Society of Hospital Medicine (SHM): Hospital Medicine (SHM Annual Meeting)

SAN DIEGO – Hospitalists spend one-quarter of their practice time on team-related activities, yet some could stand to improve their performance as a patient-centered care team member, Dr. Kevin J. O’Leary said in a video interview at the annual meeting of the Society of Hospital Medicine.

Research shows that other team professionals, especially nurses, are not pleased with how hospitalists engage and collaborate with them, said Dr. O’Leary, chief of the division of hospital medicine at Northwestern University, Chicago.

To improve communication and coordination of care, Dr. O’Leary, who is also associate chair for quality in the department of medicine at the medical school, offered some teamwork interventions, including unit-based co-leadership, that hospitalists can try at their facilities. He reported having no financial disclosures.

[email protected]

SAN DIEGO – Hospitalists spend one-quarter of their practice time on team-related activities, yet some could stand to improve their performance as a patient-centered care team member, Dr. Kevin J. O’Leary said in a video interview at the annual meeting of the Society of Hospital Medicine.

Research shows that other team professionals, especially nurses, are not pleased with how hospitalists engage and collaborate with them, said Dr. O’Leary, chief of the division of hospital medicine at Northwestern University, Chicago.

To improve communication and coordination of care, Dr. O’Leary, who is also associate chair for quality in the department of medicine at the medical school, offered some teamwork interventions, including unit-based co-leadership, that hospitalists can try at their facilities. He reported having no financial disclosures.

[email protected]

SAN DIEGO – Hospitalists spend one-quarter of their practice time on team-related activities, yet some could stand to improve their performance as a patient-centered care team member, Dr. Kevin J. O’Leary said in a video interview at the annual meeting of the Society of Hospital Medicine.

Research shows that other team professionals, especially nurses, are not pleased with how hospitalists engage and collaborate with them, said Dr. O’Leary, chief of the division of hospital medicine at Northwestern University, Chicago.

To improve communication and coordination of care, Dr. O’Leary, who is also associate chair for quality in the department of medicine at the medical school, offered some teamwork interventions, including unit-based co-leadership, that hospitalists can try at their facilities. He reported having no financial disclosures.

[email protected]

SAN DIEGO – Difficult patients, demanding families. What is your hospitalist team’s solution to dealing with the stress of managing difficult people and tense situations?

The toll that difficult patients take on hospitalists, nurses, and other doctors trying to provide appropriate care and appropriate discharge most certainly contributes to high rates of burnout, Dr. John Nelson said at the annual meeting of the Society of Hospital Medicine.

“The way it works now, all over our hospitals, we say ‘Yeah, you got that tough patient. Yup. Sorry. Hang in there’,” he said. Instead we need a team approach, a way “to provide care for these patients without undue stress and stomach churning, crying and anger, and fear for our safety” so that the patient gets appropriate care and careers aren’t adversely affected.

In his presentation, “Think Different: A New Approach to High-Cost, Low-Quality Care Provided to High-Utilizer Patients,” Dr. Nelson discussed the problems faced by hospitalists and hospital staffs trying to manage patients who argue with providers about pain medication, or their family members who “are so upset that the CT scan wasn’t done when promised.”

Then there are the patients with severe behavioral or mental health issues, who “hit and throw things. … I don’t think it’s ideal to say, ‘You go in there and take care of that person or call security.’ ”

These are patients who “can chew up 2 hours of your morning when you’ve got 19 patients to round on and the ED has started calling,” said Dr. Nelson of Overlake Hospital Medical Center in Bellevue, Wash.

The response to these exceptionally problematic patients happens “on sort of an ad hoc basis,” he said. “Emails go around. … ‘Tomorrow morning, we’re going to try to have a care conference about this patient. Can you come? Can you come?’ ... It’s a terrible stream of emails, [and] all these things are so vague that it limits our success.”

