James S. Newman, MD, FACP

This is my last issue as physician editor of The Hospitalist. It has certainly been an interesting and rewarding two years. It has been an exceptional experience working with Lisa Dionne, Wiley, and SHM.

I look forward to the changes my worthy successor Jeff Glasheen, MD, will put into place. As I approach the end of my tenure, I can glimpse the light at the end of the tunnel.

I have a sense of déjà vu. I have a sense of déjà vu. I know the feeling well. I’ve noted it on the last day on a rotation, the last hour on a shift; I even remember it from the last month of residency. All of these were periods of transition, variations on the well known theme of “senior-itis.” A colleague, a one-year hospitalist named Jeremy Cetnar who is off to greener oncologic pastures, suggested his final few weeks on service were like being a lame duck president; a combination of temporizing and survival.

What is a lame duck beside the punch line for a corny joke? The term may have originated in the London stock exchange in the mid-18th century. When settlement day came, and a member was unable to meet his debt, he “waddled” out of Exchange Alley. From an avian standpoint one could also be a rook (a type of crow), which was a swindler. That was better then being a dove, which was the rook’s prey (hence the saying “They got rooked”).

Perhaps better to be a mammal like a bull or a bear, than a lame duck. Lame ducks are also seen in entertainment. There is a Finnish rock band and a Norwegian ska punk band by that name. The lame duck is also a well-known tango position, but my orthopedist has forbidden me from demonstrating.

The 20th Amendment (the big XX) is called the lame duck amendment. It comes right after XIX, also known as the “No shoes, no shirt, no service” amendment. (Actually XIX is “The right of the citizens of the U.S. to vote shall not be denied or abridged on account of sex”—a biggie for sure).

Amendment XX was established in 1933 to reduce the time between the election of the president and Congress and the beginning of their terms. Having a delayed inauguration could lead to problems, as in the case of Abraham Lincoln: The Confederate States seceded before he could be sworn into office.

It is never easy to sit in office as a lame duck, whether a senator, congressman, or president. As a president, the current two-term limit creates the lame duck situation more frequently. Prior to the inception of this limit, there was always the possibility of running for a third term to add spice to those last years in office. The first Roosevelt to run for a third term was Teddy, running as a “Bull Moose.” He lost his bid to Woodrow Wilson in 1912. After FDR, there would be no more two-term-plus presidents.

There have been five lame ducks since the amendment was passed: Eisenhower, Nixon, Reagan, Clinton, and our current lame president, Bush. The last two years of the second term can be hard. For Eisenhower and Reagan their prestige and public admiration carried them through. Nixon and Clinton were significantly less lucky in this regard. How the current resident of 1600 Pennsylvania Ave. finishes his term will be of great interest to historians—and to those of us who live through it.

“How does this have anything to do with hospital medicine?” you may ask yourself, as the readers of this column frequently query.

As a resident, the last few months were never ending. The predominant sensation was being ready to move on. If it’s the last day on service after a long run, and a patient gets admitted, I still sometimes have to fight that feeling. There are unanswered questions, tests to be ordered, labs pending, but still you know that when those results come back, it won’t be you who interprets them. It creates a disconnect that is hard to avoid.

For a one-year hospitalist, spending a year on service as filler between residency and fellowship, this is a huge issue. As the transitional hospitalist nears the end, how can he or she stay involved in decision-making and maintain interest in the workings and improvement of the group? Transitional hospitalists are an important resource in many academic centers, and making their entire year a success is of paramount importance to the patients they serve.

The best recommendation I can make is to make sure one-year hospitalists are not on service their last two weeks. Let them save their vacation time and non-service time until the end, when they really need it for the transition to the next phase in their lives. This also helps avoid the creation of a malcontent and the potential for substandard care by a disengaged provider.

As physician editor—aka Grand Kahuna—of The Hospitalist, I have felt that sensation of being ready to hand over the reins. I am ready for my senescence. Nonetheless, it has been a great two years. We have covered stories from all over the world—Iraq, Afghanistan, Holland, and Brazil. We have explored medical history from ancient Greece to colonial America. We have even looked at maggot debridement. Oh, and also some hospitalist stuff.

I can’t wait to see what The Hospitalist will look like in the years to come. As the great poet-physician Oliver Wendell Holmes Sr. observed, “The great thing in the world is not so much where we stand, as in what direction we are moving.” TH

Dr. Newman served as physician editor of The Hospitalist since 2005. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

This is my last issue as physician editor of The Hospitalist. It has certainly been an interesting and rewarding two years. It has been an exceptional experience working with Lisa Dionne, Wiley, and SHM.

I look forward to the changes my worthy successor Jeff Glasheen, MD, will put into place. As I approach the end of my tenure, I can glimpse the light at the end of the tunnel.

