalists should take time to make a plan to handle personal, professional, team, and organizational requirements. For instance, health care workers should get a physical to take stock of how their bodies reacted to the stress of the pandemic. He said they should also recognize the difference between posttraumatic stress, which is to be expected, and posttraumatic stress disorder (PTSD), which is less common.

“It’s only at the extreme that it becomes a dysfunction and you have to address it with the help of others,” he said. Hospitalists should examine the state of their emotional and spiritual relationships – with family and friends as well as with God or other figures important to them spiritually.

Professionally, hospitalists should review professional accomplishments and shortcomings and make changes based on those assessments, he said. It’s also a good time to assess leadership issues – recall who the contributors were and who could have done more. Hospitalists should also consider contributing post-pandemic articles to the Journal of Hospital Medicine, he said.

Lt. Gen. Hertling concluded by suggesting that hospitalists seek feedback on themselves and their own leadership qualities, from their team members.

“Really press the issue,” he said, “and get a good critique on how you can improve personally and professionally in terms of your leadership approach.”

Click here for the preview issue of the SHM Converge Daily News newsletter.

Click here for the preview issue of the SHM Converge Daily News newsletter.

Click here for the preview issue of the SHM Converge Daily News newsletter.

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

As Jade Myers set out to help create the virtual platform for SHM Converge, she was aware, through surveys and other communication, that the top wish of members of the Society of Hospital Medicine was an extensive and interactive educational experience.

“People really wanted to get back to the in-person conference,” said Ms. Myers, SHM’s director of meetings. “While we couldn’t do that, we can provide the same caliber and as robust an experience from an educational perspective as we would for an in-person activity.”

That has required significant revamping of the virtual platform compared to the platform for last year’s annual conference. In 2020, there was only one session running live at a time. This year, there will be 12 sessions running at the same time. There will also be more opportunities for networking, as well as other features for enjoyment and a sense of calm.

Here are some features of the SHM Converge platform:

• A host segment to kick-start each day, with an introduction of the day’s sessions and events.
• Nine didactic educational sessions at any given time. These sessions will include a live chat for peer-to-peer engagement, as well as questions and answers throughout the session to continue the discussion between speakers and participants.
• Three workshops at any given time. These sessions – on topics such as communication, gender equity, and clinical guidelines – will provide an opportunity for dynamic small-group discussion.
• A scientific abstract poster competition and reception, with an e-gallery of about 700 posters, providing a networking opportunity and highlighting emerging scientific and clinical cases.
• Special Interest Forums, in the form of live, interactive Zoom conferences. There will be 25 forums, which are designed to build community and facilitate collaboration.
• A variety of games, including trivia and a word scramble.
• Personalized profiles with information such as “Hospitalist in Training,” or “Committee Member.” These will be visible to other attendees to make it easier for people to connect when they have something in common.
• Early- and Mid-Career Speed Mentorship, in which a mentor and mentee can interact one-on-one, with each mentee able to meet with two mentors, with pairings designed for the best mentorship experience.
• Sessions on wellness and resilience.

“People are kind of Zoom fatigued,” Ms. Myers said, “so we’re trying to meet their needs while also offering an opportunity for respite, because our attendees are on the front lines right now, and they’re dealing with all types of fatigue and challenging times.”

The annual conference was on target for a banner year in 2020 before the COVID-19 pandemic forced the cancellation of the in-person conference in San Diego, and SHM Converge is a product of planning that began then, as organizers started considering a virtual event.

“In 2020, we were slated to have the largest conference in person that we have ever had,” said Hayleigh Scott, SHM’s meeting projects manager. “San Diego was going to be our really big year.”

But attendance at last year’s virtual conference was a fraction of what was expected at the in-person conference. This year, that seems poised to improve. There will be many more offerings, with more than 125 AMA PRA Category 1 Credits™ and 45 Maintenance of Certification points possible, Ms. Myers said. Because attendees won’t have to worry about being in two places at once, it will be possible to secure more CME credits at SHM Converge than at any previous SHM annual conference, she said.

