Teachable Moments

Practically everyone who lives in America has heard about the Baltimore riots, precipitated by the death of a man while in police custody. Their scope was unprecedented; their implications, far reaching. I, like many Americans, stayed glued to the news to keep abreast of the latest updates for a variety of reasons, one of which was that I live and work nearby, and personal safety was a major concern. At the peak of the violence, when people were leaving the city in droves, I kept in close contact with my brother, a physician who works in a hospital at the epicenter of the chaos. Fortunately, he got out safely, as did most people. Yet many, including citizens and police officers, were injured, some seriously so.

No matter where you stand regarding the events surrounding the riots, the fact remains that we as physicians are not infrequently called upon to care for patients who have victimized or been victimized by others. We care for those who are slowly destroying themselves and endangering others with their abuse of drugs and alcohol, yet refuse any help we offer for their substance abuse. Some hospitalists work in hospitals with booming prison wards, and thus frequently care for murderers, thieves, child abusers, and others whom we may secretly fear, yet openly pledge to protect, respect, and care for. While I could not find a good scholarly article addressing how we as physicians do versus how we should handle these situations, I believe many of us have struggled with the personal emotions and ethical dilemmas raised by some of these cases.

How much can we and should we get involved? How do we mask our personal opinions of patients who have committed egregious acts and provide not only the best care possible, but do so while treating them with the respect and dignity that we allow for other patients? And if we go the extra mile to provide emotional support and encouragement, will we really have any positive impact on them, or will they just shut us out? Where do we draw the line between just being health care providers and being compassionate, nonjudgmental clinicians who can really impact their lives?

I don’t think there is an easy answer to any of these questions, and each patient is different. But I believe that many people still look up to their health care providers, and there will be those times when we can be more than their doctor; we can be their (much-needed) friend. Meanwhile, we need to guard against the natural human inclination to act as judge and jury toward those who have committed acts we personally find reprehensible. Every patient deserves our very best medical care, even when we cannot find it within ourselves to give this service with a smile.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Practically everyone who lives in America has heard about the Baltimore riots, precipitated by the death of a man while in police custody. Their scope was unprecedented; their implications, far reaching. I, like many Americans, stayed glued to the news to keep abreast of the latest updates for a variety of reasons, one of which was that I live and work nearby, and personal safety was a major concern. At the peak of the violence, when people were leaving the city in droves, I kept in close contact with my brother, a physician who works in a hospital at the epicenter of the chaos. Fortunately, he got out safely, as did most people. Yet many, including citizens and police officers, were injured, some seriously so.

No matter where you stand regarding the events surrounding the riots, the fact remains that we as physicians are not infrequently called upon to care for patients who have victimized or been victimized by others. We care for those who are slowly destroying themselves and endangering others with their abuse of drugs and alcohol, yet refuse any help we offer for their substance abuse. Some hospitalists work in hospitals with booming prison wards, and thus frequently care for murderers, thieves, child abusers, and others whom we may secretly fear, yet openly pledge to protect, respect, and care for. While I could not find a good scholarly article addressing how we as physicians do versus how we should handle these situations, I believe many of us have struggled with the personal emotions and ethical dilemmas raised by some of these cases.

How much can we and should we get involved? How do we mask our personal opinions of patients who have committed egregious acts and provide not only the best care possible, but do so while treating them with the respect and dignity that we allow for other patients? And if we go the extra mile to provide emotional support and encouragement, will we really have any positive impact on them, or will they just shut us out? Where do we draw the line between just being health care providers and being compassionate, nonjudgmental clinicians who can really impact their lives?

I don’t think there is an easy answer to any of these questions, and each patient is different. But I believe that many people still look up to their health care providers, and there will be those times when we can be more than their doctor; we can be their (much-needed) friend. Meanwhile, we need to guard against the natural human inclination to act as judge and jury toward those who have committed acts we personally find reprehensible. Every patient deserves our very best medical care, even when we cannot find it within ourselves to give this service with a smile.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Practically everyone who lives in America has heard about the Baltimore riots, precipitated by the death of a man while in police custody. Their scope was unprecedented; their implications, far reaching. I, like many Americans, stayed glued to the news to keep abreast of the latest updates for a variety of reasons, one of which was that I live and work nearby, and personal safety was a major concern. At the peak of the violence, when people were leaving the city in droves, I kept in close contact with my brother, a physician who works in a hospital at the epicenter of the chaos. Fortunately, he got out safely, as did most people. Yet many, including citizens and police officers, were injured, some seriously so.

No matter where you stand regarding the events surrounding the riots, the fact remains that we as physicians are not infrequently called upon to care for patients who have victimized or been victimized by others. We care for those who are slowly destroying themselves and endangering others with their abuse of drugs and alcohol, yet refuse any help we offer for their substance abuse. Some hospitalists work in hospitals with booming prison wards, and thus frequently care for murderers, thieves, child abusers, and others whom we may secretly fear, yet openly pledge to protect, respect, and care for. While I could not find a good scholarly article addressing how we as physicians do versus how we should handle these situations, I believe many of us have struggled with the personal emotions and ethical dilemmas raised by some of these cases.

How much can we and should we get involved? How do we mask our personal opinions of patients who have committed egregious acts and provide not only the best care possible, but do so while treating them with the respect and dignity that we allow for other patients? And if we go the extra mile to provide emotional support and encouragement, will we really have any positive impact on them, or will they just shut us out? Where do we draw the line between just being health care providers and being compassionate, nonjudgmental clinicians who can really impact their lives?

I don’t think there is an easy answer to any of these questions, and each patient is different. But I believe that many people still look up to their health care providers, and there will be those times when we can be more than their doctor; we can be their (much-needed) friend. Meanwhile, we need to guard against the natural human inclination to act as judge and jury toward those who have committed acts we personally find reprehensible. Every patient deserves our very best medical care, even when we cannot find it within ourselves to give this service with a smile.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

My job recently changed to include some administrative responsibilities, so having done purely clinical work for my entire career as a physician, I thought it wise to begin broadening my horizons to learn how to best meet the new challenges ahead of me. Fortunately, not only was the Hospital Medicine 2015 conference just an hour’s drive away, it occurred just when I needed it most, within days of my taking on a new role.

Naturally, I opted for the Practice Management track this year since I will need a different skill set than I currently have. In the first session, called Case Studies in Improving Patient Experience, I learned about a patient named John, who had developed typical ischemic chest pain during a weekly tennis game with his wife. His doctors did everything right, or so they thought. They exceeded the national guidelines for each quality measure, including the time it took them to revascularize his blocked artery. John had no significant residual damage and within 2 weeks was back on the tennis courts.

But there had been a huge disconnect. His doctors practiced excellent medicine, yet John was displeased with his care. The hospital team had not communicated well with John during his hospital stay. A great success story seen through the eyes of his medical team was a great failure as seen through the eyes of John and his wife. The hospital team’s lack of communication trumped the fact that they had played a huge role in saving John’s life.

As a matter of fact, John and his wife were so distraught over their experience that they went to the hospital administration to express their concerns about how poorly they had been treated.

