Things overheard at the Society of Hospital Medicine Meeting

Here’s some more of the buzz from SHM 2008.

From Wachter’s World: How do you say no to relentless demand for hospitalist coverage? The scope of hospitalist coverage varies from one place to another. Hospitalists cannot be “house physicians” nor can they cover for every doc in town. My take on the issue is simple. Just say no. Your hospitalist group will be of no value to anybody if it burns itself out.

Also from Wachter’s World, related to the topic above: Recruiting, recruiting, recruiting! It appears most programs are looking to expand, driven by the constant need for more coverage. Great if you’re looking for a job, not so great if your program is short staffed. Despite the grandiose ideas expressed at SMH 2008 about hospitalists leading the health care quality revolution I suspect most programs are just struggling to meet day-to-day demands of patient care and call coverage. Every hospital has opportunities for improvement. For hospitalists to really take charge somebody has to carve out the time. That means lightening the patient load. Good luck convincing your administration.

From an attendee: In the wake of the impending CMS payment rules for hospital complications the new meme is POA (present on admission). Be on the lookout for the coming pandemic of decubs and urinary tract infections POA as the sensitivity for diagnosing these conditions goes way up. (Does one WBC per high power field really make a diagnosis of UTI?).

Again from Wachter’s World: Are you co-managing surgical patients yet? We’ve come a long way from the House of God where specialty wars and turfing (dumping the patient to a different specialty service) were the norm. Co-management is a new buzzword among hospitalist types. Collaboration between specialties is a wonderful idea, but one in need of better definition. Demarcation of responsibility remains important. All kinds of problems arise if it’s not clear who’s in charge of what. That’s my problem with the idea of co-management. What does it mean, exactly? Here’s my bias: Hospitalists can make sure patients’ statins and beta blockers get continued, help keep their electrolytes from getting screwed up, manage post operative cardiac problems and run ventilators. I’m not sure they should be fiddling with NG tubes, chest tubes or post operative pain management. However it’s done, demarcate the lines clearly.