The volume of content will be a heavy load on SHM personnel. Last year, three society staff members were on hand at each session to make sure it ran smoothly and to answer questions. With 12 sessions running simultaneously this year, many more staff members will need to be involved. But that is not unfamiliar for the society during meeting week, Ms. Myers said.

“We’re going to need to pull from pretty much our entire staff in order to make this conference happen, which is exciting and daunting,” she said. “It’s always been an all-hands-on-deck program and this is going to be more similar to an in-person conference in that way.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”

With dozens and dozens of sessions on the SHM Converge program, picking what to go to can feel virtually impossible.

The editorial board of The Hospitalist is here to help. With knowledge in an array of subspecialties – and experience in attending many SHM annual conferences, they have pointed out sessions they consider “must see,” whether based on the importance of the topic, the entertainment aspect, or the dynamic qualities of the speakers.

Here are their selections:
 

Ilaria Gadalla, DMSc, PA-C, physician assistant department chair, South University, West Palm Beach, Fla.

What You Say, What They Hear: Conversations with Your Hospital C-suite (Tuesday, May 4, 1:40 p.m. to 2:40 p.m.)

“As a department leader, developing my communication skills is always an area I seek to improve,” Dr. Gadalla said. “Tips to help with interpreting the audience and tailoring presentations for receptive feedback are invaluable tools.”

Hiring the Right Hospitalist: The Other Kind of Choosing Wisely (Wednesday, May 5, 2 p.m. to 3 p.m.)

“[This] is also an interesting session – selection criteria in the age of virtual interviewing is challenging,” she said. “I look forward to benefiting from my colleagues’ experience to enhance my leadership style.”

Shyam Odeti, MD, SFHM, FAAFP, MBA, hospitalist at Ballad Health, Johnson City, Tenn.

Understanding High-Value Care: Cost, Rationing, Overuse, and Underuse: Workshop (Tuesday May 4, 1:40 p.m. to 2:40 p.m.)

“Health care in the U.S. is expensive, and we have to pay utmost attention to the cost while providing the highest-quality medical care and service to sustain the health care,” Dr. Odeti said. “I am excited about this workshop organized by Dr. Justin Glasgow, Dr. Sarah Baron, Dr. Mona Krouss, and Dr. Harry Cho. I have known these leaders in the health care quality and patient safety arena over several years and their immense contributions to their organizations and the quality improvement special interest group of SHM. This workshop will help us understand how to define value in health care, implement high-value care, and eliminate low-value care.”

Hospitalists Piloting the Twin Engines of the Mid-Revenue Cycle Ship: A Primer on Utilization Management and Clinical Documentation Improvement (Thursday, May 6, 2:30 p.m. to 3:30 p.m.)

“The business of running hospitals carries with it many financial challenges,” Dr. Odeti said. “The intersection of tremendous fixed overhead and the vagaries of payer behavior is the cause. The COVID-19 pandemic and its devastating impact have compounded the problem. Hospitalists are natural institution leaders who are fundamental in overcoming this impasse through taking command and piloting the twin-engine ship of utilization management and clinical documentation improvement. These two domains working in synergy with experienced pilots are critical to attaining both high-quality care and the long-term viability of our health care systems. Dr. Aziz Ansari has been an expert in this domain and a highly sought-after speaker at SHM annual conferences. His sessions are incredibly captivating and educational.”

Harry Cho, MD, FACP, SFHM, chief value officer at NYC Health+ Hospitals

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“[I am] always looking forward to a fun-filled session for medical learning with this fantastic group of facilitators,” Dr. Cho said.

Back to the Future - Things I Wish I Knew Earlier in my Career (Wednesday, May 5, 3:50 p.m. to 4:30 p.m.)

“Listening to Brad Sharpe brings me back to the days in training, eagerly absorbing every pearl of wisdom from mentors,” he said.

Marina Farah, MD, MHA, performance improvement consultant, FarahMD Consulting, Corvallis, Ore.

James Kim, MD, associate professor of medicine, Emory University, Atlanta

Health Equity and Disparities in Hospitalized Patients (Tuesday, May 4, 3:30 p.m. to 4:10 p.m. )

“[Kimberly Manning, MD] is an amazing speaker, and I know that this is a topic that she can speak about both eloquently and passionately,” Dr. Kim said. “She has been advocating for her patients at Grady for years and so this is something that she has first-hand experience about.”

Top 5 Clinical Practice Guidelines Every Hospitalist Needs to Know: Workshop (Wednesday, May 5, 3:50 p.m. to 4:50 p.m. )

“This sounds like a high-yield session,” he said. “For busy clinicians, being able to know what guidelines should affect your daily practice is extremely important.”

Lonika Sood, MD, MHPE, FACP, FHM, clinical education director of internal medicine, Washington State University, Spokane

Anika Kumar, MD, FAAP, FHM, assistant professor of pediatrics, Cleveland Clinic Lerner College of Medicine

Fireside Chat: Story-telling and the Nocturnist in Pediatrics (Tuesday, May 4, 3:30 p.m. to 4:50 p.m.)

“I look forward to their discussion about storytelling and the role narrative medicine plays in patient care, especially pediatrics,” Dr. Kumar said.

Febrile Infant Update (Thursday, May 6, 3:10 p.m. to 3:50 p.m.)

“This clinical update session with Dr. Russell McCulloh will be exciting, as caring for febrile infants is bread-and-butter pediatric hospital medicine,” she said. “And this update will help review new research in this diagnosis.”

Kranthi Sitammagari, MD, FACP, CHCQM-PHYADV, director of clinical operations, quality, and patient experience, Atrium Health Hospitalist Group, Monroe, N.C.

Any session in the “Clinical Updates” and “Quality” tracks

“I would recommend ‘Clinical Updates’ and ‘Quality’ sessions, as they are so close to my practice and I look forward to those sessions,” Dr. Sitammagari said. “Clinical Updates provide the latest updates in clinical practice which is very useful for everyday patient management for hospitalists. Quality sessions discuss innovative ways to improve the quality of hospitalist practice.”

Raman Palabindala, MD, SFHM, medical director of utilization management, University of Mississippi Medical Center, Jackson

Medical Jeopardy (Thursday, May 6, 2:30 p.m. to 3:10 p.m.)

“I will always promote my fun event, Medical Jeopardy (Dr. Palabindala is a moderator). It is going to be a challenge between three great attendings from three great organizations across the country to win the national Jeopardy competition. Not only will you learn a lot, but you also will have a lot of fun. I am sure it is going to be more entertaining this time, given virtual play.”

LAMA’s DRAMA: Left AMA – Documentation & Rules of AMA (Friday, May 7, 3:30 p.m. to 4:30 p.m.)

“I also recommend the talk by Dr. Medarametla not just for the title LAMA DRAMA (for ‘left against medical advice’),” he said. “We all need to learn this one to the core and I am sure he will deliver the most engaging presentation.”

Ingrid Pinzon, MD, FACP, was working as a medical assistant to a physician a decade ago when she heard the doctor prescribe ibuprofen to a woman who was in the latter stages of pregnancy. Dr. Pinzon was a doctor, having received her education and training in Colombia, but because she had emigrated to the United States and hadn’t yet completed her certification and training here, she was not recognized yet as an American physician.

But she knew that ibuprofen was not recommended during late-term pregnancy, and she was alarmed. She informed the physician of the mistake. The doctor headed to Google, Dr. Pinzon said, and called the patient to rescind the ibuprofen prescription. But she soon fired Dr. Pinzon, seemingly for having had the courage to speak up.

Dr. Pinzon, now medical director of care coordination at Emory Johns Creek Hospital in Atlanta, will describe her experience as an immigrant physician in the Society of Hospital Medicine Converge session: “A Walk in Our Shoes: Immigrant Physicians Sharing Their Stories.” She will be joined by Patricia O’Brien, MD, PhD, FAAP, a pediatric hospitalist in Tampa; Manpreet Malik, MD, a hospitalist at Emory University; and Benji Mathews, MD, SFHM, FACP, chief of hospital medicine at HealthPartners and associate professor at the University of Minnesota.

They will describe their struggles to find their way in the United States, along with the satisfaction of having hard work pay off with better lives for themselves and their families. And together, they’ll provide a variety of narratives that will show, contrary to how many Americans view immigrants, how the experiences of immigrants don’t follow the same path, but each one carves out a path of his or her own.

“The thrust of this is really storytelling, along with putting into context what we can do to help our hospitalist brothers and sisters who are immigrants, and shining the light on it,” Dr. O’Brien said.

Dr. Pinzon was working as a doctor for the Colombian government when she began receiving threats from soldiers in a guerrilla army, which didn’t agree with her alignment with the government. One day, a guerrilla soldier threatened her and her two daughters – aged 5 and 11 at the time – and accurately described her daughters’ whereabouts.

Less than a week later, she and her daughters flew from Bogota to the United States, never to return to Colombia.

“I dropped everything I had when I came here,” she said. An immigration attorney initially recommended that she marry an American man in order to stay in the United States. When Dr. Pinzon declined, they pursued political asylum, and she received it less than a year later.

For 3 years, she worked jobs as assistants in medical offices and in other jobs, well below her education level, as she guided her daughters through school and went through the U.S. medical certification process. She was besieged by doubt constantly, she said.

“I cried for 3 years in a row,” she said. “I wanted to go back to my country. I didn’t want to stay here.”

Finally, she did her medical residency between 2011 and 2014, and got a job with Emory. Her daughters are grown, and one is a doctor in general surgery residency. Dr. Pinzon said she is happy to care for patients, particularly those who are Spanish-speaking and struggle as she did. But she often encounters patients who don’t hide that they dislike her accent.

“I will mute the TV and I will say: ‘I have a strong accent and so I want to make sure communication is clear,’ ” she said. “We have to prove ourselves all of the time. I feel like I have to prove myself to my patients that I’m a good doctor all of the time.” American-born doctors, she added, “shouldn’t take for granted what they already have.”

Dr. O’Brien grew up in Ireland, but in the late 1980s, the country was in a serious recession, with unemployment close to 20%, and her father applied for residency in Canada and the United States. They were accepted in Canada first, and moved there in 1988. A few years later, her parents moved them to Florida.

“They knew in order for us to do well, we had to go abroad,” she said. Dr. O’Brien went to college, medical school and graduate school in Florida, and completed residency in Cincinnati. Feeling the tug of her birthplace, she moved back to Ireland and worked there for a couple years.

“I never really wanted to leave because it was my home,” she said. While there, she came to a new-found appreciation for the U.S. health care system. It’s true that, in Ireland, everyone is insured, but there long wait times – for example, up to 2 years for a sedated nonurgent MRI for a child. She once had to send a patient to Dublin in a taxi with a nurse because an ambulance was unavailable.

“After going back to Ireland, where – I honestly thought I was going to go back and settle there – I realized how visionary my parents were in moving us,” Dr. O’Brien said. “This system in the U.S., there are lot of things broken about it, but we have all the resources.”

She moved back to the United States in August 2016, during a period of anti-immigrant rhetoric.

Nonetheless, Dr. O’Brien said she is happy to be here despite the lack of tolerance she sees in a minority of the U.S. population.

“Have a bit of sensitivity toward your provider. Maybe they speak with an accent. Maybe they don’t speak English perfectly. Maybe they have a different skin color. But their intention is good and it’s to help you and improve your health,” she said.

Ingrid Pinzon, MD, FACP, was working as a medical assistant to a physician a decade ago when she heard the doctor prescribe ibuprofen to a woman who was in the latter stages of pregnancy. Dr. Pinzon was a doctor, having received her education and training in Colombia, but because she had emigrated to the United States and hadn’t yet completed her certification and training here, she was not recognized yet as an American physician.

But she knew that ibuprofen was not recommended during late-term pregnancy, and she was alarmed. She informed the physician of the mistake. The doctor headed to Google, Dr. Pinzon said, and called the patient to rescind the ibuprofen prescription. But she soon fired Dr. Pinzon, seemingly for having had the courage to speak up.

Dr. Pinzon, now medical director of care coordination at Emory Johns Creek Hospital in Atlanta, will describe her experience as an immigrant physician in the Society of Hospital Medicine Converge session: “A Walk in Our Shoes: Immigrant Physicians Sharing Their Stories.” She will be joined by Patricia O’Brien, MD, PhD, FAAP, a pediatric hospitalist in Tampa; Manpreet Malik, MD, a hospitalist at Emory University; and Benji Mathews, MD, SFHM, FACP, chief of hospital medicine at HealthPartners and associate professor at the University of Minnesota.