This story also was aired as part of a segment on National Public Radio. Some of the comments of listeners echoed the sentiments we hear often, such as “doctors don’t know how to communicate with patients” and “doctors don’t care.” While the former statement may be true in many cases, the latter couldn’t be further from the truth. We do care. Why else would we sacrifice so much of our lives to help others? There are certainly other careers that pay more than medicine, especially considering all the time and financial investment that go into becoming a physician.

So why is it that as intelligent as we are as a group, we often fall short of meeting the communication goals that are so important to our patients? Some believe – and I am one of them – that most physicians are examples of the cognitive load theory. Our brains are simply overloaded. This theory, developed by psychologist John Sweller in the 1980s, refers to the total amount of mental effort used in one’s working memory.

There are three types of cognitive load: intrinsic, extraneous, and germane. Intrinsic cognitive load refers to how much effort goes into a particular topic, and in the field of medicine, the complexity of the information we deal with is very high, as is our intrinsic load.

Extraneous cognitive load refers to how this information is presented to us. When the pager is incessantly beeping, a line of nurses is waiting to ask a question, you desperately need to get to the ED to admit a potential stroke patient, and you eye a family member anxiously pacing the hallway and waiting for a chance to speak with you, your brain is bombarded with a variety of complex issues coming in all directions. In short, your extraneous load is through the roof.

The germane cognitive load refers to the work you put into processing information and creating a permanent store of that knowledge, creating a schema, so to speak. For instance, after much experience, it has become relatively simple to classify a patient as having heart failure if he presents with bilateral leg edema, progressive shortness of breath, and crackles on exam.

Experience helps us with our germane cognitive load and sometimes we have little control over our intrinisic load, but there are many potential opportunities to organize our extraneous cognitive load into chunks that flow more seamlessly, make our workday run more smoothly, and free up mental energy and time to deal effectively with other important issues. We all have our personal preferences for how we like our workday to flow. Chances are, with a little creativity, we can have a significant impact on our own extraneous loads.

Getting back to John, he is just one of many patients who feel emotionally neglected, not respected, or not kept up to date regarding their statuses. Considering his doctors, they were probably overwhelmed with the load they were carrying; the responsibility for a life is something only medical professionals can fully grasp. I know there have been times when I too felt simply overwhelmed and unable to do every single thing that would have been good, but not crucial, to the goal of curing the patient. Had I managed my intrinisic load better, perhaps I would have been better equipped to spend more time talking to patients and their family members. I suspect I am not alone.

My job recently changed to include some administrative responsibilities, so having done purely clinical work for my entire career as a physician, I thought it wise to begin broadening my horizons to learn how to best meet the new challenges ahead of me. Fortunately, not only was the Hospital Medicine 2015 conference just an hour’s drive away, it occurred just when I needed it most, within days of my taking on a new role.

Naturally, I opted for the Practice Management track this year since I will need a different skill set than I currently have. In the first session, called Case Studies in Improving Patient Experience, I learned about a patient named John, who had developed typical ischemic chest pain during a weekly tennis game with his wife. His doctors did everything right, or so they thought. They exceeded the national guidelines for each quality measure, including the time it took them to revascularize his blocked artery. John had no significant residual damage and within 2 weeks was back on the tennis courts.

But there had been a huge disconnect. His doctors practiced excellent medicine, yet John was displeased with his care. The hospital team had not communicated well with John during his hospital stay. A great success story seen through the eyes of his medical team was a great failure as seen through the eyes of John and his wife. The hospital team’s lack of communication trumped the fact that they had played a huge role in saving John’s life.

As a matter of fact, John and his wife were so distraught over their experience that they went to the hospital administration to express their concerns about how poorly they had been treated.

This story also was aired as part of a segment on National Public Radio. Some of the comments of listeners echoed the sentiments we hear often, such as “doctors don’t know how to communicate with patients” and “doctors don’t care.” While the former statement may be true in many cases, the latter couldn’t be further from the truth. We do care. Why else would we sacrifice so much of our lives to help others? There are certainly other careers that pay more than medicine, especially considering all the time and financial investment that go into becoming a physician.

So why is it that as intelligent as we are as a group, we often fall short of meeting the communication goals that are so important to our patients? Some believe – and I am one of them – that most physicians are examples of the cognitive load theory. Our brains are simply overloaded. This theory, developed by psychologist John Sweller in the 1980s, refers to the total amount of mental effort used in one’s working memory.

There are three types of cognitive load: intrinsic, extraneous, and germane. Intrinsic cognitive load refers to how much effort goes into a particular topic, and in the field of medicine, the complexity of the information we deal with is very high, as is our intrinsic load.

Extraneous cognitive load refers to how this information is presented to us. When the pager is incessantly beeping, a line of nurses is waiting to ask a question, you desperately need to get to the ED to admit a potential stroke patient, and you eye a family member anxiously pacing the hallway and waiting for a chance to speak with you, your brain is bombarded with a variety of complex issues coming in all directions. In short, your extraneous load is through the roof.

The germane cognitive load refers to the work you put into processing information and creating a permanent store of that knowledge, creating a schema, so to speak. For instance, after much experience, it has become relatively simple to classify a patient as having heart failure if he presents with bilateral leg edema, progressive shortness of breath, and crackles on exam.

Experience helps us with our germane cognitive load and sometimes we have little control over our intrinisic load, but there are many potential opportunities to organize our extraneous cognitive load into chunks that flow more seamlessly, make our workday run more smoothly, and free up mental energy and time to deal effectively with other important issues. We all have our personal preferences for how we like our workday to flow. Chances are, with a little creativity, we can have a significant impact on our own extraneous loads.

Getting back to John, he is just one of many patients who feel emotionally neglected, not respected, or not kept up to date regarding their statuses. Considering his doctors, they were probably overwhelmed with the load they were carrying; the responsibility for a life is something only medical professionals can fully grasp. I know there have been times when I too felt simply overwhelmed and unable to do every single thing that would have been good, but not crucial, to the goal of curing the patient. Had I managed my intrinisic load better, perhaps I would have been better equipped to spend more time talking to patients and their family members. I suspect I am not alone.

My job recently changed to include some administrative responsibilities, so having done purely clinical work for my entire career as a physician, I thought it wise to begin broadening my horizons to learn how to best meet the new challenges ahead of me. Fortunately, not only was the Hospital Medicine 2015 conference just an hour’s drive away, it occurred just when I needed it most, within days of my taking on a new role.

Naturally, I opted for the Practice Management track this year since I will need a different skill set than I currently have. In the first session, called Case Studies in Improving Patient Experience, I learned about a patient named John, who had developed typical ischemic chest pain during a weekly tennis game with his wife. His doctors did everything right, or so they thought. They exceeded the national guidelines for each quality measure, including the time it took them to revascularize his blocked artery. John had no significant residual damage and within 2 weeks was back on the tennis courts.

But there had been a huge disconnect. His doctors practiced excellent medicine, yet John was displeased with his care. The hospital team had not communicated well with John during his hospital stay. A great success story seen through the eyes of his medical team was a great failure as seen through the eyes of John and his wife. The hospital team’s lack of communication trumped the fact that they had played a huge role in saving John’s life.