I have a sense of déjà vu. I have a sense of déjà vu. I know the feeling well. I’ve noted it on the last day on a rotation, the last hour on a shift; I even remember it from the last month of residency. All of these were periods of transition, variations on the well known theme of “senior-itis.” A colleague, a one-year hospitalist named Jeremy Cetnar who is off to greener oncologic pastures, suggested his final few weeks on service were like being a lame duck president; a combination of temporizing and survival.

What is a lame duck beside the punch line for a corny joke? The term may have originated in the London stock exchange in the mid-18th century. When settlement day came, and a member was unable to meet his debt, he “waddled” out of Exchange Alley. From an avian standpoint one could also be a rook (a type of crow), which was a swindler. That was better then being a dove, which was the rook’s prey (hence the saying “They got rooked”).

Perhaps better to be a mammal like a bull or a bear, than a lame duck. Lame ducks are also seen in entertainment. There is a Finnish rock band and a Norwegian ska punk band by that name. The lame duck is also a well-known tango position, but my orthopedist has forbidden me from demonstrating.

The 20th Amendment (the big XX) is called the lame duck amendment. It comes right after XIX, also known as the “No shoes, no shirt, no service” amendment. (Actually XIX is “The right of the citizens of the U.S. to vote shall not be denied or abridged on account of sex”—a biggie for sure).

Amendment XX was established in 1933 to reduce the time between the election of the president and Congress and the beginning of their terms. Having a delayed inauguration could lead to problems, as in the case of Abraham Lincoln: The Confederate States seceded before he could be sworn into office.

It is never easy to sit in office as a lame duck, whether a senator, congressman, or president. As a president, the current two-term limit creates the lame duck situation more frequently. Prior to the inception of this limit, there was always the possibility of running for a third term to add spice to those last years in office. The first Roosevelt to run for a third term was Teddy, running as a “Bull Moose.” He lost his bid to Woodrow Wilson in 1912. After FDR, there would be no more two-term-plus presidents.

There have been five lame ducks since the amendment was passed: Eisenhower, Nixon, Reagan, Clinton, and our current lame president, Bush. The last two years of the second term can be hard. For Eisenhower and Reagan their prestige and public admiration carried them through. Nixon and Clinton were significantly less lucky in this regard. How the current resident of 1600 Pennsylvania Ave. finishes his term will be of great interest to historians—and to those of us who live through it.

“How does this have anything to do with hospital medicine?” you may ask yourself, as the readers of this column frequently query.

As a resident, the last few months were never ending. The predominant sensation was being ready to move on. If it’s the last day on service after a long run, and a patient gets admitted, I still sometimes have to fight that feeling. There are unanswered questions, tests to be ordered, labs pending, but still you know that when those results come back, it won’t be you who interprets them. It creates a disconnect that is hard to avoid.

For a one-year hospitalist, spending a year on service as filler between residency and fellowship, this is a huge issue. As the transitional hospitalist nears the end, how can he or she stay involved in decision-making and maintain interest in the workings and improvement of the group? Transitional hospitalists are an important resource in many academic centers, and making their entire year a success is of paramount importance to the patients they serve.

The best recommendation I can make is to make sure one-year hospitalists are not on service their last two weeks. Let them save their vacation time and non-service time until the end, when they really need it for the transition to the next phase in their lives. This also helps avoid the creation of a malcontent and the potential for substandard care by a disengaged provider.

As physician editor—aka Grand Kahuna—of The Hospitalist, I have felt that sensation of being ready to hand over the reins. I am ready for my senescence. Nonetheless, it has been a great two years. We have covered stories from all over the world—Iraq, Afghanistan, Holland, and Brazil. We have explored medical history from ancient Greece to colonial America. We have even looked at maggot debridement. Oh, and also some hospitalist stuff.

I can’t wait to see what The Hospitalist will look like in the years to come. As the great poet-physician Oliver Wendell Holmes Sr. observed, “The great thing in the world is not so much where we stand, as in what direction we are moving.” TH

Dr. Newman served as physician editor of The Hospitalist since 2005. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

This is my last issue as physician editor of The Hospitalist. It has certainly been an interesting and rewarding two years. It has been an exceptional experience working with Lisa Dionne, Wiley, and SHM.

I look forward to the changes my worthy successor Jeff Glasheen, MD, will put into place. As I approach the end of my tenure, I can glimpse the light at the end of the tunnel.

I have a sense of déjà vu. I have a sense of déjà vu. I know the feeling well. I’ve noted it on the last day on a rotation, the last hour on a shift; I even remember it from the last month of residency. All of these were periods of transition, variations on the well known theme of “senior-itis.” A colleague, a one-year hospitalist named Jeremy Cetnar who is off to greener oncologic pastures, suggested his final few weeks on service were like being a lame duck president; a combination of temporizing and survival.

