Author Archive for Elizabeth Jones
Elizabeth (Liz) Jones is an associate editor at HCPro. She writes and contributes to several monthly newsletters including Medical Staff Briefing, Hospitalist Leadership Advisor, and Credentialing and Peer Review Legal Insider. Liz graduated from Salem (MA) State College in 2003 with a B.A. in professional writing. Before joining HCPro, Liz wrote for a national monthly business publication where she gained experience in executive-level business and healthcare issues.
Patient hand offs more about skills than checklists
As I continue to research patient hand offs for an upcoming article in Hospitalist Leadership Advisor, I’ve realized that hand offs are less about forms, tools, and checklists and more about having good communication skills.
I know I’m guilty of assuming that other people can read my mind from time to time—we all are. I recall asking my husband if we could go to the curtain store one day to pick out some shades for the dining room. We were on the highway for quite some time before he asked, “Where’s the curtain store?” Of course! I know where it is because I’m a home deco diva, but he had never been there before. I assumed that because I knew, he knew, and I probably would have been mad when he blew by the exit. Sounds trivial, but when it comes to patient care and physician relationships, these details are critical.
Here are three tips that I’ve picked up from my sources that will not only help practicing hospitalists improve the quality of patient hand offs, but also help leaders brush up their every day communication skills.
Explain your rationale: When handing patients off to another hospitalist, explain what symptoms prompted you to order certain tests, and be sure to tell the hospitalist taking over the care of your patient exactly what they need to look for when the test results come back. Don’t just say “Order texts X, Y, Z.”
Repeat back information: To ensure that your understanding of an issue matches the other person’s intended meaning, repeat back what they’ve said to you. You do this with driving directions, right? (So, I’m taking a left on to Mason St. and a right at the blinking red light.) So why not incorporate this strategy into your clinical work or leadership activities? “Repeat-backs have not only been shown to improve patient safety and prevent errors, but they also enhance memory,” says Vineet Arora, MD, MAPP, Assistant Professor of Medicine, Associate Director Internal Medicine Residency, and Assistant Dean Scholarship & Discovery at the Pritzker School of Medicine, University of Chicago.
Don’t assume a note will suffice: If you’ve ever left a note for a family member to pick up milk, you’ve probably been disappointed. That person either never got the note or didn’t know whether you wanted skim, 2%, or whole. “You are able to communicate better, richer information more effectively through the verbal communication channel than any other communication channel,” says Arpana Vidyarthi, MD, Director of Quality and Safety in the Division of Hospital Medicine, Director of Patient Safety and Quality Programs GME, Director of the Institute for Physician Leadership, and Associate Professor of Clinical Medicine at the University of California, San Francisco.
For more tips and advice for improving patient hand offs, look for your January issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing.
Internet playing increasing role in physician job searches
More physicians are ditching the fancy resume paper and stamps in favor of Internet searches, according to a recent American Medical News article. In addition, physician recruiters are relying less on expensive search firms and more on the Internet and word of mouth to get physicians on board. The article states that in 2009, the number of inhouse recruiters who regularly used external search firms dropped to 49% from 55.1% in 2008. Take the poll below to share how your hospitalist program handles recruitment searches.
More OB hospitalists share their thoughts on program development
Jodie M. Horton, MD, medical director of the OB hospitalist department at Inova Loudoun Hospital in Leesburg, VA, shares her thoughts about OB hospitalist program development in response to our October 20 blog post. Here are her answers to our two most pressing questions:
As an OB hospitalist, what do your responsibilities entail?
OB hospitalist programs usually take 24-hour call shifts, although there are programs that do 12-hour shifts. We see a wide range of problems, including gynecological emergencies, surgery, triage, and C-sections.
OB hospitalist programs: What the field has to say
I did an interview with Rob Olson, MD, an OB hospitalist practicing in Spokane, WA, to follow up on “Four tips for an effective OB hospitalist program” in the November issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing. Olson is the administrator and moderator of http://obgynhospitalist.com.
Susan Rutherford, medical director or Women’s and Children’s Services at Evergreen Healthcare in Kirkland, WA, also chimed in with her thoughts. I’d love to hear yours, too!
LJ: How is operating an OB hospitalist program different than a traditional internal medicine hospitalist program? Are there any special considerations?
RO: There are many similarities in all hospitalist programs. The differences between internal medicine (and for that matter, pediatric) hospitalists and OB hospitalists are that OB hospitalists perform surgery, have more urgent and emergency patients, have more consultations from family practitioners and midwives, and overall request fewer consultations from other specialists.