As a matter of fact, John and his wife were so distraught over their experience that they went to the hospital administration to express their concerns about how poorly they had been treated.

This story also was aired as part of a segment on National Public Radio. Some of the comments of listeners echoed the sentiments we hear often, such as “doctors don’t know how to communicate with patients” and “doctors don’t care.” While the former statement may be true in many cases, the latter couldn’t be further from the truth. We do care. Why else would we sacrifice so much of our lives to help others? There are certainly other careers that pay more than medicine, especially considering all the time and financial investment that go into becoming a physician.

So why is it that as intelligent as we are as a group, we often fall short of meeting the communication goals that are so important to our patients? Some believe – and I am one of them – that most physicians are examples of the cognitive load theory. Our brains are simply overloaded. This theory, developed by psychologist John Sweller in the 1980s, refers to the total amount of mental effort used in one’s working memory.

There are three types of cognitive load: intrinsic, extraneous, and germane. Intrinsic cognitive load refers to how much effort goes into a particular topic, and in the field of medicine, the complexity of the information we deal with is very high, as is our intrinsic load.

Extraneous cognitive load refers to how this information is presented to us. When the pager is incessantly beeping, a line of nurses is waiting to ask a question, you desperately need to get to the ED to admit a potential stroke patient, and you eye a family member anxiously pacing the hallway and waiting for a chance to speak with you, your brain is bombarded with a variety of complex issues coming in all directions. In short, your extraneous load is through the roof.

The germane cognitive load refers to the work you put into processing information and creating a permanent store of that knowledge, creating a schema, so to speak. For instance, after much experience, it has become relatively simple to classify a patient as having heart failure if he presents with bilateral leg edema, progressive shortness of breath, and crackles on exam.

Experience helps us with our germane cognitive load and sometimes we have little control over our intrinisic load, but there are many potential opportunities to organize our extraneous cognitive load into chunks that flow more seamlessly, make our workday run more smoothly, and free up mental energy and time to deal effectively with other important issues. We all have our personal preferences for how we like our workday to flow. Chances are, with a little creativity, we can have a significant impact on our own extraneous loads.

Getting back to John, he is just one of many patients who feel emotionally neglected, not respected, or not kept up to date regarding their statuses. Considering his doctors, they were probably overwhelmed with the load they were carrying; the responsibility for a life is something only medical professionals can fully grasp. I know there have been times when I too felt simply overwhelmed and unable to do every single thing that would have been good, but not crucial, to the goal of curing the patient. Had I managed my intrinisic load better, perhaps I would have been better equipped to spend more time talking to patients and their family members. I suspect I am not alone.

According to the National Hospice Foundation, an estimated 70 million Americans will need hospice and palliative care services in the next 20 years, and most of us cannot even begin to remember all the patients we have treated who were ultimately transferred from a medical ward to some form of hospice.

Hospice care is often a compassionate, appropriate recommendation, but is it not always an easy subject for hospitalists to broach. After all, we went into medicine to cure the sick. At least on a subconscious level, we may feel we have failed our patients when all we have to offer them is hospice. Plus, we are often at the disadvantage of not having enough time with our patients and their families to develop the trust needed to accept such a life-altering recommendation.

It’s important to remember that, even when we can’t cure our patients, we can offer them symptomatic relief and the ability to heal on a certain level. Sometimes, the recommendation of hospice is a much-welcomed release for patients and their families, a way to finally ease the burdens of uncertainty and of pain, both physical and emotional.

Palliative care can be an important addition to the care plan, as it focuses on relieving suffering, regardless of the stage of disease. Palliative care incorporates support, as well as assistance with communication about care needs. Within an integrated care model, palliative care may be provided alongside curative or life-prolonging treatments.

Palliative care can be particularly useful for helping patients to prepare for the emotional transition from seeking aggressive but likely futile care to accepting the ultimate reality of their disease process. Even when death is not imminent, having the appropriate support systems in place for patients and their families can play a significant role in easing their minds and helping them make informed, appropriate treatment decisions.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

According to the National Hospice Foundation, an estimated 70 million Americans will need hospice and palliative care services in the next 20 years, and most of us cannot even begin to remember all the patients we have treated who were ultimately transferred from a medical ward to some form of hospice.

Hospice care is often a compassionate, appropriate recommendation, but is it not always an easy subject for hospitalists to broach. After all, we went into medicine to cure the sick. At least on a subconscious level, we may feel we have failed our patients when all we have to offer them is hospice. Plus, we are often at the disadvantage of not having enough time with our patients and their families to develop the trust needed to accept such a life-altering recommendation.

It’s important to remember that, even when we can’t cure our patients, we can offer them symptomatic relief and the ability to heal on a certain level. Sometimes, the recommendation of hospice is a much-welcomed release for patients and their families, a way to finally ease the burdens of uncertainty and of pain, both physical and emotional.

Palliative care can be an important addition to the care plan, as it focuses on relieving suffering, regardless of the stage of disease. Palliative care incorporates support, as well as assistance with communication about care needs. Within an integrated care model, palliative care may be provided alongside curative or life-prolonging treatments.

Palliative care can be particularly useful for helping patients to prepare for the emotional transition from seeking aggressive but likely futile care to accepting the ultimate reality of their disease process. Even when death is not imminent, having the appropriate support systems in place for patients and their families can play a significant role in easing their minds and helping them make informed, appropriate treatment decisions.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

According to the National Hospice Foundation, an estimated 70 million Americans will need hospice and palliative care services in the next 20 years, and most of us cannot even begin to remember all the patients we have treated who were ultimately transferred from a medical ward to some form of hospice.

Hospice care is often a compassionate, appropriate recommendation, but is it not always an easy subject for hospitalists to broach. After all, we went into medicine to cure the sick. At least on a subconscious level, we may feel we have failed our patients when all we have to offer them is hospice. Plus, we are often at the disadvantage of not having enough time with our patients and their families to develop the trust needed to accept such a life-altering recommendation.

It’s important to remember that, even when we can’t cure our patients, we can offer them symptomatic relief and the ability to heal on a certain level. Sometimes, the recommendation of hospice is a much-welcomed release for patients and their families, a way to finally ease the burdens of uncertainty and of pain, both physical and emotional.

Palliative care can be an important addition to the care plan, as it focuses on relieving suffering, regardless of the stage of disease. Palliative care incorporates support, as well as assistance with communication about care needs. Within an integrated care model, palliative care may be provided alongside curative or life-prolonging treatments.

Palliative care can be particularly useful for helping patients to prepare for the emotional transition from seeking aggressive but likely futile care to accepting the ultimate reality of their disease process. Even when death is not imminent, having the appropriate support systems in place for patients and their families can play a significant role in easing their minds and helping them make informed, appropriate treatment decisions.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

They say you can’t have it all, and they’re right. But you can have most of it. By that I mean you can achieve a work-life balance that will enable you to thrive in your career while you raise your dream family. While this goal may never be easy, and you may always feel like you want to do more, give more, and reach more, that’s just the nature of the beast. We are all overachievers. That’s how we’re programmed; it’s in our DNA. Why else would we have taken on so much debt and sacrificed so many years for a career? And while many of us specifically chose hospital medicine so we could offset our stressful, hectic work life with plenty of time off for self and family, our reality is still replete with everyday challenges and, frequently, burnout.