One alternative might be to designate a special team to get the data, intervene, and resolve whatever it is that has made the relationship “go off the rails,” he said. This rapid response team might be composed of the ED doctor, coordinators, social workers, psychiatrists, a nurse on the unit, the primary care doctor if available, and others – about 10 people, any 6 of whom would intervene in managing the difficult patient.

Dr. Nelson said he didn’t know what such a team would cost, nor was he aware of any other health care organization that had tried such a strategy.

The team Dr. Nelson said he envisions would develop templates of successful interventions. “Today, we try to fully customize a brand new completely special intervention for every patient. … I think that’s very hard … and we’re not going to be successful trying to do that one-off every time, and reinvent it every time.”

Rather, the response team would develop a menu of interventions appropriate to the situation. One might be that the CEO is sent in to apologize. Another might be placing security stands at the door, or escorting combative family members off the campus. Another might be to develop a behavior contract that the patient signs. Maybe the patient’s expectation can be reasonably met.

Once the team members have gone through various interventions, they can determine which ones work and develop “a much less distressing, much more well-organized approach to responding to these kinds of patients,” Dr. Nelson said.

Staff and physicians should not go home “worried they’re going to be sued, or dreading returning to work the next day because they’re going to have to face this very, very difficult family, and no one is really helping,” he said.

SAN DIEGO – Difficult patients, demanding families. What is your hospitalist team’s solution to dealing with the stress of managing difficult people and tense situations?

The toll that difficult patients take on hospitalists, nurses, and other doctors trying to provide appropriate care and appropriate discharge most certainly contributes to high rates of burnout, Dr. John Nelson said at the annual meeting of the Society of Hospital Medicine.

“The way it works now, all over our hospitals, we say ‘Yeah, you got that tough patient. Yup. Sorry. Hang in there’,” he said. Instead we need a team approach, a way “to provide care for these patients without undue stress and stomach churning, crying and anger, and fear for our safety” so that the patient gets appropriate care and careers aren’t adversely affected.

In his presentation, “Think Different: A New Approach to High-Cost, Low-Quality Care Provided to High-Utilizer Patients,” Dr. Nelson discussed the problems faced by hospitalists and hospital staffs trying to manage patients who argue with providers about pain medication, or their family members who “are so upset that the CT scan wasn’t done when promised.”

Then there are the patients with severe behavioral or mental health issues, who “hit and throw things. … I don’t think it’s ideal to say, ‘You go in there and take care of that person or call security.’ ”

These are patients who “can chew up 2 hours of your morning when you’ve got 19 patients to round on and the ED has started calling,” said Dr. Nelson of Overlake Hospital Medical Center in Bellevue, Wash.

The response to these exceptionally problematic patients happens “on sort of an ad hoc basis,” he said. “Emails go around. … ‘Tomorrow morning, we’re going to try to have a care conference about this patient. Can you come? Can you come?’ ... It’s a terrible stream of emails, [and] all these things are so vague that it limits our success.”

One alternative might be to designate a special team to get the data, intervene, and resolve whatever it is that has made the relationship “go off the rails,” he said. This rapid response team might be composed of the ED doctor, coordinators, social workers, psychiatrists, a nurse on the unit, the primary care doctor if available, and others – about 10 people, any 6 of whom would intervene in managing the difficult patient.

Dr. Nelson said he didn’t know what such a team would cost, nor was he aware of any other health care organization that had tried such a strategy.

The team Dr. Nelson said he envisions would develop templates of successful interventions. “Today, we try to fully customize a brand new completely special intervention for every patient. … I think that’s very hard … and we’re not going to be successful trying to do that one-off every time, and reinvent it every time.”

Rather, the response team would develop a menu of interventions appropriate to the situation. One might be that the CEO is sent in to apologize. Another might be placing security stands at the door, or escorting combative family members off the campus. Another might be to develop a behavior contract that the patient signs. Maybe the patient’s expectation can be reasonably met.