What is a lame duck beside the punch line for a corny joke? The term may have originated in the London stock exchange in the mid-18th century. When settlement day came, and a member was unable to meet his debt, he “waddled” out of Exchange Alley. From an avian standpoint one could also be a rook (a type of crow), which was a swindler. That was better then being a dove, which was the rook’s prey (hence the saying “They got rooked”).

Perhaps better to be a mammal like a bull or a bear, than a lame duck. Lame ducks are also seen in entertainment. There is a Finnish rock band and a Norwegian ska punk band by that name. The lame duck is also a well-known tango position, but my orthopedist has forbidden me from demonstrating.

The 20th Amendment (the big XX) is called the lame duck amendment. It comes right after XIX, also known as the “No shoes, no shirt, no service” amendment. (Actually XIX is “The right of the citizens of the U.S. to vote shall not be denied or abridged on account of sex”—a biggie for sure).

Amendment XX was established in 1933 to reduce the time between the election of the president and Congress and the beginning of their terms. Having a delayed inauguration could lead to problems, as in the case of Abraham Lincoln: The Confederate States seceded before he could be sworn into office.

It is never easy to sit in office as a lame duck, whether a senator, congressman, or president. As a president, the current two-term limit creates the lame duck situation more frequently. Prior to the inception of this limit, there was always the possibility of running for a third term to add spice to those last years in office. The first Roosevelt to run for a third term was Teddy, running as a “Bull Moose.” He lost his bid to Woodrow Wilson in 1912. After FDR, there would be no more two-term-plus presidents.

There have been five lame ducks since the amendment was passed: Eisenhower, Nixon, Reagan, Clinton, and our current lame president, Bush. The last two years of the second term can be hard. For Eisenhower and Reagan their prestige and public admiration carried them through. Nixon and Clinton were significantly less lucky in this regard. How the current resident of 1600 Pennsylvania Ave. finishes his term will be of great interest to historians—and to those of us who live through it.

“How does this have anything to do with hospital medicine?” you may ask yourself, as the readers of this column frequently query.

As a resident, the last few months were never ending. The predominant sensation was being ready to move on. If it’s the last day on service after a long run, and a patient gets admitted, I still sometimes have to fight that feeling. There are unanswered questions, tests to be ordered, labs pending, but still you know that when those results come back, it won’t be you who interprets them. It creates a disconnect that is hard to avoid.

For a one-year hospitalist, spending a year on service as filler between residency and fellowship, this is a huge issue. As the transitional hospitalist nears the end, how can he or she stay involved in decision-making and maintain interest in the workings and improvement of the group? Transitional hospitalists are an important resource in many academic centers, and making their entire year a success is of paramount importance to the patients they serve.

The best recommendation I can make is to make sure one-year hospitalists are not on service their last two weeks. Let them save their vacation time and non-service time until the end, when they really need it for the transition to the next phase in their lives. This also helps avoid the creation of a malcontent and the potential for substandard care by a disengaged provider.

As physician editor—aka Grand Kahuna—of The Hospitalist, I have felt that sensation of being ready to hand over the reins. I am ready for my senescence. Nonetheless, it has been a great two years. We have covered stories from all over the world—Iraq, Afghanistan, Holland, and Brazil. We have explored medical history from ancient Greece to colonial America. We have even looked at maggot debridement. Oh, and also some hospitalist stuff.

I can’t wait to see what The Hospitalist will look like in the years to come. As the great poet-physician Oliver Wendell Holmes Sr. observed, “The great thing in the world is not so much where we stand, as in what direction we are moving.” TH

Dr. Newman served as physician editor of The Hospitalist since 2005. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It is standard wisdom that when patients say they drink two beers a day, you should double that amount. Possibly triple it. I’ve had patients tell me they “don’t drink anymore,” meaning any more then they did before.

Though we tend to believe our patients when they recite their litany of pains and woes, when it comes to alcohol (and several other topics such as chronic pain, disability exams, and worker’s compensation) our credulity is often tested.

Mr. Q had been my patient for several years. He was a chain-smoking, hard-drinking Korean War veteran. He was a diminutive, cachectic, dyspneic, but extremely pleasant man. He was always accompanied to my clinic (in my prehospitalist days) with his ever-suffering, massive, and markedly less affable wife in tow.

