Is HM Intensive Enough?
The second day got off to a roaring start with the best of the Research, Innovations and Clinical Vignettes (RIV). The most hotly anticipated research was from Emory University, where Kristin Wise, MD, and her colleagues evaluated an intensivist vs. hospitalist model for ICU staffing and found that after correction for baseline differences in acute illnesses, overall there were no differences in mortality between the two groups. Despite being constrained by methodological differences between the comparator groups and a lack of randomization, the data represents an important first step in addressing the huge shortfall of intensivist providers. (650)
Why My Wife Never Listens
Vinny Arora, MD, MA, of the University of Chicago and Erin R. Stucky, MD, of Rady Children’s Hospital in San Diego addressed the tremendously important topic of improving in-hospital handoffs. Part of the problem, they noted, is the egocentric heuristic. This cognitive shortcoming results in the sender believing that they are clearly expressing themselves because the message is apparent to them. Research shows that 40% of the time, the piece of information deemed most important by the sender is not identified as such by the recipient. Disconnect increases the better the sender knows the recipient, which explains much of our difficulty communicating in the hospital and domestically. Overcoming this requires vigilance on the sender’s part to be sure the message is accurately conveyed. (793)
Could We Go Bankrupt?
We all have too many patients and not enough providers. Thus, I was shocked when Scott F. Enderby, MD, of East Bay Physicians Medical Group in San Francisco spoke of a hospitalist group that went from profitability to bankruptcy in one year after adding four new employees. In his Finance 101 session, we learned how it happened despite an expected increase in clinical revenue: The group was constrained by a lack of liquidity that was retrospectively obvious from their balance sheet and operations and cash flow statements. Considering that more than a third of hospitalist directors do not know their group’s most basic financial metrics, this was a reminder that many more of us may be at risk in this increasingly unforgiving economy. (741)
Wachter’s World
As has become an annual meeting tradition, HM pioneer Robert Wachter, MD, FHM, professor and associate chairman of the department of medicine at the University of California at San Francisco, closed the meeting with his uniquely insightful comments on the state of healthcare. In using a case of mistaken identity he adeptly illustrated many of the key safety problems we face in healthcare. Further, he called for a transition away from a “no blame” medical culture to one of accountability. Once again, Dr. Wachter proved that despite going last, he continues to be out in front. (582)
A Child’s Calming Touch
This was my seventh consecutive annual meeting, and like the six before, it has exceeded my every expectation. From knowledge gained to the chance to speak and share my research to the opportunity to network and catch up with friends, the meeting was filled with lasting memories. Still, at times my hectic schedule bordered on chaos. It was during those times that I turned to a short, 23-second voicemail my wife sent the first day. On it my son, almost 2 years old, is belly-laughing as only a child can—pure, unbridled, carefree.
For me, it acted as a mariner, calming me at the end of a busy day, serving as a reminder of the important things in life, guiding me home. (674)
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of hospital medicine and the hospitalist training program, and as associate program director of the Internal Medicine Residency Program.