Once the team members have gone through various interventions, they can determine which ones work and develop “a much less distressing, much more well-organized approach to responding to these kinds of patients,” Dr. Nelson said.

Staff and physicians should not go home “worried they’re going to be sued, or dreading returning to work the next day because they’re going to have to face this very, very difficult family, and no one is really helping,” he said.

SAN DIEGO – Difficult patients, demanding families. What is your hospitalist team’s solution to dealing with the stress of managing difficult people and tense situations?

The toll that difficult patients take on hospitalists, nurses, and other doctors trying to provide appropriate care and appropriate discharge most certainly contributes to high rates of burnout, Dr. John Nelson said at the annual meeting of the Society of Hospital Medicine.

“The way it works now, all over our hospitals, we say ‘Yeah, you got that tough patient. Yup. Sorry. Hang in there’,” he said. Instead we need a team approach, a way “to provide care for these patients without undue stress and stomach churning, crying and anger, and fear for our safety” so that the patient gets appropriate care and careers aren’t adversely affected.

In his presentation, “Think Different: A New Approach to High-Cost, Low-Quality Care Provided to High-Utilizer Patients,” Dr. Nelson discussed the problems faced by hospitalists and hospital staffs trying to manage patients who argue with providers about pain medication, or their family members who “are so upset that the CT scan wasn’t done when promised.”

Then there are the patients with severe behavioral or mental health issues, who “hit and throw things. … I don’t think it’s ideal to say, ‘You go in there and take care of that person or call security.’ ”

These are patients who “can chew up 2 hours of your morning when you’ve got 19 patients to round on and the ED has started calling,” said Dr. Nelson of Overlake Hospital Medical Center in Bellevue, Wash.

The response to these exceptionally problematic patients happens “on sort of an ad hoc basis,” he said. “Emails go around. … ‘Tomorrow morning, we’re going to try to have a care conference about this patient. Can you come? Can you come?’ ... It’s a terrible stream of emails, [and] all these things are so vague that it limits our success.”

One alternative might be to designate a special team to get the data, intervene, and resolve whatever it is that has made the relationship “go off the rails,” he said. This rapid response team might be composed of the ED doctor, coordinators, social workers, psychiatrists, a nurse on the unit, the primary care doctor if available, and others – about 10 people, any 6 of whom would intervene in managing the difficult patient.

Dr. Nelson said he didn’t know what such a team would cost, nor was he aware of any other health care organization that had tried such a strategy.

The team Dr. Nelson said he envisions would develop templates of successful interventions. “Today, we try to fully customize a brand new completely special intervention for every patient. … I think that’s very hard … and we’re not going to be successful trying to do that one-off every time, and reinvent it every time.”

Rather, the response team would develop a menu of interventions appropriate to the situation. One might be that the CEO is sent in to apologize. Another might be placing security stands at the door, or escorting combative family members off the campus. Another might be to develop a behavior contract that the patient signs. Maybe the patient’s expectation can be reasonably met.

Once the team members have gone through various interventions, they can determine which ones work and develop “a much less distressing, much more well-organized approach to responding to these kinds of patients,” Dr. Nelson said.

Staff and physicians should not go home “worried they’re going to be sued, or dreading returning to work the next day because they’re going to have to face this very, very difficult family, and no one is really helping,” he said.

SAN DIEGO – The way Dr. Michael Kedansky sees it, a hospitalist’s responsibility to a patient doesn’t end when that person is discharged.

“What happens beyond the walls of the hospital matters to us as clinicians,” he said at the annual meeting of the Society of Hospital Medicine. “Readmission is both an undesirable clinical outcome for our patients and a significant cost to the hospital.”