We eagerly seek out best practices to optimize patient care, but how often do we seek advice from trusted colleagues on their “best practices” for balancing work and home? While talking with some of my female colleagues recently, I expressed my dismay that my dishwasher had broken and I frequently found myself washing dinner dishes as I juggled homework for my two 6-year-olds and responded to a seemingly incessant pager. One laughed as she recalled the pains she went through to have not one, but two dishwashers installed in her kitchen during her remodel. Washing dishes by hand simply wasn’t realistic for her. Her two little boys demanded whatever physical and emotional energy she had left after a stressful day at the hospital.

It is okay to admit that you don’t have all the answers, and it is cathartic to accept that you may never be the homemaker your mother was and forget about matching your grandmothers’ skillsets. At some Alcoholics Anonymous meetings, new members stand up and introduce themselves by saying, “Hello, my name is ___, and I am an alcoholic.” I personally felt like a huge weight had been lifted from my shoulders when one day, I finally acknowledged I didn’t have all the answers and I could never follow all of the parenting experts’ advice. After all, experts come and go, and with it, their expert recommendations. I don’t even want to abide by the “no more than 30 minutes of screen time per day” mantra. My parents raised five children on rerun after rerun of “The Andy Griffith Show,” “The Brady Bunch,” and other sitcoms, not to mention movies and musicals, and every one of us has a terminal degree, and still remember how much fun we had as children. My parents set high expectations, and they taught us how to reach them, plain and simple. We worked hard and we got to play hard, too.

The bottom line is that different techniques work for different people. Find out which ones work for you and your family and pursue them, regardless of what others may think. And above all, don’t let guilt get the best of you, because it will eat away at you and potentially destroy all you want to accomplish. You know, the guilt of missing a soccer game or a school play, or even the guilt of stopping for fast food when you are just too tired to cook a nutritious meal. Give yourself a break. The realistic goal is to optimize your work-life balance; the elusive one is to perfect it.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

They say you can’t have it all, and they’re right. But you can have most of it. By that I mean you can achieve a work-life balance that will enable you to thrive in your career while you raise your dream family. While this goal may never be easy, and you may always feel like you want to do more, give more, and reach more, that’s just the nature of the beast. We are all overachievers. That’s how we’re programmed; it’s in our DNA. Why else would we have taken on so much debt and sacrificed so many years for a career? And while many of us specifically chose hospital medicine so we could offset our stressful, hectic work life with plenty of time off for self and family, our reality is still replete with everyday challenges and, frequently, burnout.

We eagerly seek out best practices to optimize patient care, but how often do we seek advice from trusted colleagues on their “best practices” for balancing work and home? While talking with some of my female colleagues recently, I expressed my dismay that my dishwasher had broken and I frequently found myself washing dinner dishes as I juggled homework for my two 6-year-olds and responded to a seemingly incessant pager. One laughed as she recalled the pains she went through to have not one, but two dishwashers installed in her kitchen during her remodel. Washing dishes by hand simply wasn’t realistic for her. Her two little boys demanded whatever physical and emotional energy she had left after a stressful day at the hospital.

It is okay to admit that you don’t have all the answers, and it is cathartic to accept that you may never be the homemaker your mother was and forget about matching your grandmothers’ skillsets. At some Alcoholics Anonymous meetings, new members stand up and introduce themselves by saying, “Hello, my name is ___, and I am an alcoholic.” I personally felt like a huge weight had been lifted from my shoulders when one day, I finally acknowledged I didn’t have all the answers and I could never follow all of the parenting experts’ advice. After all, experts come and go, and with it, their expert recommendations. I don’t even want to abide by the “no more than 30 minutes of screen time per day” mantra. My parents raised five children on rerun after rerun of “The Andy Griffith Show,” “The Brady Bunch,” and other sitcoms, not to mention movies and musicals, and every one of us has a terminal degree, and still remember how much fun we had as children. My parents set high expectations, and they taught us how to reach them, plain and simple. We worked hard and we got to play hard, too.

The bottom line is that different techniques work for different people. Find out which ones work for you and your family and pursue them, regardless of what others may think. And above all, don’t let guilt get the best of you, because it will eat away at you and potentially destroy all you want to accomplish. You know, the guilt of missing a soccer game or a school play, or even the guilt of stopping for fast food when you are just too tired to cook a nutritious meal. Give yourself a break. The realistic goal is to optimize your work-life balance; the elusive one is to perfect it.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

They say you can’t have it all, and they’re right. But you can have most of it. By that I mean you can achieve a work-life balance that will enable you to thrive in your career while you raise your dream family. While this goal may never be easy, and you may always feel like you want to do more, give more, and reach more, that’s just the nature of the beast. We are all overachievers. That’s how we’re programmed; it’s in our DNA. Why else would we have taken on so much debt and sacrificed so many years for a career? And while many of us specifically chose hospital medicine so we could offset our stressful, hectic work life with plenty of time off for self and family, our reality is still replete with everyday challenges and, frequently, burnout.

We eagerly seek out best practices to optimize patient care, but how often do we seek advice from trusted colleagues on their “best practices” for balancing work and home? While talking with some of my female colleagues recently, I expressed my dismay that my dishwasher had broken and I frequently found myself washing dinner dishes as I juggled homework for my two 6-year-olds and responded to a seemingly incessant pager. One laughed as she recalled the pains she went through to have not one, but two dishwashers installed in her kitchen during her remodel. Washing dishes by hand simply wasn’t realistic for her. Her two little boys demanded whatever physical and emotional energy she had left after a stressful day at the hospital.

It is okay to admit that you don’t have all the answers, and it is cathartic to accept that you may never be the homemaker your mother was and forget about matching your grandmothers’ skillsets. At some Alcoholics Anonymous meetings, new members stand up and introduce themselves by saying, “Hello, my name is ___, and I am an alcoholic.” I personally felt like a huge weight had been lifted from my shoulders when one day, I finally acknowledged I didn’t have all the answers and I could never follow all of the parenting experts’ advice. After all, experts come and go, and with it, their expert recommendations. I don’t even want to abide by the “no more than 30 minutes of screen time per day” mantra. My parents raised five children on rerun after rerun of “The Andy Griffith Show,” “The Brady Bunch,” and other sitcoms, not to mention movies and musicals, and every one of us has a terminal degree, and still remember how much fun we had as children. My parents set high expectations, and they taught us how to reach them, plain and simple. We worked hard and we got to play hard, too.

