Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
What advice would you give a hospitalist in their first few years of practice who wants to develop a focused area of expertise, such as perioperative medicine, quality improvement, or medical education, while maintaining a full clinical load?
I think my two big pieces of advice are: Pick one thing; you don't have to stay with it your entire career, so whatever seems interesting right now is just fine. I have moved from education to QI to even some basic science work, which I would never have predicted. Part of the fun is figuring out wh...
What advice would you give a hospitalist in their first few years of practice who wants to develop a focused area of expertise, such as perioperative medicine, quality improvement, or medical education, while maintaining a full clinical load?
I think my two big pieces of advice are: Pick one thing; you don't have to stay with it your entire career, so whatever seems interesting right now is just fine. I have moved from education to QI to even some basic science work, which I would never have predicted. Part of the fun is figuring out wh...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What would you tell a trainee who is interested in pursuing a career in geriatric medicine but is concerned about the relatively low number of people who enter/match into the field?
A trainee who is interested in pursuing a career in geriatric medicine should consider the long-term potential of contributing meaningfully to the field and to the lives of their patients. Although there are concerns from trainees about the relatively low number of people who enter/match into the fi...
For hospitalized patients with confirmed viral respiratory infections who clinically improve but remain PCR-positive, how long do you maintain isolation precautions?
This is a great question and one that routinely comes up for patients, their families, and staff. Precautions should be continued until symptoms improve and for a minimum of 14 days after the onset of signs and symptoms. This is especially important for patients who can spread virus to individuals t...
How do you approach laboratory evaluation in patients with fatigue?
First search for evidence by history and physical examination for any evidence of inflammation. If there is tailor the lab workup rather than ordering tests as screening tools. ESR and CRP to start with. Anything more without a reasonable a priori likelihood of the targeted diagnosis is just asking ...
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
What is the single best piece of advice you received when starting out as a hospitalist for the first time?
Billing is just a part of routine practice. While everyone is scared of overbilling, underbilling is also a big problem. During my training, I had very little exposure to billing and coding. During my hospitalist onboarding, we had a couple of sessions on billing, but I was anxious when I submitted ...
What is the single best piece of advice you received when starting out as a hospitalist for the first time?
Billing is just a part of routine practice. While everyone is scared of overbilling, underbilling is also a big problem. During my training, I had very little exposure to billing and coding. During my hospitalist onboarding, we had a couple of sessions on billing, but I was anxious when I submitted ...
How do you counsel patients on the risks and benefits of antidepressant use during pregnancy?
I always frame the decision as being between the risks and benefits of the medication vs. the underlying condition. We are always aiming for the "minimum effective dose" but "effective" is just as important as "minimum." Medications are, of course, not the only way to treat psychiatric illness and a...