He defined a successful hospital discharge as one in which the patient is not readmitted and transitions to his or her home with an eventual recovery of function. This means that they’re taking the correct medications, follow-up visits are scheduled and honored, and that they feel safe in their home environment, said Dr. Kedansky, chief medical officer of transitional care services for Sound Physicians, which has more than 2,000 physicians in more than 180 hospitals and postacute facilities in the United States. Common barriers that prevent successful care transitions, he said, include the patient not understanding discharge instructions, ineffective medication reconciliation, lack of follow-up appointment availability, need for caregiver training/education, poor continuity of care and transfer of information, and psychosocial factors.

Dr. Kedansky defined effective transitional care as “a set of actions designed to ensure the coordination and continuity of health care as patients move one from one health care setting to another or home. It’s a way to address the current gaps in care, so patients can move safely from hospital to home and back to their PCP.” The problem is, transitional care sometimes takes a back seat to competing demands in the health care landscape. For example, one study found that only 50% of Medicare patients readmitted to the hospital within 30 days of discharge were seen by a follow-up provider (N Engl J Med. 2009;360:1418-28).

One novel care transitions intervention is the so-called Coleman model, in which a “transitions coach” works with patients for 30 days after discharge to help them understand and manage their complex postdischarge needs and ensure continuity of care across settings. Developed by Dr. Eric Coleman, four key aspects of the model include medication self-management, use of a patient-centered record, primary care and specialist follow-up, and knowledge of “red flags.” The process includes an initial visit in the hospital, telephone contact, and a home visit. A randomized trial of 750 community-dwelling adults aged 65 and older showed that those who received the intervention had 20%-40% lower overall hospital readmission rates, compared with controls (Arch Intern Med. 2006;166[17]:1822-8). In addition, they were about 50% less likely to be readmitted at 30, 90, and 180 days for the same condition that caused the initial hospitalization. Barriers to implementing the intervention, Dr. Kedansky said, include costs of startup, training staff, and the question of exactly who sees the savings.

Three more common models of delivering care transitions involve the following:

Traditional internist or family physician. Advantages of this model, he said, include better continuity of care, “both in relationships and transfer of information,” no additional resources required, and a high potential for patient satisfaction. Limitations of this model include a reduction in the physician presence, a high workload, and risk for burnout.

Extensivist. Advantages of this model, which was outlined in a recent JAMA article based on the experience of CareMore Health System (JAMA. 2016;315[1]:23-4), include improved continuity at the time of high-risk transitions, and evidence which demonstrates a reduction in readmission rates and lower costs of care. Drawbacks include the fact that it’s a high-cost model that has not been scaled beyond health plan settings. “There is no model to use extensivists in the fee-for-service world,” Dr. Kedansky said.

Hospitalist + post–acute care provider + PCP. Advantages of this model, he said, are that it’s easier to scale, physicians can develop an area of expertise, and they have a presence in the hospital or skilled nursing facility. One limitation is that it can lead to reduced continuity of care. “Until recently, this has been a volume-based model of care,” he added.

According to Dr. Kedansky, postacute expenses account for 65% of spending during a 90-day acute episode of care. The Bundled Payments for Care Improvement Initiative (BPCI), developed by the Centers for Medicare & Medicaid Services, is a shared savings model aimed at reducing post–acute care spending. Creative components of initiative, he said, include waivers for telemedicine and home health, waiver of the 3-night stay rule, and sharing and using data to define preferred, high performance networks. “I see BPCI as a game changer, as it turbocharges our physician-based models and incentivizes the right behavior,” he said. “The key to working in a bundled payment world is to teach hospitalists and other providers how to think differently, while managing patients across a full 90-day episode of care. Care redesign to improve clinical outcomes for patients leads to success and shared savings in this type of payment model.”

He concluded his remarks by advising physicians to “work through the list of items that ensure a successful care transition: patient education, caregiver training, medication reconciliation, and warm hand-offs of information.”

Dr. Kedansky reported having no financial disclosures.

[email protected]

SAN DIEGO – The way Dr. Michael Kedansky sees it, a hospitalist’s responsibility to a patient doesn’t end when that person is discharged.

