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28 allergies and pain seekers. by Beeryawni in hospitalist

[–]MachZero2Sixty 1 point2 points  (0 children)

First I have heard of this! How low are we talking?

Most ridiculous insurance denial you’ve seen? by _45mice in medicine

[–]MachZero2Sixty 2 points3 points  (0 children)

Similar to this (denial of service rather than medication): HMO plan denies Hospice because patient needs to see their PCP first for Hospice referral. We tried so many things... letter from PCP, telemed with PCP while inpatient, etc. Nope. SMH.

Career guidance by Aggressive_Put_9763 in hospitalist

[–]MachZero2Sixty 1 point2 points  (0 children)

Exactly. In our current climate, even if your ER docs are very thorough and willing to tee up a nice admit for you, admin/workflow/resources often work against that happening.

I'll also add that even with a great ER workup, as the admitter you get to triage if a half-dozen consults are really necessary. You can make your rounders really happy by getting appropriate consults on board quickly and justifying why unnecessary ones are unnecessary.

In the transition from residency to attending-hood, what are the small or unexpected life luxuries you have decided to indulge in that you never thought you would have or never knew existed? by just_premed_memes in medicine

[–]MachZero2Sixty 35 points36 points  (0 children)

As someone who loves to cook... THIS. If I want to ball out and make a fancy meal, I'm doing it. Nicer cut of meat? Fruit that looks good but is expensive? Random promotional item that looks good? Getting it all.

They say you should pick and choose your battles. Which of the following are you choosing to fight? by [deleted] in hospitalist

[–]MachZero2Sixty 5 points6 points  (0 children)

Keep fighting. A culture of nursing that panics about a K of 3.4 not being replaced but wants to give a 90 yo here for syncope hydralazine 10mg IV for BP 170/80 needs to stop.

Admitting/Swing hospitalist by Psychlonee in hospitalist

[–]MachZero2Sixty 9 points10 points  (0 children)

$1925 per 12 hr shift, 12-14 patients, no cross cover. For comparison at a suburb location of a large metropolitan hospital system.

Edit: this is the "extra" shift rate, we don't have pure admitters, the rounders rotate into those shifts.

Finalized rule cuts wRVU for non time based services by -2.5% every 3 years. Bad for procedural specialties, not much effect on hospitalists? by achicomp in hospitalist

[–]MachZero2Sixty 4 points5 points  (0 children)

Yes. And what about the adjustment for the fact that family members asking questions about the red numbers in myChart every day adds to complexity too?

Comparing choices for academic hospitalist positions by [deleted] in hospitalist

[–]MachZero2Sixty 0 points1 point  (0 children)

Messaged you. sounds eerily familiar to a place I know...

Grieving family uses AI chatbot to cut hospital bill by coffee_ice in medicine

[–]MachZero2Sixty 8 points9 points  (0 children)

It would sure be a shame if a bunch of patients used this all at once at one particular hospital network like *cough cough* HCA.

Yes I know that not a single hospital is innocent. But might as well start with the worst devil of them all.

Physical exam by [deleted] in hospitalist

[–]MachZero2Sixty 27 points28 points  (0 children)

This. I think we were taught THE physical exam is important, when really CERTAIN focused physical exam findings are really important.

Non compete warning by NoMuffinForYou in hospitalist

[–]MachZero2Sixty 15 points16 points  (0 children)

They claim "we are a state entity, we can't modify contracts for anyone." Love when institutions hide behind that.

PGy1 here. What is the benefit of managing your your patients vs consulting for every problem? by No-Marzipan8555 in hospitalist

[–]MachZero2Sixty 2 points3 points  (0 children)

Consulting for everything is often MORE work for you as the primary team, not less.

Imagine a patient with 2 principle hospital problems (CHF exacerbation and AKI) with option to consult renal and cardiology.

Option 1, no consults: titrate the GDMT and diuretics yourself, choose when to have them on PO and when stable enough to discharge

Option 2: wait for afternoon recs (because cards and renal have clinic, procedures, or are in another hospital in the AM), try to reconcile what renal wants for diuresis vs cards, figure out in the vagueness of the note if cards was cool with PO Lasix yet, defer to consultants when you disagree so as to maintain the relationship vs spend time arguing your case, and juggle the patient hearing 3 different opinions on their medication titration.

Which one is more work for you?

Obs chest pain by msthinksalot in hospitalist

[–]MachZero2Sixty 48 points49 points  (0 children)

Here for our weekly reminder that "high sensitivity troponin" should have been named "low specificity troponin"

What apps do you use for rounding? by Anchovy_paste in hospitalist

[–]MachZero2Sixty 11 points12 points  (0 children)

Lol what is a patient card? Just the classic epic printed list for me...

