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Disease By Choice

“Why should I take my blood pressure medication,” you ask? The more I do this thing called hospitalist medicine, the more I appreciate the power of lifestyle choices we all make.

Every opportunity I get I give my patients my smoking lecture and charge their insurance  a CPT 99406. Everybody knows that smoking is bad for you and it causes lung cancer. Nobody knows all the other stuff. They’re always shocked.

Maybe it’s time for me to start a blood pressure lecture. I often have  patients who say: “Why should I take my blood pressure medication?” They always answer their own question with the same answer: “I was feeling fine. I didn’t see a reason to take my blood pressure medication.”

You see, these are people with insurance. These are people with the Medicare National Bank. These are people who don’t have to lift a finger or a dime to pay any out-of-pocket expenses for their healthcare. And yet, they still lack the motivation to care for themselves, even with incredible resources out there these days to help them — things like great online blood pressure chart sites for home monitoring.

Whatever the reason — whether it’s ignorance, laziness, lack of motivation, lack of remembering, or selfishness — people just don’t take care of themselves. Read more »

*This blog post was originally published at The Happy Hospitalist*

Hospital(ist) Food Service, Too?

What is a hospitalist and what kind of care does a hospitalist provide? It’s funny to read what people are writing these days about my professional role in patient care. It now appears hospitalists don’t manage medical issues anymore, but rather go through seven years of medical training to discuss the efficiency of the cafeteria food with their patients.

I read one article where the reader (obviously not a hospitalist) suggests that a hospitalist is a medical doctor who can do all the things normal doctors can, but instead of seeing patients all day, he makes rounds through the hospital, talking to patients to find out what can make their hospital stay better. And what kind of issues does the hospitalist deal with on their rounds? Why, the efficiency of the cafeteria food, of course.

I guess I was sleeping the day I was supposed to learn about the efficiency of hospital food in medical school. Maybe that means, after reviewing the SHM/MGMA 2010 hospitalist salary compensation report, I should request a pay cut because of my failure to provide cafeteria support. Or better yet, maybe I could make it up by asking security if I could provide takedown support on some code assists. Okay, I feel better about my role as a hospitalist.

*This blog post was originally published at The Happy Hospitalist*

Does It Matter What The Hospitalist Thinks?

I read this article about a young child with heterotaxy syndrome with great interest. Not because I find heterotaxy syndrome something of great fascination, but because of the lack of communication — on both ends of the spectrum:

Even though 5 other Dr. all came in and listened to his lungs and said that he didn’t sound like he was wheezing and that his lungs sounded really good. But because this hospital is overly political, process driven, bureaucratic, and in a constant state of litigious fear they are unable to make any conclusions based on actual medicine and patient care. Common sense is blown out the window when you  have a system were a hospitalist one year out of medical school has an opinion that is as valuable as a cardiologist with 25+ years experience.

But in fairness, they all had to “really consider her opinion.”

So they went and got a pulmonologist to evaluate him, which Scott and I were very happy about because there was nothing in the world that would’ve made me more happy in that moment than to have her proven wrong. Which she was.

The whole article is a case study in stress, distrust, and legalism. Read more »

*This blog post was originally published at The Happy Hospitalist*

Hospital Medicine: Trying To Recruit A Lead Doctor

How can you find a hospitalist director with enough experience to lead a team of hospitalists? Recruitment can be tough. A reader recently asked for my opinion:

I am searching for a Hospitalist to lead a department in the state of XXX and I’m not finding any leads. On a good day, I can find a new graduate interested in moving to XXX, but I have not been able to find an experienced Hospitalist who has the supervisory experience to lead a department.  …and this is an opportunity (full time & permanent) for good pay with an excellent work/life balance. Where would you suggest I look for my Lead Hospitalist?

My first thought is for you to purchase a booth at the Society of Hospital Medicine’s yearly conference and then bombard all the hospitalists with pens and squeezy balls while trying to pocket an email and home address or two. Read more »

*This blog post was originally published at The Happy Hospitalist*

The Big Apple Tells Smokers To Take A Hike (And Not In The Park)

It looks like New York City is leading the way for public health safety by introducing a public smoking ban in all public parks, malls, plazas, beaches and playgrounds or risk a $50 fine:

Research showed, he said, that someone seated within three feet of a smoker — even in the open air — was exposed to roughly the same levels of secondhand smoke as someone sitting indoors in the same situation.

What took so long? Go, New York. I hope you succeed. Next up: Charging parents who smoke in their homes occupied by minors with child negligence.

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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