The bottom line is that different techniques work for different people. Find out which ones work for you and your family and pursue them, regardless of what others may think. And above all, don’t let guilt get the best of you, because it will eat away at you and potentially destroy all you want to accomplish. You know, the guilt of missing a soccer game or a school play, or even the guilt of stopping for fast food when you are just too tired to cook a nutritious meal. Give yourself a break. The realistic goal is to optimize your work-life balance; the elusive one is to perfect it.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

It’s easy to get so caught up in our day-to-day routines. At the hospital, we’re meeting core measures, documenting correctly, following clinical guidelines, and simply striving to stay up to date with the literature. At home, there are soccer games, recitals, and homework – and some rare personal time. We often shift to automatic pilot in a desperate attempt to balance the seemingly never-ending demands.

But does the very nature of our hectic lives sometimes prevent us from seeing the bigger picture, especially when it comes to the things that are really important to our patients? Yes, we know what lab values automatically trigger an order for a statin, and what ejection fraction on the echocardiogram warrants an ACE inhibitor, but how often do we really take the time to find out about the outcomes that are important to our patients? Sometimes they aren’t the evidence-based clinical outcomes we are trying to reproduce with our treatments.

For many patients, the desired outcome is to feel better, plain and simple. All the fancy lingo and drugs with unpronounceable names and unintelligible indications can be overwhelming. They make some patients shut down, and ultimately shut us out. We may not even realize it until our patients are readmitted as a result of noncompliance with our well-thought-out treatment plans.

There are our male patients who rarely take their blood pressure medicine because of the side effect of sexual dysfunction. And then there are those patients who don’t take their medications or see their doctors regularly because they just cannot afford it. While they seem to be in agreement with the follow-up plan for medical visits and testing, patients may be ashamed to admit they are uninsured or underinsured. They know they will never be adherent because they just cannot afford the costs of our treatment plan.

Instead of getting frustrated with our noncompliant patients, we could better serve them by getting more personal – gaining their trust as we carefully and respectfully uncover the layers of the limitations they face and the outcomes that matter to them. We need to aim to be viewed as our patients’ caring advocates and not just aloof professionals with no clue about their daily struggles.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

It’s easy to get so caught up in our day-to-day routines. At the hospital, we’re meeting core measures, documenting correctly, following clinical guidelines, and simply striving to stay up to date with the literature. At home, there are soccer games, recitals, and homework – and some rare personal time. We often shift to automatic pilot in a desperate attempt to balance the seemingly never-ending demands.

But does the very nature of our hectic lives sometimes prevent us from seeing the bigger picture, especially when it comes to the things that are really important to our patients? Yes, we know what lab values automatically trigger an order for a statin, and what ejection fraction on the echocardiogram warrants an ACE inhibitor, but how often do we really take the time to find out about the outcomes that are important to our patients? Sometimes they aren’t the evidence-based clinical outcomes we are trying to reproduce with our treatments.

For many patients, the desired outcome is to feel better, plain and simple. All the fancy lingo and drugs with unpronounceable names and unintelligible indications can be overwhelming. They make some patients shut down, and ultimately shut us out. We may not even realize it until our patients are readmitted as a result of noncompliance with our well-thought-out treatment plans.

There are our male patients who rarely take their blood pressure medicine because of the side effect of sexual dysfunction. And then there are those patients who don’t take their medications or see their doctors regularly because they just cannot afford it. While they seem to be in agreement with the follow-up plan for medical visits and testing, patients may be ashamed to admit they are uninsured or underinsured. They know they will never be adherent because they just cannot afford the costs of our treatment plan.

Instead of getting frustrated with our noncompliant patients, we could better serve them by getting more personal – gaining their trust as we carefully and respectfully uncover the layers of the limitations they face and the outcomes that matter to them. We need to aim to be viewed as our patients’ caring advocates and not just aloof professionals with no clue about their daily struggles.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

It’s easy to get so caught up in our day-to-day routines. At the hospital, we’re meeting core measures, documenting correctly, following clinical guidelines, and simply striving to stay up to date with the literature. At home, there are soccer games, recitals, and homework – and some rare personal time. We often shift to automatic pilot in a desperate attempt to balance the seemingly never-ending demands.

But does the very nature of our hectic lives sometimes prevent us from seeing the bigger picture, especially when it comes to the things that are really important to our patients? Yes, we know what lab values automatically trigger an order for a statin, and what ejection fraction on the echocardiogram warrants an ACE inhibitor, but how often do we really take the time to find out about the outcomes that are important to our patients? Sometimes they aren’t the evidence-based clinical outcomes we are trying to reproduce with our treatments.

For many patients, the desired outcome is to feel better, plain and simple. All the fancy lingo and drugs with unpronounceable names and unintelligible indications can be overwhelming. They make some patients shut down, and ultimately shut us out. We may not even realize it until our patients are readmitted as a result of noncompliance with our well-thought-out treatment plans.

There are our male patients who rarely take their blood pressure medicine because of the side effect of sexual dysfunction. And then there are those patients who don’t take their medications or see their doctors regularly because they just cannot afford it. While they seem to be in agreement with the follow-up plan for medical visits and testing, patients may be ashamed to admit they are uninsured or underinsured. They know they will never be adherent because they just cannot afford the costs of our treatment plan.

Instead of getting frustrated with our noncompliant patients, we could better serve them by getting more personal – gaining their trust as we carefully and respectfully uncover the layers of the limitations they face and the outcomes that matter to them. We need to aim to be viewed as our patients’ caring advocates and not just aloof professionals with no clue about their daily struggles.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When patients question your diagnosis, how do you react?

As physicians, we take great pride in our ability to diagnose and treat disease, and as hospitalists, our patients are sicker, so we need to make the right diagnosis and make it fast. A diagnostic delay of even a few days can sometimes cost a patient his life.

So when the patient or a family member disagrees with your diagnosis – especially when they have no remote understanding of the condition – it can be easy to dismiss their concerns. And then there are the times when you’ve missed something and they are right.

I will never forget a 60-year-old male patient I encountered early in my career as a hospitalist. He had presented with diffuse abdominal pain which later localized to both lower quadrants, diarrhea, and CT scan evidence of gastroenteritis. Multiple doctors who saw the patient before me all had the same diagnosis, a simple case of gastroenteritis. By day 2, he was afebrile, had a normal white blood cell count, was eating, and was ambulating down the hallway with his large family, seemingly in no distress.

He related that he still had abdominal pain, but felt comfortable with his diagnosis and was amenable to being discharged to follow-up with the gastroenterologist who had consulted on him during his stay in the hospital. His niece, on the other hand, was not happy with the diagnosis. The look on her face was intense, not disrespectful, as she related her conviction that her uncle had something more going on than a bout of gastroenteritis. She knew her uncle far better than I did, and his pain was concerning to her.

So I went back to the drawing board to make sure nothing had been missed, and there, hidden in plain sight, was a vital piece of information that we had all overlooked. The CT scan report that showed signs consistent with gastroenteritis made no mention whatsoever of his appendix.

Not satisfied with simply having another radiologist read the film, I insisted that a surgeon see the patient. To the surgeon’s great surprise, and mine, he found evidence of appendicitis. By 10 a.m. the next morning, the patient was in the OR having a now-perforated appendix removed. After numerous apologies to the family and patient, he was discharged home on postop day 2, doing well.