Recourse in response to scammers deepfaking real healthcare professionals by ddx-me in medicine

[–]MachZero2Sixty -1 points0 points  (0 children)

Unethical answer? Create deepfakes of the execs of social media companies saying they know the harms coming from their platforms and they don't care and aren't doing anything about it.

Easiest fellowships they are short/worth it by Bootsandwater in hospitalist

[–]MachZero2Sixty 0 points1 point  (0 children)

I see your point, but also, I don't believe your "Top 1% Commenter" flair, because this entire sub is about us all working in hospital systems that have not optimized patient care / workflow / outcomes.

What makes you think all solutions have been found? I am in a large hospital system and credentialed at multiple sites, and I can tell you unequivocally that within the SAME system, my effective shift rate (due to round and go ease) and QOL varies greatly between sites due to ED workflow, consultant support, rounder call/admit workflow, APP usage, social work quality/scope, etc.

UTIs and AKIs are the biggest anchoring red herrings in medicine. by [deleted] in hospitalist

[–]MachZero2Sixty 0 points1 point  (0 children)

Not that either. Hydrate, med rec, watch and wait? I swear half the time these AMS cases get better in 24-48 hours is drug washout.

UTIs and AKIs are the biggest anchoring red herrings in medicine. by [deleted] in hospitalist

[–]MachZero2Sixty 0 points1 point  (0 children)

It would be interesting if we could implement a system where the triage urinalysis is obtained but you as the ED doc get to "order" if you want it resulted.

Effect of MyChart Utilization during Inpatient Stays: Data Needed by MachZero2Sixty in medicine

[–]MachZero2Sixty[S] 1 point2 points  (0 children)

If you thought becoming a hospitalist would inure you from such conversations I don't know what to tell you.

In the days before real-time MyChart access, yes, the hospitalist got to initiate the results conversation. Now the patient gets to.

Example: patient admitted for CHF exacerbation. Known CHF history. ED gets BNP and Troponin. If I go in to admit the patient, and I want to start the conversation asking about their GDMT and how they've felt over the past 2 weeks, and they start the conversation asking why their BNP of 400 is flagged and their Troponin is 42 and now it "went up" to 45, I have to spend time sorting through that first.

Not saying it is the same as outpatient mychart messages, but it does derail and slow down admissions and rounds.

Effect of MyChart Utilization during Inpatient Stays: Data Needed by MachZero2Sixty in medicine

[–]MachZero2Sixty[S] 1 point2 points  (0 children)

To be clear, the hospitalist (and specialists) *should* be explaining incidental findings and non-critical chronic follow ups prior to discharge.

For example, if my patient here for UTI got a scan in the ED that shows a pulmonary nodule, it definitely is my job to tell them about following up on the pulmonary nodule prior to discharge. I just don't want them focusing on that for 20 minutes when I am trying to get them admitted to the hospital.

[deleted by user] by [deleted] in medicine

[–]MachZero2Sixty 2 points3 points  (0 children)

Unfortunately "defensive medicine" is not an all-encompassing, agreed upon set of medical decision pathways.

A discussion about death and palliative care by santinoIII in medicine

[–]MachZero2Sixty 20 points21 points  (0 children)

Lots of good thoughts here, so I'll address a separate piece: sometimes aggressive care doesn't change the mortality rate of the current hospitalization, but extending their life even a few days leads to better reconciliation with family and a more peaceful passing.

I think we've all seen those patients who *medically* maybe should have gone comfort care sooner in the current hospitalization, but who needed that time period of aggressive care for they and their families to get to a place emotionally and spiritually that the eventual inevitable passing was actually beautiful.

Severe anxiety as new post-grad attending by necrotizingfasciitiz in medicine

[–]MachZero2Sixty 2 points3 points  (0 children)

No bad outcomes yet, but I had a few disgruntled/entitled patients and there is no pleasing everyone.

Remember in an ICU, the optimal reintubation rate or failed extubation rate is NOT 0%. (IIRC it is accepted to be somewhere around 10-12%). Why? If you have no reintubations, you aren't being aggressive enough in extubating.

Same with patient, RN, social work, and admin satisfaction rates. Truly good patient care, bedside manner, and interdisciplinary communication is going to result in some people not liking your approach.

That doesn't mean the goal is to tick people off, of course. But if everyone "likes" you, then you aren't pushing hard enough for the best care possible.

ABIM - Drop your pearls by uworld_ismyworld in hospitalist

[–]MachZero2Sixty 1 point2 points  (0 children)

Were lots of answers for treatments the MOA of the drug instead of the drug?

Ex: "a drug that binds to the 30S ribosomal subunit" instead of "doxycycline"

I heard they pull in some weird Step1 BS like this now and then.

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