Contest winner: OPPE forms simplified
Thanks to Sharon Chaput, RN, CSHA, director of regulatory and quality management at Brattleboro Retreat in Brattleboro, VT for sending in this OPPE indicator form and OPPE master grid. We here at HCPro have heard for several years now how tricky it can be to measure physician performance, so we’re happy to share these forms, which can be adapted to meet the needs of any specialty.
“The Joint Commission surveyor told us this past June that this form is the best he has seen in the country,” Chaput writes.
Heads up: Physicians are people, too
Two new studies support mysterious rumors that doctors are people, too. According to a study in the Sept. 23/30 issue of JAMA, fatigue isn’t the only factor that increases the likelihood that a physician will make a medical error. Other factors, such as financial and familial distress, also contribute. When developing a burnout prevention program, it is important to separate fatigue from other stress factors, the study suggests.
On a similar note, another study in the same issue of JAMA says that meditation may help relieve symptoms of burnout caused by fatigue and personal problems, as well as improve physicians’ relationships with patients. Physicians who participated in a mindful communication education program demonstrated sustained improvements in well-being, and their attitudes associated with patient-centered care improved.
Contest entry: Go paperless
Jenna Duch, medical staff coordinator at Akron Children’s Hospital in Ohio, submitted a suggestion to the Greeley Medical Staff Institute Symposium contest that we wanted to share because it will help save the environment. Duch puts all of the medical staff orientation materials onto a USB key rather than stuffing several trees’ worth of paper into cumbersome binders. She includes hyperlinks on the agenda page to guide medical staff members through all of the documents and help them find specific information. Transitioning to USB drives is a strategy any department–including hopsitalist programs–can do!
Many physicians favor public option
I just read about a recent study conducted by the Robert Wood Johnson Foundation to gauge physician’s reactions to healthcare reform.
Sixty-three percent of physicians support some type of government-backed healthcare reform, says the study, which appeared in the New England Journal of Medicine .
Check out this article from United Press International.
I’d love to hear what physicians out there think–and why! Comment below.
Hospitalist teachers drive students into internal and family medicine
In my last post, I mentioned an article in the July issue of The Hospitalist. The article discussed medical school debt versus physician pay, and how students are being driven away from careers in internal medicine and family medicine because the debt-to-salary ratio is skewed. The article suggests several ways in which society can lower medical school debt and drive more medical students into internal medicine and family medicine. One that struck me is for medical schools to create a clear hospital medicine career path for students spearheaded by hospitalists who take on teaching roles. “The stronger the mentors, the more internal medicine students you’re going to recruit,” one source said.
Are any of you mentoring medical students in your “spare time?” I’d love to hear what advice you give them. Do you set up formal times to meet or are you a mentor-on-call? Do you end up giving career advice, or do you spend most of your mentoring time soothing emotional breakdowns? What do you tell them about debt and finances?
Do lifestyle benefits outweigh lower pay?
When I interview hospitalists for Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing, many of them tell me that they chose to go into hospital medicine because it offers a better lifestyle. Many work Monday through Friday and rotate call on the weekends, which means they get to see their children’s soccer games and dance recitals, and they get to sleep through most nights. However, hospitalists may not be getting the best financial deal possible.
An article that appeared in the July issue of The Hospitalist highlights a recent trend: medical students are choosing high-paying specialties over internal medicine or family medicine based on their financial debt. This may mean that there will be fewer hospitalists to go around in the future, especially because most medical school graduates carry between $120,000 to $160,000 in debt, yet they only make $196,700 (mean). That puts them at the middle to lower end of the physician pay scale.
So, I guess the question is does the lifestyle benefit outweigh the financial limitations? Do you revel in the ability to practice medicine on a reasonable schedule, or do you lament the fact that you’ll probably have grandchildren before you pay off your medical school debt?
New handoff guidelines from SHM
I’m writing a case study for the September issue of Hospitalist Leadership Advisor (supplemental newsletter to Medical Staff Briefing) on a hospital that has developed a hybrid scheduling model. Basically, physicians spend one week on hospitalist duty and three weeks practicing in their outpatient offices. Naturally, I asked about patient handoffs—I figure if you’re not going to be back for three weeks, you should have a darn good system in place. And they do—hand-written notes are not allowed (electronic documentation only, thank you), and physicians discuss patient handoffs either face to face or over the phone so that there are no hanging questions. To boot, every Monday morning starts with a case conference.
Happenstance, I later ran into the Society of Hospital Medicine’s new recommendations for patient handoffs in the July issue of ACP Hospitalist. How many of these can you check off?
Hospitalists should:
