Geoff Giordano

A year ago in March, I looked my father in the eyes for the last time as he mouthed the words "help me" from his ICU bed. But despite being surrounded by teams of medical personnel and the latest healthcare technology, I felt utterly powerless to make a clear decision—and unclear to whom to turn for sound advice.

After 30 days of care in a well-known teaching hospital in the Northeast, my father was about to succumb to Stage 4 lung cancer, a tumor invading his spine. Moments before his plea, the ICU team had conducted a breathing test that apparently went awry—beginning the trial while my mother and I were downstairs receiving the latest round of conflicting information from a pair of doctors debating his outlook for discharge, physical rehabilitation, and hospice care. They casually informed us that a breathing test was about to occur; we rushed back to my father's side to learn the unfortunate outcome.

Prior to the episode that led to his being moved to the ICU, my father had been residing in a room directly across from a small hospitalist oncology office. What ensued was dizzying to behold: an endless parade of consultations; a narrowly averted million-dollar-plus spinal surgery in the wee hours; a too-zealous resident's further injuring of my father's right leg, which had already been compromised by a tumor degrading the femur.

My mother, my wife, and I struggled to maintain Dad's always-indomitable spirit while parsing the barrage of input regarding his potential for quality of life outside the hospital. We sat in numerous meetings, often with a pair of doctors espousing diametrically opposed outlooks. We tried to keep track of whom we were speaking with and who was in charge at any given moment; the lists we kept looked like the roster of a sports team, amply covered in scribbled-out names, phone numbers—and question marks.

It was only after my father tried feebly to speak his last words to me that the doctor who'd appeared to be most in charge pulled me aside at the door of the ICU. My mother and I hemmed and hawed in trying to decide whether to accede to another round of heroic measures. I was surprised by the somewhat terse tone of voice this senior physician used in dissuading us from allowing further life-extending efforts. I would have welcomed such honesty wholeheartedly far earlier in the process.

One of the value propositions hospitalists tout to their employers and patients is their expertise in coordinating care and facilitating communication among caregivers. Of course, there are nearly as many methods for doing so as there are hospitalist teams.

As the medical process grows more complex and specialized, with more "stakeholders" weighing in on the conversation, the hospitalist's role in taking charge of and energetically managing the flow of information for the benefit of beleaguered kin is more vital than ever. I can't speak for all loved ones who must witness the passage of a parent, a child, or a spouse, but for me, a hospitalist's firm hand would have made a world of difference in how we navigated this inevitable event.

Geoff Giordano was editor of The Hospitalist from 2007 to 2008. His father, Thomas, a lifelong journalist, wrote several articles for the magazine during that period.

A year ago in March, I looked my father in the eyes for the last time as he mouthed the words "help me" from his ICU bed. But despite being surrounded by teams of medical personnel and the latest healthcare technology, I felt utterly powerless to make a clear decision—and unclear to whom to turn for sound advice.

After 30 days of care in a well-known teaching hospital in the Northeast, my father was about to succumb to Stage 4 lung cancer, a tumor invading his spine. Moments before his plea, the ICU team had conducted a breathing test that apparently went awry—beginning the trial while my mother and I were downstairs receiving the latest round of conflicting information from a pair of doctors debating his outlook for discharge, physical rehabilitation, and hospice care. They casually informed us that a breathing test was about to occur; we rushed back to my father's side to learn the unfortunate outcome.

Prior to the episode that led to his being moved to the ICU, my father had been residing in a room directly across from a small hospitalist oncology office. What ensued was dizzying to behold: an endless parade of consultations; a narrowly averted million-dollar-plus spinal surgery in the wee hours; a too-zealous resident's further injuring of my father's right leg, which had already been compromised by a tumor degrading the femur.

My mother, my wife, and I struggled to maintain Dad's always-indomitable spirit while parsing the barrage of input regarding his potential for quality of life outside the hospital. We sat in numerous meetings, often with a pair of doctors espousing diametrically opposed outlooks. We tried to keep track of whom we were speaking with and who was in charge at any given moment; the lists we kept looked like the roster of a sports team, amply covered in scribbled-out names, phone numbers—and question marks.

It was only after my father tried feebly to speak his last words to me that the doctor who'd appeared to be most in charge pulled me aside at the door of the ICU. My mother and I hemmed and hawed in trying to decide whether to accede to another round of heroic measures. I was surprised by the somewhat terse tone of voice this senior physician used in dissuading us from allowing further life-extending efforts. I would have welcomed such honesty wholeheartedly far earlier in the process.

