October 25th, 2011 by Happy Hospitalist in Health Policy, Opinion
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With all the talk about how EMR/EHR resources will make practicing medicine better, faster and safer, I learned of an unintended consequence that is probably under appreciated these days. Hospitalists are being asked to admit more and more patients because, for primary care doctors, when they compare EMR medicine with the old way of doing things, EMR is just too time consuming to make it worth their effort.
That’s right, hospitalists are admitting more patients because the primary care doctors find their time costs for navigating their new EMR, which they bought to qualify for EHR stimulus funds under ARRA, are simply too great. In a business where efficiency must prevail, EHRs Read more »
*This blog post was originally published at The Happy Hospitalist*
August 28th, 2011 by RyanDuBosar in Better Health Network
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Four out of five doctors agree that they don’t need scans to make the right diagnosis.
It’s an old-fashioned concept frequently discussed among ACP members, but the history and physical combined with basic tests is way more important to diagnosis than ordering scans and advanced tests. A recent research letter in the Archives of Internal Medicine makes the case.
In the letter, Israeli researchers described a prospective study of 442 consecutive patients admitted from the emergency department in 53 days.
A senior resident examined all patients within 24 hours of admission (mean=14), including a history, physical, and review of ancillary test findings done at the emergency department, such as blood and urine tests, electrocardiography, and chest radiography. The resident also reviewed additional tests such as Read more »
*This blog post was originally published at ACP Hospitalist*
July 28th, 2011 by John Mandrola, M.D. in Opinion
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Today I would like to say thanks to a group of colleagues that too often go un-thanked.
These would be my hospital-based internal medicine friends: hospitalists are what they are called.
This idea came to me after reading Dr Robert Centor’s post on KevinMD. In his usual concise manner, he laments the lack of respect that many sub-specialists show hospitalists.
I feel differently about my hard-working colleagues.
As a sub, sub-specialist who works primarily in the hospital, I would like to say how grateful I am to have knowledgeable, hospital-based internists available.
I believe, and write frequently about the importance of seeing the forest through the trees. A good doctor must see the big picture: a little atrial fib, for instance, isn’t a major problem if you can’t move, eat or have widespread Cancer.
But for good patient care, the details are important too. Hospitalists are good at details. In fact, Read more »
*This blog post was originally published at Dr John M*
February 1st, 2011 by DrWes in Better Health Network, Opinion
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It came as a Twitter “follow” from @coldfeet65, a self-proclaimed “Nurse Practitioner Hospitalist.” I had never heard this term before. Does it mean a nurse practitioner who cares for hospitalists? Or is it a hospitalist who is a nurse practitioner? Or maybe it’s a nurse practitioner who helps hospitalists? (Honestly, I think I know which one she means, but you get my point.)
Perhaps this is a prescient glimpse to healthcare of the future, where our more typical nurse and doctor labels are supplanted by more and more monikers that serve to confuse, rather than clarify, each of our roles in healthcare delivery. As specialists in cardiology, we’ve seen a similar trend with cardiology hospitalists. But we should be clear what this means to the patients and doctors going forward.
No doubt most people in America still expect to see a doctor when they come to the hospital. Increasingly, it appears that might not be the case. Your doctor might be a robot while a nurse (aka, nurse practitioner) will be the one providing the hands-on care in the inpatient setting. Is that a good thing? Honestly, I’m not sure.
No one argues that the costs in healthcare need to be cut. No doubt the central authority has deemed that doctor salaries will be a big part of that effort. Already, 20 states have cut physician Medicaid payments for fiscal year 2010 and, given the current economic pressure on our states both now and after they start feeling the financial impact of the “Affordable” Care Act in 2019, this trend is not likely to improve anytime soon. As a result, we are seeing that the world is full of “creative solutions” to our healthcare access crisis and the evolution to “nurse practitioner hospitalists” might be one of these. Read more »
*This blog post was originally published at Dr. Wes*
May 3rd, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
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Hospital rankings matter. Specifically, those published in U.S. News & World Report carry additional weight. Hospitals use these numbers in advertising campaigns, and patients often choose hospitals based on these rankings.
But does a high place really mean you’re getting better care? Not necessarily. Read more »
*This blog post was originally published at KevinMD.com*