They will describe their struggles to find their way in the United States, along with the satisfaction of having hard work pay off with better lives for themselves and their families. And together, they’ll provide a variety of narratives that will show, contrary to how many Americans view immigrants, how the experiences of immigrants don’t follow the same path, but each one carves out a path of his or her own.

“The thrust of this is really storytelling, along with putting into context what we can do to help our hospitalist brothers and sisters who are immigrants, and shining the light on it,” Dr. O’Brien said.

Dr. Pinzon was working as a doctor for the Colombian government when she began receiving threats from soldiers in a guerrilla army, which didn’t agree with her alignment with the government. One day, a guerrilla soldier threatened her and her two daughters – aged 5 and 11 at the time – and accurately described her daughters’ whereabouts.

Less than a week later, she and her daughters flew from Bogota to the United States, never to return to Colombia.

“I dropped everything I had when I came here,” she said. An immigration attorney initially recommended that she marry an American man in order to stay in the United States. When Dr. Pinzon declined, they pursued political asylum, and she received it less than a year later.

For 3 years, she worked jobs as assistants in medical offices and in other jobs, well below her education level, as she guided her daughters through school and went through the U.S. medical certification process. She was besieged by doubt constantly, she said.

“I cried for 3 years in a row,” she said. “I wanted to go back to my country. I didn’t want to stay here.”

Finally, she did her medical residency between 2011 and 2014, and got a job with Emory. Her daughters are grown, and one is a doctor in general surgery residency. Dr. Pinzon said she is happy to care for patients, particularly those who are Spanish-speaking and struggle as she did. But she often encounters patients who don’t hide that they dislike her accent.

“I will mute the TV and I will say: ‘I have a strong accent and so I want to make sure communication is clear,’ ” she said. “We have to prove ourselves all of the time. I feel like I have to prove myself to my patients that I’m a good doctor all of the time.” American-born doctors, she added, “shouldn’t take for granted what they already have.”

Dr. O’Brien grew up in Ireland, but in the late 1980s, the country was in a serious recession, with unemployment close to 20%, and her father applied for residency in Canada and the United States. They were accepted in Canada first, and moved there in 1988. A few years later, her parents moved them to Florida.

“They knew in order for us to do well, we had to go abroad,” she said. Dr. O’Brien went to college, medical school and graduate school in Florida, and completed residency in Cincinnati. Feeling the tug of her birthplace, she moved back to Ireland and worked there for a couple years.

“I never really wanted to leave because it was my home,” she said. While there, she came to a new-found appreciation for the U.S. health care system. It’s true that, in Ireland, everyone is insured, but there long wait times – for example, up to 2 years for a sedated nonurgent MRI for a child. She once had to send a patient to Dublin in a taxi with a nurse because an ambulance was unavailable.

“After going back to Ireland, where – I honestly thought I was going to go back and settle there – I realized how visionary my parents were in moving us,” Dr. O’Brien said. “This system in the U.S., there are lot of things broken about it, but we have all the resources.”

She moved back to the United States in August 2016, during a period of anti-immigrant rhetoric.

Nonetheless, Dr. O’Brien said she is happy to be here despite the lack of tolerance she sees in a minority of the U.S. population.

“Have a bit of sensitivity toward your provider. Maybe they speak with an accent. Maybe they don’t speak English perfectly. Maybe they have a different skin color. But their intention is good and it’s to help you and improve your health,” she said.

Ingrid Pinzon, MD, FACP, was working as a medical assistant to a physician a decade ago when she heard the doctor prescribe ibuprofen to a woman who was in the latter stages of pregnancy. Dr. Pinzon was a doctor, having received her education and training in Colombia, but because she had emigrated to the United States and hadn’t yet completed her certification and training here, she was not recognized yet as an American physician.