One of the value propositions hospitalists tout to their employers and patients is their expertise in coordinating care and facilitating communication among caregivers. Of course, there are nearly as many methods for doing so as there are hospitalist teams.

As the medical process grows more complex and specialized, with more "stakeholders" weighing in on the conversation, the hospitalist's role in taking charge of and energetically managing the flow of information for the benefit of beleaguered kin is more vital than ever. I can't speak for all loved ones who must witness the passage of a parent, a child, or a spouse, but for me, a hospitalist's firm hand would have made a world of difference in how we navigated this inevitable event.

Geoff Giordano was editor of The Hospitalist from 2007 to 2008. His father, Thomas, a lifelong journalist, wrote several articles for the magazine during that period.

A year ago in March, I looked my father in the eyes for the last time as he mouthed the words "help me" from his ICU bed. But despite being surrounded by teams of medical personnel and the latest healthcare technology, I felt utterly powerless to make a clear decision—and unclear to whom to turn for sound advice.

After 30 days of care in a well-known teaching hospital in the Northeast, my father was about to succumb to Stage 4 lung cancer, a tumor invading his spine. Moments before his plea, the ICU team had conducted a breathing test that apparently went awry—beginning the trial while my mother and I were downstairs receiving the latest round of conflicting information from a pair of doctors debating his outlook for discharge, physical rehabilitation, and hospice care. They casually informed us that a breathing test was about to occur; we rushed back to my father's side to learn the unfortunate outcome.

Prior to the episode that led to his being moved to the ICU, my father had been residing in a room directly across from a small hospitalist oncology office. What ensued was dizzying to behold: an endless parade of consultations; a narrowly averted million-dollar-plus spinal surgery in the wee hours; a too-zealous resident's further injuring of my father's right leg, which had already been compromised by a tumor degrading the femur.

My mother, my wife, and I struggled to maintain Dad's always-indomitable spirit while parsing the barrage of input regarding his potential for quality of life outside the hospital. We sat in numerous meetings, often with a pair of doctors espousing diametrically opposed outlooks. We tried to keep track of whom we were speaking with and who was in charge at any given moment; the lists we kept looked like the roster of a sports team, amply covered in scribbled-out names, phone numbers—and question marks.

It was only after my father tried feebly to speak his last words to me that the doctor who'd appeared to be most in charge pulled me aside at the door of the ICU. My mother and I hemmed and hawed in trying to decide whether to accede to another round of heroic measures. I was surprised by the somewhat terse tone of voice this senior physician used in dissuading us from allowing further life-extending efforts. I would have welcomed such honesty wholeheartedly far earlier in the process.

One of the value propositions hospitalists tout to their employers and patients is their expertise in coordinating care and facilitating communication among caregivers. Of course, there are nearly as many methods for doing so as there are hospitalist teams.

As the medical process grows more complex and specialized, with more "stakeholders" weighing in on the conversation, the hospitalist's role in taking charge of and energetically managing the flow of information for the benefit of beleaguered kin is more vital than ever. I can't speak for all loved ones who must witness the passage of a parent, a child, or a spouse, but for me, a hospitalist's firm hand would have made a world of difference in how we navigated this inevitable event.

Geoff Giordano was editor of The Hospitalist from 2007 to 2008. His father, Thomas, a lifelong journalist, wrote several articles for the magazine during that period.

A team of a dozen hospitalist experts has joined forces with The Hospitalist to provide our readers exclusive insights into the critical issues facing hospital medicine.

Team Hospitalist comprises a diverse array of hospital medicine talent by region, specialty, and experience. The team was selected late last year from a pool of more than two dozen candidates, and each member will serve a two-year term.

Meet Team Hospitalist

R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston

 

Brian Bossard, MD, director, Inpatient Physician Associates, Lincoln, Neb.

 

 

Maj. Heather Cereste, MD, MC, codirector, geriatric medicine service, assistant professor, Uniformed Services University of the Health Sciences, Bethesda, Md.; internist and chairperson, Bioethics Committee, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas

 

Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappahannock Hospital, Va.

 

William T. Ford, MD, program medical director, Cogent Healthcare; chief, section of hospital medicine, Temple University, Philadelphia

 

David Grace, MD, area medical officer, The Schumacher Group Hospital Medicine Division, Lafayette, La.

 

Kenneth Patrick, MD, intensive-care unit director, Chestnut Hill Hospital, Philadelphia

 

Richard Rohr, MD, vice president for medical affairs, Cortland Regional Medical Center, Cortland, N.Y.

 

Sandeep Sachdeva, MD, FAHA, director, hospitalist services, Banner Gateway Medical Center, Gilbert, Ariz.