“What happens beyond the walls of the hospital matters to us as clinicians,” he said at the annual meeting of the Society of Hospital Medicine. “Readmission is both an undesirable clinical outcome for our patients and a significant cost to the hospital.”

He defined a successful hospital discharge as one in which the patient is not readmitted and transitions to his or her home with an eventual recovery of function. This means that they’re taking the correct medications, follow-up visits are scheduled and honored, and that they feel safe in their home environment, said Dr. Kedansky, chief medical officer of transitional care services for Sound Physicians, which has more than 2,000 physicians in more than 180 hospitals and postacute facilities in the United States. Common barriers that prevent successful care transitions, he said, include the patient not understanding discharge instructions, ineffective medication reconciliation, lack of follow-up appointment availability, need for caregiver training/education, poor continuity of care and transfer of information, and psychosocial factors.

Dr. Kedansky defined effective transitional care as “a set of actions designed to ensure the coordination and continuity of health care as patients move one from one health care setting to another or home. It’s a way to address the current gaps in care, so patients can move safely from hospital to home and back to their PCP.” The problem is, transitional care sometimes takes a back seat to competing demands in the health care landscape. For example, one study found that only 50% of Medicare patients readmitted to the hospital within 30 days of discharge were seen by a follow-up provider (N Engl J Med. 2009;360:1418-28).

One novel care transitions intervention is the so-called Coleman model, in which a “transitions coach” works with patients for 30 days after discharge to help them understand and manage their complex postdischarge needs and ensure continuity of care across settings. Developed by Dr. Eric Coleman, four key aspects of the model include medication self-management, use of a patient-centered record, primary care and specialist follow-up, and knowledge of “red flags.” The process includes an initial visit in the hospital, telephone contact, and a home visit. A randomized trial of 750 community-dwelling adults aged 65 and older showed that those who received the intervention had 20%-40% lower overall hospital readmission rates, compared with controls (Arch Intern Med. 2006;166[17]:1822-8). In addition, they were about 50% less likely to be readmitted at 30, 90, and 180 days for the same condition that caused the initial hospitalization. Barriers to implementing the intervention, Dr. Kedansky said, include costs of startup, training staff, and the question of exactly who sees the savings.

Three more common models of delivering care transitions involve the following:

Traditional internist or family physician. Advantages of this model, he said, include better continuity of care, “both in relationships and transfer of information,” no additional resources required, and a high potential for patient satisfaction. Limitations of this model include a reduction in the physician presence, a high workload, and risk for burnout.

Extensivist. Advantages of this model, which was outlined in a recent JAMA article based on the experience of CareMore Health System (JAMA. 2016;315[1]:23-4), include improved continuity at the time of high-risk transitions, and evidence which demonstrates a reduction in readmission rates and lower costs of care. Drawbacks include the fact that it’s a high-cost model that has not been scaled beyond health plan settings. “There is no model to use extensivists in the fee-for-service world,” Dr. Kedansky said.

Hospitalist + post–acute care provider + PCP. Advantages of this model, he said, are that it’s easier to scale, physicians can develop an area of expertise, and they have a presence in the hospital or skilled nursing facility. One limitation is that it can lead to reduced continuity of care. “Until recently, this has been a volume-based model of care,” he added.

According to Dr. Kedansky, postacute expenses account for 65% of spending during a 90-day acute episode of care. The Bundled Payments for Care Improvement Initiative (BPCI), developed by the Centers for Medicare & Medicaid Services, is a shared savings model aimed at reducing post–acute care spending. Creative components of initiative, he said, include waivers for telemedicine and home health, waiver of the 3-night stay rule, and sharing and using data to define preferred, high performance networks. “I see BPCI as a game changer, as it turbocharges our physician-based models and incentivizes the right behavior,” he said. “The key to working in a bundled payment world is to teach hospitalists and other providers how to think differently, while managing patients across a full 90-day episode of care. Care redesign to improve clinical outcomes for patients leads to success and shared savings in this type of payment model.”

He concluded his remarks by advising physicians to “work through the list of items that ensure a successful care transition: patient education, caregiver training, medication reconciliation, and warm hand-offs of information.”

Dr. Kedansky reported having no financial disclosures.

[email protected]

SAN DIEGO – The way Dr. Michael Kedansky sees it, a hospitalist’s responsibility to a patient doesn’t end when that person is discharged.

“What happens beyond the walls of the hospital matters to us as clinicians,” he said at the annual meeting of the Society of Hospital Medicine. “Readmission is both an undesirable clinical outcome for our patients and a significant cost to the hospital.”

He defined a successful hospital discharge as one in which the patient is not readmitted and transitions to his or her home with an eventual recovery of function. This means that they’re taking the correct medications, follow-up visits are scheduled and honored, and that they feel safe in their home environment, said Dr. Kedansky, chief medical officer of transitional care services for Sound Physicians, which has more than 2,000 physicians in more than 180 hospitals and postacute facilities in the United States. Common barriers that prevent successful care transitions, he said, include the patient not understanding discharge instructions, ineffective medication reconciliation, lack of follow-up appointment availability, need for caregiver training/education, poor continuity of care and transfer of information, and psychosocial factors.

Dr. Kedansky defined effective transitional care as “a set of actions designed to ensure the coordination and continuity of health care as patients move one from one health care setting to another or home. It’s a way to address the current gaps in care, so patients can move safely from hospital to home and back to their PCP.” The problem is, transitional care sometimes takes a back seat to competing demands in the health care landscape. For example, one study found that only 50% of Medicare patients readmitted to the hospital within 30 days of discharge were seen by a follow-up provider (N Engl J Med. 2009;360:1418-28).

One novel care transitions intervention is the so-called Coleman model, in which a “transitions coach” works with patients for 30 days after discharge to help them understand and manage their complex postdischarge needs and ensure continuity of care across settings. Developed by Dr. Eric Coleman, four key aspects of the model include medication self-management, use of a patient-centered record, primary care and specialist follow-up, and knowledge of “red flags.” The process includes an initial visit in the hospital, telephone contact, and a home visit. A randomized trial of 750 community-dwelling adults aged 65 and older showed that those who received the intervention had 20%-40% lower overall hospital readmission rates, compared with controls (Arch Intern Med. 2006;166[17]:1822-8). In addition, they were about 50% less likely to be readmitted at 30, 90, and 180 days for the same condition that caused the initial hospitalization. Barriers to implementing the intervention, Dr. Kedansky said, include costs of startup, training staff, and the question of exactly who sees the savings.

Three more common models of delivering care transitions involve the following:

Traditional internist or family physician. Advantages of this model, he said, include better continuity of care, “both in relationships and transfer of information,” no additional resources required, and a high potential for patient satisfaction. Limitations of this model include a reduction in the physician presence, a high workload, and risk for burnout.

Extensivist. Advantages of this model, which was outlined in a recent JAMA article based on the experience of CareMore Health System (JAMA. 2016;315[1]:23-4), include improved continuity at the time of high-risk transitions, and evidence which demonstrates a reduction in readmission rates and lower costs of care. Drawbacks include the fact that it’s a high-cost model that has not been scaled beyond health plan settings. “There is no model to use extensivists in the fee-for-service world,” Dr. Kedansky said.

Hospitalist + post–acute care provider + PCP. Advantages of this model, he said, are that it’s easier to scale, physicians can develop an area of expertise, and they have a presence in the hospital or skilled nursing facility. One limitation is that it can lead to reduced continuity of care. “Until recently, this has been a volume-based model of care,” he added.