But she knew that ibuprofen was not recommended during late-term pregnancy, and she was alarmed. She informed the physician of the mistake. The doctor headed to Google, Dr. Pinzon said, and called the patient to rescind the ibuprofen prescription. But she soon fired Dr. Pinzon, seemingly for having had the courage to speak up.

Dr. Pinzon, now medical director of care coordination at Emory Johns Creek Hospital in Atlanta, will describe her experience as an immigrant physician in the Society of Hospital Medicine Converge session: “A Walk in Our Shoes: Immigrant Physicians Sharing Their Stories.” She will be joined by Patricia O’Brien, MD, PhD, FAAP, a pediatric hospitalist in Tampa; Manpreet Malik, MD, a hospitalist at Emory University; and Benji Mathews, MD, SFHM, FACP, chief of hospital medicine at HealthPartners and associate professor at the University of Minnesota.

They will describe their struggles to find their way in the United States, along with the satisfaction of having hard work pay off with better lives for themselves and their families. And together, they’ll provide a variety of narratives that will show, contrary to how many Americans view immigrants, how the experiences of immigrants don’t follow the same path, but each one carves out a path of his or her own.

“The thrust of this is really storytelling, along with putting into context what we can do to help our hospitalist brothers and sisters who are immigrants, and shining the light on it,” Dr. O’Brien said.

Dr. Pinzon was working as a doctor for the Colombian government when she began receiving threats from soldiers in a guerrilla army, which didn’t agree with her alignment with the government. One day, a guerrilla soldier threatened her and her two daughters – aged 5 and 11 at the time – and accurately described her daughters’ whereabouts.

Less than a week later, she and her daughters flew from Bogota to the United States, never to return to Colombia.

“I dropped everything I had when I came here,” she said. An immigration attorney initially recommended that she marry an American man in order to stay in the United States. When Dr. Pinzon declined, they pursued political asylum, and she received it less than a year later.

For 3 years, she worked jobs as assistants in medical offices and in other jobs, well below her education level, as she guided her daughters through school and went through the U.S. medical certification process. She was besieged by doubt constantly, she said.

“I cried for 3 years in a row,” she said. “I wanted to go back to my country. I didn’t want to stay here.”

Finally, she did her medical residency between 2011 and 2014, and got a job with Emory. Her daughters are grown, and one is a doctor in general surgery residency. Dr. Pinzon said she is happy to care for patients, particularly those who are Spanish-speaking and struggle as she did. But she often encounters patients who don’t hide that they dislike her accent.

“I will mute the TV and I will say: ‘I have a strong accent and so I want to make sure communication is clear,’ ” she said. “We have to prove ourselves all of the time. I feel like I have to prove myself to my patients that I’m a good doctor all of the time.” American-born doctors, she added, “shouldn’t take for granted what they already have.”

Dr. O’Brien grew up in Ireland, but in the late 1980s, the country was in a serious recession, with unemployment close to 20%, and her father applied for residency in Canada and the United States. They were accepted in Canada first, and moved there in 1988. A few years later, her parents moved them to Florida.

“They knew in order for us to do well, we had to go abroad,” she said. Dr. O’Brien went to college, medical school and graduate school in Florida, and completed residency in Cincinnati. Feeling the tug of her birthplace, she moved back to Ireland and worked there for a couple years.

“I never really wanted to leave because it was my home,” she said. While there, she came to a new-found appreciation for the U.S. health care system. It’s true that, in Ireland, everyone is insured, but there long wait times – for example, up to 2 years for a sedated nonurgent MRI for a child. She once had to send a patient to Dublin in a taxi with a nurse because an ambulance was unavailable.

“After going back to Ireland, where – I honestly thought I was going to go back and settle there – I realized how visionary my parents were in moving us,” Dr. O’Brien said. “This system in the U.S., there are lot of things broken about it, but we have all the resources.”

She moved back to the United States in August 2016, during a period of anti-immigrant rhetoric.

Nonetheless, Dr. O’Brien said she is happy to be here despite the lack of tolerance she sees in a minority of the U.S. population.

“Have a bit of sensitivity toward your provider. Maybe they speak with an accent. Maybe they don’t speak English perfectly. Maybe they have a different skin color. But their intention is good and it’s to help you and improve your health,” she said.