 

Matthew Szvetecz, MD, director, Division of Internal Medicine, Kadlec Medical Associates, Richland, Wash.

 

Julia Wright, MD, clinical associate professor of medicine, University of Wisconsin Hospitals and Clinics; associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison

 

David Yu, MD, FACP, medical director of hospitalist services, Decatur Memorial Hospital; clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine

Team members will share their professional expertise on a regular basis within the pages of The Hospitalist and on our Web site (www.the-hospitalist.org) via blogs and discussion rooms. The team’s contributions will range from being tapped as sources for stories to sharing short accounts of their experiences relating to topics they are intimately familiar with.

Advancing the mission of hospital medicine is at the core of why team members say they desire to participate on this unique panel.

“Physicians practicing hospital medicine over the next couple of years must remember that providing excellent care to our patients remains our highest priority,” says Ken Patrick, MD, director of the intensive-care unit at Chestnut Hill Hospital in Philadelphia. “Being compassionate, empathetic, and communicating effectively to our patients, their families, and their primary care physicians can be exceedingly difficult in the stressful hospital environment. Having been trained in both primary care and critical care medicine and practiced hospital medicine for more than 25 years remind me just how vitally important this is for our profession.”

Nuts-and-bolts issues like funding, technology, research, and quality standards are uppermost on these experts’ minds.

Specializing in electronic medical technology and progressive scheduling, David J. Yu, MD, hopes to share his approaches to innovating hospital medicine. “Hospitalist programs will encounter more difficult problems … which will require medical directors to forego traditional and exhausted methods of practice,” says Dr. Yu, medical director of hospitalist services, Decatur Memorial Hospital, and clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine. “I hope to share my experiences in creating innovative approaches to scheduling and our creative use of electronic medical technology to advance the art of hospital medicine into the 21st century.”

The evolution of hospital medicine presents opportunities—and risks—says Rajeev Alexander, MD, lead hospitalist, Oregon Medical Group, Eugene, Ore.

“I enjoy the intellectual challenge hospitalist medicine presents, the range of pathologies and sorts of problems we’re asked about—everything from intensive care work to end-of-life care,” he says. “I would like to see hospitalist medicine evolve an identity along the lines of emergency medicine and/or anesthesia.” However, he fears hospitalists could be seen as, or become, either “physicians with a rapid turnover and without ties to the community who treat the position as a mere stepping stone before a higher-paying specialty fellowship, or ... overgrown house officers who, because of their status as employed physicians, are seen as fungible by hospital administrators.”

But the buck should stop with hospitalists when it comes to improving care quality, says Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappa­hannock Hospital, Va.

“So many outside forces are working to constrain medicine in so many ways, I am hoping that we … can come together to so thoroughly and definitively improve the quality of our care that those outside agencies will feel comfortable stepping back and interfering less in how we practice,” says Dr. Ferrance.

When it comes to research, hospitalists could be in the driver’s seat, says R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston.

“The [National Institutes of Health] and the academic institutions who count on NIH funding have focused a great deal of publicity in recent years on ‘translational’ research that is supposed to move scientific discovery from the bench more expeditiously to the bedside,” Dr. Axon says. “Increasingly, hospitalists are the doctors at the bedside, and I see a huge opportunity for our specialty to both perform research and to set a relevant research agenda over the next several years.”

The bottom line is that hospitalists must focus on achieving three things, says Julia Wright, MD, associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison. Her priorities are establishing hospital medicine as a specialty, creating uniform standards for hospitalists, and excelling in patient care and care-delivery systems. TH

Geoff Giordano is editor of The Hospitalist.

A team of a dozen hospitalist experts has joined forces with The Hospitalist to provide our readers exclusive insights into the critical issues facing hospital medicine.

Team Hospitalist comprises a diverse array of hospital medicine talent by region, specialty, and experience. The team was selected late last year from a pool of more than two dozen candidates, and each member will serve a two-year term.

Meet Team Hospitalist

R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston

 

Brian Bossard, MD, director, Inpatient Physician Associates, Lincoln, Neb.

 

 

Maj. Heather Cereste, MD, MC, codirector, geriatric medicine service, assistant professor, Uniformed Services University of the Health Sciences, Bethesda, Md.; internist and chairperson, Bioethics Committee, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas

 

Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappahannock Hospital, Va.

 

William T. Ford, MD, program medical director, Cogent Healthcare; chief, section of hospital medicine, Temple University, Philadelphia

 

David Grace, MD, area medical officer, The Schumacher Group Hospital Medicine Division, Lafayette, La.

 

Kenneth Patrick, MD, intensive-care unit director, Chestnut Hill Hospital, Philadelphia

 

Richard Rohr, MD, vice president for medical affairs, Cortland Regional Medical Center, Cortland, N.Y.

 

Sandeep Sachdeva, MD, FAHA, director, hospitalist services, Banner Gateway Medical Center, Gilbert, Ariz.

 

Matthew Szvetecz, MD, director, Division of Internal Medicine, Kadlec Medical Associates, Richland, Wash.

 

Julia Wright, MD, clinical associate professor of medicine, University of Wisconsin Hospitals and Clinics; associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison

 

David Yu, MD, FACP, medical director of hospitalist services, Decatur Memorial Hospital; clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine

Team members will share their professional expertise on a regular basis within the pages of The Hospitalist and on our Web site (www.the-hospitalist.org) via blogs and discussion rooms. The team’s contributions will range from being tapped as sources for stories to sharing short accounts of their experiences relating to topics they are intimately familiar with.

Advancing the mission of hospital medicine is at the core of why team members say they desire to participate on this unique panel.

“Physicians practicing hospital medicine over the next couple of years must remember that providing excellent care to our patients remains our highest priority,” says Ken Patrick, MD, director of the intensive-care unit at Chestnut Hill Hospital in Philadelphia. “Being compassionate, empathetic, and communicating effectively to our patients, their families, and their primary care physicians can be exceedingly difficult in the stressful hospital environment. Having been trained in both primary care and critical care medicine and practiced hospital medicine for more than 25 years remind me just how vitally important this is for our profession.”

Nuts-and-bolts issues like funding, technology, research, and quality standards are uppermost on these experts’ minds.

Specializing in electronic medical technology and progressive scheduling, David J. Yu, MD, hopes to share his approaches to innovating hospital medicine. “Hospitalist programs will encounter more difficult problems … which will require medical directors to forego traditional and exhausted methods of practice,” says Dr. Yu, medical director of hospitalist services, Decatur Memorial Hospital, and clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine. “I hope to share my experiences in creating innovative approaches to scheduling and our creative use of electronic medical technology to advance the art of hospital medicine into the 21st century.”

The evolution of hospital medicine presents opportunities—and risks—says Rajeev Alexander, MD, lead hospitalist, Oregon Medical Group, Eugene, Ore.

“I enjoy the intellectual challenge hospitalist medicine presents, the range of pathologies and sorts of problems we’re asked about—everything from intensive care work to end-of-life care,” he says. “I would like to see hospitalist medicine evolve an identity along the lines of emergency medicine and/or anesthesia.” However, he fears hospitalists could be seen as, or become, either “physicians with a rapid turnover and without ties to the community who treat the position as a mere stepping stone before a higher-paying specialty fellowship, or ... overgrown house officers who, because of their status as employed physicians, are seen as fungible by hospital administrators.”

But the buck should stop with hospitalists when it comes to improving care quality, says Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappa­hannock Hospital, Va.

“So many outside forces are working to constrain medicine in so many ways, I am hoping that we … can come together to so thoroughly and definitively improve the quality of our care that those outside agencies will feel comfortable stepping back and interfering less in how we practice,” says Dr. Ferrance.

When it comes to research, hospitalists could be in the driver’s seat, says R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston.

“The [National Institutes of Health] and the academic institutions who count on NIH funding have focused a great deal of publicity in recent years on ‘translational’ research that is supposed to move scientific discovery from the bench more expeditiously to the bedside,” Dr. Axon says. “Increasingly, hospitalists are the doctors at the bedside, and I see a huge opportunity for our specialty to both perform research and to set a relevant research agenda over the next several years.”

The bottom line is that hospitalists must focus on achieving three things, says Julia Wright, MD, associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison. Her priorities are establishing hospital medicine as a specialty, creating uniform standards for hospitalists, and excelling in patient care and care-delivery systems. TH

Geoff Giordano is editor of The Hospitalist.

A team of a dozen hospitalist experts has joined forces with The Hospitalist to provide our readers exclusive insights into the critical issues facing hospital medicine.

Team Hospitalist comprises a diverse array of hospital medicine talent by region, specialty, and experience. The team was selected late last year from a pool of more than two dozen candidates, and each member will serve a two-year term.

Meet Team Hospitalist

R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston

 

Brian Bossard, MD, director, Inpatient Physician Associates, Lincoln, Neb.

 

 

Maj. Heather Cereste, MD, MC, codirector, geriatric medicine service, assistant professor, Uniformed Services University of the Health Sciences, Bethesda, Md.; internist and chairperson, Bioethics Committee, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas

 

Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappahannock Hospital, Va.