According to Dr. Kedansky, postacute expenses account for 65% of spending during a 90-day acute episode of care. The Bundled Payments for Care Improvement Initiative (BPCI), developed by the Centers for Medicare & Medicaid Services, is a shared savings model aimed at reducing post–acute care spending. Creative components of initiative, he said, include waivers for telemedicine and home health, waiver of the 3-night stay rule, and sharing and using data to define preferred, high performance networks. “I see BPCI as a game changer, as it turbocharges our physician-based models and incentivizes the right behavior,” he said. “The key to working in a bundled payment world is to teach hospitalists and other providers how to think differently, while managing patients across a full 90-day episode of care. Care redesign to improve clinical outcomes for patients leads to success and shared savings in this type of payment model.”

He concluded his remarks by advising physicians to “work through the list of items that ensure a successful care transition: patient education, caregiver training, medication reconciliation, and warm hand-offs of information.”

Dr. Kedansky reported having no financial disclosures.

[email protected]

SAN DIEGO – Surgeon General Dr. Vivek H. Murthy called for a culture of “emotional well-being” to curb physician burnout and reduce the number of distressed physicians who take their lives each year.

“I think we have to have a focus on emotional well-being from the time people get into medical school,” he said during a press briefing at the annual meeting of the Society of Hospital Medicine. “We’re not just talking about trying to build a couple of intervention programs where people meet in small groups once a week. This is about shifting perspective in culture, recognizing that emotional well-being is an essential tool for clinicians to be able to do their jobs well.”

Dr. Murthy expressed concern for medical students who enter the profession “with the highest of ideals. But once they get into medicine, they run into challenges and obstacles. They find that the system isn’t always set up to allow them to live up to those ideals.”

Those challenges, he continued, “can wear on people’s emotional well-being. It can lead them to a sense of futility. It can increase burnout, and it can tax people to the point where, sadly, in some cases, people are driven to harm themselves.”

Dr. Murthy also is the cofounder of VISIONS, an HIV/AIDS education program in India and the United States, which he led for 8 years.

[email protected]

SAN DIEGO – Surgeon General Dr. Vivek H. Murthy called for a culture of “emotional well-being” to curb physician burnout and reduce the number of distressed physicians who take their lives each year.

“I think we have to have a focus on emotional well-being from the time people get into medical school,” he said during a press briefing at the annual meeting of the Society of Hospital Medicine. “We’re not just talking about trying to build a couple of intervention programs where people meet in small groups once a week. This is about shifting perspective in culture, recognizing that emotional well-being is an essential tool for clinicians to be able to do their jobs well.”

Dr. Murthy expressed concern for medical students who enter the profession “with the highest of ideals. But once they get into medicine, they run into challenges and obstacles. They find that the system isn’t always set up to allow them to live up to those ideals.”

Those challenges, he continued, “can wear on people’s emotional well-being. It can lead them to a sense of futility. It can increase burnout, and it can tax people to the point where, sadly, in some cases, people are driven to harm themselves.”

Dr. Murthy also is the cofounder of VISIONS, an HIV/AIDS education program in India and the United States, which he led for 8 years.

[email protected]

SAN DIEGO – Surgeon General Dr. Vivek H. Murthy called for a culture of “emotional well-being” to curb physician burnout and reduce the number of distressed physicians who take their lives each year.

“I think we have to have a focus on emotional well-being from the time people get into medical school,” he said during a press briefing at the annual meeting of the Society of Hospital Medicine. “We’re not just talking about trying to build a couple of intervention programs where people meet in small groups once a week. This is about shifting perspective in culture, recognizing that emotional well-being is an essential tool for clinicians to be able to do their jobs well.”

Dr. Murthy expressed concern for medical students who enter the profession “with the highest of ideals. But once they get into medicine, they run into challenges and obstacles. They find that the system isn’t always set up to allow them to live up to those ideals.”

Those challenges, he continued, “can wear on people’s emotional well-being. It can lead them to a sense of futility. It can increase burnout, and it can tax people to the point where, sadly, in some cases, people are driven to harm themselves.”

Dr. Murthy also is the cofounder of VISIONS, an HIV/AIDS education program in India and the United States, which he led for 8 years.

[email protected]