That very scary near miss taught me a valuable lesson: Sometimes the gut instinct of patients and their family members is just as accurate as the gut instinct of a physician, and we need to fully respect their input, whether or not we agree with them.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When doctors become patients, the experience forces us to better our ability to practice the art of medicine because we gain more empathy and are able to relate to our patients’ feelings on a different level.

It’s one thing to read about the conditions we treat, and quite another when we are the ones lying flat on our backs looking up at the faces of complete strangers whom we are expected to trust for compassionate, competent, and sometimes life-altering care.

One of my first brushes with walking in my patients’ shoes was undergoing an MRI. Patients’ concerns that I had considered irrational and unfounded became understandable as I lay in the machine, unable to see anything but the inside of a tube or to move more than a few inches in any direction. All I could hear was the incessant, loud clicking of the machine as it took image after image. Alone with my thoughts, and the uncertainty of the test results, I could truly empathize with my patients’ anxieties about the procedure.

If you have never personally experienced a significant illness, I strongly recommend watching a movie called “The Doctor.” Early in my career, I remember watching this movie and it had a profound impact, the next best thing to getting sick myself, so to speak. The main character, played by William Hurt, is a brilliant, albeit insensitive doctor who is diagnosed with cancer and forced to deal in his most vulnerable state with the frustration of an inefficient medical system. Perhaps most intriguing, he is confronted head on with his own mortality and must seemingly place his trust in the hands of another brilliant and cold clinician. The result is a moving storyline; if you have never been seriously ill, this movie might just forever change your practice style.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When doctors become patients, the experience forces us to better our ability to practice the art of medicine because we gain more empathy and are able to relate to our patients’ feelings on a different level.

It’s one thing to read about the conditions we treat, and quite another when we are the ones lying flat on our backs looking up at the faces of complete strangers whom we are expected to trust for compassionate, competent, and sometimes life-altering care.

One of my first brushes with walking in my patients’ shoes was undergoing an MRI. Patients’ concerns that I had considered irrational and unfounded became understandable as I lay in the machine, unable to see anything but the inside of a tube or to move more than a few inches in any direction. All I could hear was the incessant, loud clicking of the machine as it took image after image. Alone with my thoughts, and the uncertainty of the test results, I could truly empathize with my patients’ anxieties about the procedure.

If you have never personally experienced a significant illness, I strongly recommend watching a movie called “The Doctor.” Early in my career, I remember watching this movie and it had a profound impact, the next best thing to getting sick myself, so to speak. The main character, played by William Hurt, is a brilliant, albeit insensitive doctor who is diagnosed with cancer and forced to deal in his most vulnerable state with the frustration of an inefficient medical system. Perhaps most intriguing, he is confronted head on with his own mortality and must seemingly place his trust in the hands of another brilliant and cold clinician. The result is a moving storyline; if you have never been seriously ill, this movie might just forever change your practice style.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

When doctors become patients, the experience forces us to better our ability to practice the art of medicine because we gain more empathy and are able to relate to our patients’ feelings on a different level.

It’s one thing to read about the conditions we treat, and quite another when we are the ones lying flat on our backs looking up at the faces of complete strangers whom we are expected to trust for compassionate, competent, and sometimes life-altering care.

One of my first brushes with walking in my patients’ shoes was undergoing an MRI. Patients’ concerns that I had considered irrational and unfounded became understandable as I lay in the machine, unable to see anything but the inside of a tube or to move more than a few inches in any direction. All I could hear was the incessant, loud clicking of the machine as it took image after image. Alone with my thoughts, and the uncertainty of the test results, I could truly empathize with my patients’ anxieties about the procedure.

If you have never personally experienced a significant illness, I strongly recommend watching a movie called “The Doctor.” Early in my career, I remember watching this movie and it had a profound impact, the next best thing to getting sick myself, so to speak. The main character, played by William Hurt, is a brilliant, albeit insensitive doctor who is diagnosed with cancer and forced to deal in his most vulnerable state with the frustration of an inefficient medical system. Perhaps most intriguing, he is confronted head on with his own mortality and must seemingly place his trust in the hands of another brilliant and cold clinician. The result is a moving storyline; if you have never been seriously ill, this movie might just forever change your practice style.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

So it’s your first day on the service. Mrs. Jones has been there for 21 days and has a long list of consultants to address her numerous complications. You see her twice before it’s time to pull it all together and package her up for an 11 a.m. transfer to rehab the next morning. But how do you effectively weed through weeks of documentation to come up with the salient points of the hospital stay, and do so in a reasonable amount of time considering you have 20 other patients (and a few inquisitive family members) who require your undivided attention that day as well?

A preliminary discharge summary, prepared the day before anticipated discharge, can make life a lot easier. If your EMR allows you to sort notes by author or service, you can dictate the hospital course by problem more seamlessly than by reviewing the hospitalization on a day-by-day basis, especially if there are multiple notes from PT/OT, pharmacy, and other ancillary services intermingled in the providers’ documentation.

If your EMR allows you to auto-populate diagnostic test results, discharge medications, and instructions directly into a note, you can create this note on the day of actual discharge, and then copy and paste the dictation of the hospital course into the body of the final discharge summary.

Alternatively, if the provider who is better acquainted with the patient does a discharge summary prior to going off service, the upcoming provider need only add an addendum to this summary on the day of discharge. When partners do these summaries for each other, it can be a tremendous time saver. Instead of spending 45-60 minutes drudging through every progress note and consultation on an unfamiliar patient, you are able to review the preliminary discharge summary and pick up the hospital course as you would for a patient admitted the day before who already has an H&P. The doctor going off service may only need to spend 5-10 minutes dictating the summary.

Of course, different groups have different practice styles. Some groups may consistently dictate summaries prior to going off service, while others may not choose this option. There may be other ways to streamline complicated discharge summaries within groups as well, but experimenting with new and innovative ways to improve care and make our lives more efficient in the process may prove to be a win-win for all.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

So it’s your first day on the service. Mrs. Jones has been there for 21 days and has a long list of consultants to address her numerous complications. You see her twice before it’s time to pull it all together and package her up for an 11 a.m. transfer to rehab the next morning. But how do you effectively weed through weeks of documentation to come up with the salient points of the hospital stay, and do so in a reasonable amount of time considering you have 20 other patients (and a few inquisitive family members) who require your undivided attention that day as well?

A preliminary discharge summary, prepared the day before anticipated discharge, can make life a lot easier. If your EMR allows you to sort notes by author or service, you can dictate the hospital course by problem more seamlessly than by reviewing the hospitalization on a day-by-day basis, especially if there are multiple notes from PT/OT, pharmacy, and other ancillary services intermingled in the providers’ documentation.

If your EMR allows you to auto-populate diagnostic test results, discharge medications, and instructions directly into a note, you can create this note on the day of actual discharge, and then copy and paste the dictation of the hospital course into the body of the final discharge summary.