 

William T. Ford, MD, program medical director, Cogent Healthcare; chief, section of hospital medicine, Temple University, Philadelphia

 

David Grace, MD, area medical officer, The Schumacher Group Hospital Medicine Division, Lafayette, La.

 

Kenneth Patrick, MD, intensive-care unit director, Chestnut Hill Hospital, Philadelphia

 

Richard Rohr, MD, vice president for medical affairs, Cortland Regional Medical Center, Cortland, N.Y.

 

Sandeep Sachdeva, MD, FAHA, director, hospitalist services, Banner Gateway Medical Center, Gilbert, Ariz.

 

Matthew Szvetecz, MD, director, Division of Internal Medicine, Kadlec Medical Associates, Richland, Wash.

 

Julia Wright, MD, clinical associate professor of medicine, University of Wisconsin Hospitals and Clinics; associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison

 

David Yu, MD, FACP, medical director of hospitalist services, Decatur Memorial Hospital; clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine

Team members will share their professional expertise on a regular basis within the pages of The Hospitalist and on our Web site (www.the-hospitalist.org) via blogs and discussion rooms. The team’s contributions will range from being tapped as sources for stories to sharing short accounts of their experiences relating to topics they are intimately familiar with.

Advancing the mission of hospital medicine is at the core of why team members say they desire to participate on this unique panel.

“Physicians practicing hospital medicine over the next couple of years must remember that providing excellent care to our patients remains our highest priority,” says Ken Patrick, MD, director of the intensive-care unit at Chestnut Hill Hospital in Philadelphia. “Being compassionate, empathetic, and communicating effectively to our patients, their families, and their primary care physicians can be exceedingly difficult in the stressful hospital environment. Having been trained in both primary care and critical care medicine and practiced hospital medicine for more than 25 years remind me just how vitally important this is for our profession.”

Nuts-and-bolts issues like funding, technology, research, and quality standards are uppermost on these experts’ minds.

Specializing in electronic medical technology and progressive scheduling, David J. Yu, MD, hopes to share his approaches to innovating hospital medicine. “Hospitalist programs will encounter more difficult problems … which will require medical directors to forego traditional and exhausted methods of practice,” says Dr. Yu, medical director of hospitalist services, Decatur Memorial Hospital, and clinical assistant professor, family and community medicine, Southern Illinois University, School of Medicine. “I hope to share my experiences in creating innovative approaches to scheduling and our creative use of electronic medical technology to advance the art of hospital medicine into the 21st century.”

The evolution of hospital medicine presents opportunities—and risks—says Rajeev Alexander, MD, lead hospitalist, Oregon Medical Group, Eugene, Ore.

“I enjoy the intellectual challenge hospitalist medicine presents, the range of pathologies and sorts of problems we’re asked about—everything from intensive care work to end-of-life care,” he says. “I would like to see hospitalist medicine evolve an identity along the lines of emergency medicine and/or anesthesia.” However, he fears hospitalists could be seen as, or become, either “physicians with a rapid turnover and without ties to the community who treat the position as a mere stepping stone before a higher-paying specialty fellowship, or ... overgrown house officers who, because of their status as employed physicians, are seen as fungible by hospital administrators.”

But the buck should stop with hospitalists when it comes to improving care quality, says Randy Ferrance, DC, MC, internal medicine and pediatrics medical director, Riverside Tappahannock Hospice, Riverside Tappa­hannock Hospital, Va.

“So many outside forces are working to constrain medicine in so many ways, I am hoping that we … can come together to so thoroughly and definitively improve the quality of our care that those outside agencies will feel comfortable stepping back and interfering less in how we practice,” says Dr. Ferrance.

When it comes to research, hospitalists could be in the driver’s seat, says R. Neal Axon, MD, assistant professor, medicine and pediatrics, Medical University of South Carolina, Charleston.

“The [National Institutes of Health] and the academic institutions who count on NIH funding have focused a great deal of publicity in recent years on ‘translational’ research that is supposed to move scientific discovery from the bench more expeditiously to the bedside,” Dr. Axon says. “Increasingly, hospitalists are the doctors at the bedside, and I see a huge opportunity for our specialty to both perform research and to set a relevant research agenda over the next several years.”

The bottom line is that hospitalists must focus on achieving three things, says Julia Wright, MD, associate clinical professor of medicine and director of hospital medicine, University of Wisconsin School of Medicine and Public Health, Madison. Her priorities are establishing hospital medicine as a specialty, creating uniform standards for hospitalists, and excelling in patient care and care-delivery systems. TH

Geoff Giordano is editor of The Hospitalist.