Alternatively, if the provider who is better acquainted with the patient does a discharge summary prior to going off service, the upcoming provider need only add an addendum to this summary on the day of discharge. When partners do these summaries for each other, it can be a tremendous time saver. Instead of spending 45-60 minutes drudging through every progress note and consultation on an unfamiliar patient, you are able to review the preliminary discharge summary and pick up the hospital course as you would for a patient admitted the day before who already has an H&P. The doctor going off service may only need to spend 5-10 minutes dictating the summary.

Of course, different groups have different practice styles. Some groups may consistently dictate summaries prior to going off service, while others may not choose this option. There may be other ways to streamline complicated discharge summaries within groups as well, but experimenting with new and innovative ways to improve care and make our lives more efficient in the process may prove to be a win-win for all.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

So it’s your first day on the service. Mrs. Jones has been there for 21 days and has a long list of consultants to address her numerous complications. You see her twice before it’s time to pull it all together and package her up for an 11 a.m. transfer to rehab the next morning. But how do you effectively weed through weeks of documentation to come up with the salient points of the hospital stay, and do so in a reasonable amount of time considering you have 20 other patients (and a few inquisitive family members) who require your undivided attention that day as well?

A preliminary discharge summary, prepared the day before anticipated discharge, can make life a lot easier. If your EMR allows you to sort notes by author or service, you can dictate the hospital course by problem more seamlessly than by reviewing the hospitalization on a day-by-day basis, especially if there are multiple notes from PT/OT, pharmacy, and other ancillary services intermingled in the providers’ documentation.

If your EMR allows you to auto-populate diagnostic test results, discharge medications, and instructions directly into a note, you can create this note on the day of actual discharge, and then copy and paste the dictation of the hospital course into the body of the final discharge summary.

Alternatively, if the provider who is better acquainted with the patient does a discharge summary prior to going off service, the upcoming provider need only add an addendum to this summary on the day of discharge. When partners do these summaries for each other, it can be a tremendous time saver. Instead of spending 45-60 minutes drudging through every progress note and consultation on an unfamiliar patient, you are able to review the preliminary discharge summary and pick up the hospital course as you would for a patient admitted the day before who already has an H&P. The doctor going off service may only need to spend 5-10 minutes dictating the summary.

Of course, different groups have different practice styles. Some groups may consistently dictate summaries prior to going off service, while others may not choose this option. There may be other ways to streamline complicated discharge summaries within groups as well, but experimenting with new and innovative ways to improve care and make our lives more efficient in the process may prove to be a win-win for all.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

 High-quality care, optimal length of stay (LOS), patient satisfaction, cost-effectiveness – all part of the hospitalists’ creed, our raison d’être. But with these exist national, as well as local imperatives, some of which carry penalties and/or rewards. Public and private organizations devote a huge amount of resources into setting higher and higher bars of excellence for physicians. Individual hospitals adapt and tweak the methods of other centers that have outstanding track records in hopes they, too, may enjoy similar success. Yet, at the end of the day, we are the foot soldiers.

Insurers should not mandate the care we provide. Government should not have to tell us what is acceptable practice and what is not. And hospital administrators – God bless them – should not have to stab blindly in the dark for solutions to the problems that plague their individual institutions. After all, we physicians are at the patients’ bedsides. We talk to them and their families, consult effective and efficient specialists, write orders to take care of them, and ultimately discharge them to their next phase in care.

There is a tremendous amount of low-hanging fruit we easily could seize upon to make our hospitals run more smoothly and make our patients much happier (though the processes and procedures that make one institution ineffective may not plague the next).

For instance, many hospitals have a peak time for admissions, as well as for discharges, and these two times frequently do not coincide. As a result, there may be a backlog of patients in the emergency department (ED) awaiting a clean bed. Invariably, meanwhile, there are patients pacing the halls anxiously waiting for the doctor to arrive to discharge them. But if that doctor is busy seeing a new or very sick patient, that discharge may just have to wait, sometimes for several hours. Here, I have learned to try to look for opportunities instead of focusing on obstacles.

If I anticipate that a patient will be discharged the following day, I try prepare the discharge summary and patient instruction sheet, and to write the prescriptions a day in advance (when time permits). That way, on the following day, instead of devoting 45 minutes to reviewing the records of a lengthy hospital stay, I can simply check on the patient to confirm that she has no new problems and that her examination is stable. Within seconds, I can type in a discharge order and move along to the next patient. Even in the midst of a very busy day, I can typically work in this type of visit fairly early.

On the other hand, if the same patient is likely to be discharged the day after I leave the service, the same preparation by me can save my partner a great deal of time the next day. If everything is already done except the official discharge order, she, too, can likely discharge the patient early in the day, instead of late in the evening after she learns the entire service. (Who likes going home in the dark anyway?)

pupunkkop

The patient is happier. The administration is happier to have more beds freed up earlier. The little old lady in the ED with a comminuted hip fracture will get a nice warm bed quicker, and the rounder is less stressed. Everyone wins!

Listening to our patients’ desires, not just their needs can also go a long way in patient satisfaction.

I recently had a patient who was visiting from the other side of the country who, unfortunately, wound up in our ED for cellulitis. She was part of a historical group from California who had traveled to the Washington, D.C., area to attend a national function. The event was to culminate in a banquet that evening – a banquet that she was going to miss. When I saw her, she acknowledged she was getting better on the intravenous vancomycin that was started in the ED the night before, and though the line of demarcation drawn by my partner clearly showed her infection was improving, she still had mild-moderate cellulitis. Her history of methicillin-resistant Staphylococcus aureus (MRSA) made me uncomfortable discharging her on a regimen that would “probably” cover MRSA, and we all know that linezolid (Zyvox) can be incredibly expensive if not on a patient’s formulary. There we were at 5 p.m. on a Saturday. Who would be reachable for a prior authorization?

As I looked down at her sad face and saw the disappointment in her eyes, I had to do something! She was in the area for a great cause; the hospitalization was an unexpected nuisance that threatened to destroy her entire trip. The solution was simple. I called her pharmacist in California and found out that her copay for Zyvox was an affordable $30, so I could safely discharge her in time for her banquet. While that falls far short of an near-miracle that changed a life, my simple effort made a big difference for her.

The point is that when we focus on the patient’s entire needs – not just the disease that brought them to the hospital in the first place – we can create solutions to many of their problems. Sometimes it’s the finishing touches, not just the medical care, that patients remember most.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

 High-quality care, optimal length of stay (LOS), patient satisfaction, cost-effectiveness – all part of the hospitalists’ creed, our raison d’être. But with these exist national, as well as local imperatives, some of which carry penalties and/or rewards. Public and private organizations devote a huge amount of resources into setting higher and higher bars of excellence for physicians. Individual hospitals adapt and tweak the methods of other centers that have outstanding track records in hopes they, too, may enjoy similar success. Yet, at the end of the day, we are the foot soldiers.

Insurers should not mandate the care we provide. Government should not have to tell us what is acceptable practice and what is not. And hospital administrators – God bless them – should not have to stab blindly in the dark for solutions to the problems that plague their individual institutions. After all, we physicians are at the patients’ bedsides. We talk to them and their families, consult effective and efficient specialists, write orders to take care of them, and ultimately discharge them to their next phase in care.

There is a tremendous amount of low-hanging fruit we easily could seize upon to make our hospitals run more smoothly and make our patients much happier (though the processes and procedures that make one institution ineffective may not plague the next).

For instance, many hospitals have a peak time for admissions, as well as for discharges, and these two times frequently do not coincide. As a result, there may be a backlog of patients in the emergency department (ED) awaiting a clean bed. Invariably, meanwhile, there are patients pacing the halls anxiously waiting for the doctor to arrive to discharge them. But if that doctor is busy seeing a new or very sick patient, that discharge may just have to wait, sometimes for several hours. Here, I have learned to try to look for opportunities instead of focusing on obstacles.

If I anticipate that a patient will be discharged the following day, I try prepare the discharge summary and patient instruction sheet, and to write the prescriptions a day in advance (when time permits). That way, on the following day, instead of devoting 45 minutes to reviewing the records of a lengthy hospital stay, I can simply check on the patient to confirm that she has no new problems and that her examination is stable. Within seconds, I can type in a discharge order and move along to the next patient. Even in the midst of a very busy day, I can typically work in this type of visit fairly early.

On the other hand, if the same patient is likely to be discharged the day after I leave the service, the same preparation by me can save my partner a great deal of time the next day. If everything is already done except the official discharge order, she, too, can likely discharge the patient early in the day, instead of late in the evening after she learns the entire service. (Who likes going home in the dark anyway?)

pupunkkop

The patient is happier. The administration is happier to have more beds freed up earlier. The little old lady in the ED with a comminuted hip fracture will get a nice warm bed quicker, and the rounder is less stressed. Everyone wins!

Listening to our patients’ desires, not just their needs can also go a long way in patient satisfaction.

I recently had a patient who was visiting from the other side of the country who, unfortunately, wound up in our ED for cellulitis. She was part of a historical group from California who had traveled to the Washington, D.C., area to attend a national function. The event was to culminate in a banquet that evening – a banquet that she was going to miss. When I saw her, she acknowledged she was getting better on the intravenous vancomycin that was started in the ED the night before, and though the line of demarcation drawn by my partner clearly showed her infection was improving, she still had mild-moderate cellulitis. Her history of methicillin-resistant Staphylococcus aureus (MRSA) made me uncomfortable discharging her on a regimen that would “probably” cover MRSA, and we all know that linezolid (Zyvox) can be incredibly expensive if not on a patient’s formulary. There we were at 5 p.m. on a Saturday. Who would be reachable for a prior authorization?

As I looked down at her sad face and saw the disappointment in her eyes, I had to do something! She was in the area for a great cause; the hospitalization was an unexpected nuisance that threatened to destroy her entire trip. The solution was simple. I called her pharmacist in California and found out that her copay for Zyvox was an affordable $30, so I could safely discharge her in time for her banquet. While that falls far short of an near-miracle that changed a life, my simple effort made a big difference for her.

The point is that when we focus on the patient’s entire needs – not just the disease that brought them to the hospital in the first place – we can create solutions to many of their problems. Sometimes it’s the finishing touches, not just the medical care, that patients remember most.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

 High-quality care, optimal length of stay (LOS), patient satisfaction, cost-effectiveness – all part of the hospitalists’ creed, our raison d’être. But with these exist national, as well as local imperatives, some of which carry penalties and/or rewards. Public and private organizations devote a huge amount of resources into setting higher and higher bars of excellence for physicians. Individual hospitals adapt and tweak the methods of other centers that have outstanding track records in hopes they, too, may enjoy similar success. Yet, at the end of the day, we are the foot soldiers.

Insurers should not mandate the care we provide. Government should not have to tell us what is acceptable practice and what is not. And hospital administrators – God bless them – should not have to stab blindly in the dark for solutions to the problems that plague their individual institutions. After all, we physicians are at the patients’ bedsides. We talk to them and their families, consult effective and efficient specialists, write orders to take care of them, and ultimately discharge them to their next phase in care.

There is a tremendous amount of low-hanging fruit we easily could seize upon to make our hospitals run more smoothly and make our patients much happier (though the processes and procedures that make one institution ineffective may not plague the next).

For instance, many hospitals have a peak time for admissions, as well as for discharges, and these two times frequently do not coincide. As a result, there may be a backlog of patients in the emergency department (ED) awaiting a clean bed. Invariably, meanwhile, there are patients pacing the halls anxiously waiting for the doctor to arrive to discharge them. But if that doctor is busy seeing a new or very sick patient, that discharge may just have to wait, sometimes for several hours. Here, I have learned to try to look for opportunities instead of focusing on obstacles.

If I anticipate that a patient will be discharged the following day, I try prepare the discharge summary and patient instruction sheet, and to write the prescriptions a day in advance (when time permits). That way, on the following day, instead of devoting 45 minutes to reviewing the records of a lengthy hospital stay, I can simply check on the patient to confirm that she has no new problems and that her examination is stable. Within seconds, I can type in a discharge order and move along to the next patient. Even in the midst of a very busy day, I can typically work in this type of visit fairly early.

On the other hand, if the same patient is likely to be discharged the day after I leave the service, the same preparation by me can save my partner a great deal of time the next day. If everything is already done except the official discharge order, she, too, can likely discharge the patient early in the day, instead of late in the evening after she learns the entire service. (Who likes going home in the dark anyway?)

pupunkkop

The patient is happier. The administration is happier to have more beds freed up earlier. The little old lady in the ED with a comminuted hip fracture will get a nice warm bed quicker, and the rounder is less stressed. Everyone wins!

Listening to our patients’ desires, not just their needs can also go a long way in patient satisfaction.

I recently had a patient who was visiting from the other side of the country who, unfortunately, wound up in our ED for cellulitis. She was part of a historical group from California who had traveled to the Washington, D.C., area to attend a national function. The event was to culminate in a banquet that evening – a banquet that she was going to miss. When I saw her, she acknowledged she was getting better on the intravenous vancomycin that was started in the ED the night before, and though the line of demarcation drawn by my partner clearly showed her infection was improving, she still had mild-moderate cellulitis. Her history of methicillin-resistant Staphylococcus aureus (MRSA) made me uncomfortable discharging her on a regimen that would “probably” cover MRSA, and we all know that linezolid (Zyvox) can be incredibly expensive if not on a patient’s formulary. There we were at 5 p.m. on a Saturday. Who would be reachable for a prior authorization?

As I looked down at her sad face and saw the disappointment in her eyes, I had to do something! She was in the area for a great cause; the hospitalization was an unexpected nuisance that threatened to destroy her entire trip. The solution was simple. I called her pharmacist in California and found out that her copay for Zyvox was an affordable $30, so I could safely discharge her in time for her banquet. While that falls far short of an near-miracle that changed a life, my simple effort made a big difference for her.

The point is that when we focus on the patient’s entire needs – not just the disease that brought them to the hospital in the first place – we can create solutions to many of their problems. Sometimes it’s the finishing touches, not just the medical care, that patients remember most.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].