His COPD was progressively worsening, and one day he told me he was going to quit smoking. His wife laughed unpleasantly, and commented that he’d quit just like he’d quit drinking. He prided himself on the keg of beer he kept in his garage. It was this keg that drove his wife most crazy, and perhaps that was the source of his pride. He went from two packs a day to five cigarettes. He said he planned to wake up every morning and load five in an empty pack, and these would be his five for the day. He would smoke the hell out of them, but if he ran out he would wait till the next morning to reload. His wife, as usual, sat and scowled and undermined his efforts.

On a subsequent visit, when he said he was down to five cigarettes, she laughed and said he was lying; he was smoking in the closet, in the car, wherever he could when she wasn’t looking—especially in the garage. Yet, some how I believed him. Maybe.

Before he came under my care Mr. Q also had been diagnosed with cirrhosis. I warned him many times about his need to stop drinking. I gave him lurid descriptions of esophageal varices and exsanguination, and other hepatic complications too fierce to mention. He always asserted that he didn’t drink anymore, with a large wink; his wife squirming in her chair. She snorted and said he should tell that to the keg in the garage. She said he would sit there all night long, drinking and watching the old black and white. I could see him wanting to escape her beady-eyed gaze. Yet I found this harder to believe than the possibility that he’d cut back his smoking.

Over the next year or so I pleaded with him to stop drinking as he developed diabetes. I knew a dozen beers a day couldn’t be helping his condition. I talked about diet and exercise, and he just laughed at me. He said he wasn’t going to exercise much with his lungs and remarked that if I’d tasted his wife’s cooking, diet wouldn’t be an issue. I marveled at what strange, attractive force held these two people together. Mutual hatred seemed the answer.

Two months later I admitted him to the hospital with a cardiac arrhythmia. He’d popped into atrial fibrillation. His wife grumbled that her husband hadn’t been out of the garage in a week. A diagnosis immediately came to mind: holiday heart. He’d drunk himself into an arrhythmia.

I got his heart rate under control but was frustrated with my seemingly fruitless efforts to control his drinking. His wife stormed out of his hospital room. The first time I was alone with him, I asked him why he’d never stopped drinking. He looked at me and laughed bitterly. He said he knew I wouldn’t believe him but that he had not had a drink in three years. The keg had been dry all that time, he just liked to sit in the garage and pretend he was having a few to keep away from his wife. He enjoyed his garage, the tools he was too sick to use, and his old black-and-white television.

How could this be? The history and exam did not jibe with this at all. He looked and acted like an alcoholic. Yet if his story were true, how could I explain his current condition? I wanted to believe him, but his persistent liver dysfunction, diabetes, and new arrhythmia argued against it. I looked at him. He was a gnarled, emphysematous shell of a man. At least he had a nice tan. I commented on this, mentioning that he must spend some time out of the garage to keep his melanocytes so primed. He looked at me quizzically. He said he never went outside, unless it was to get the newspaper; he hated sitting in the sun.

A light bulb lit in my head, then exploded into a million pieces. What if he really hadn’t been drinking? What else could explain this clinical picture? I was sure I knew the answer now, and a lab test quickly confirmed it. To my chagrin, his ferritin was more than 2,000. Bronze diabetes: his liver abnormalities, diabetes, pseudo-tan, and cardiac arrhythmia were due to iron deposition. He had hemochromatosis!

Several years later, Mr. Q died of complications of COPD. His son found him sitting in a lounge chair in his garage, with the old black and white tuned to his favorite station. He did not die from the diagnosis I had missed. Would his clinical outcome have been any different if the diagnosis had been made earlier? Probably not. Further, if his wife had known he wasn’t drinking, he might have lost his place of refuge. I promised myself that the next time a patient told me how much they drank that I would try to be less cynical in my response.

The day he died I went home and opened a fine merlot and poured myself a glass—then didn’t drink it. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It is standard wisdom that when patients say they drink two beers a day, you should double that amount. Possibly triple it. I’ve had patients tell me they “don’t drink anymore,” meaning any more then they did before.

Though we tend to believe our patients when they recite their litany of pains and woes, when it comes to alcohol (and several other topics such as chronic pain, disability exams, and worker’s compensation) our credulity is often tested.

Mr. Q had been my patient for several years. He was a chain-smoking, hard-drinking Korean War veteran. He was a diminutive, cachectic, dyspneic, but extremely pleasant man. He was always accompanied to my clinic (in my prehospitalist days) with his ever-suffering, massive, and markedly less affable wife in tow.

His COPD was progressively worsening, and one day he told me he was going to quit smoking. His wife laughed unpleasantly, and commented that he’d quit just like he’d quit drinking. He prided himself on the keg of beer he kept in his garage. It was this keg that drove his wife most crazy, and perhaps that was the source of his pride. He went from two packs a day to five cigarettes. He said he planned to wake up every morning and load five in an empty pack, and these would be his five for the day. He would smoke the hell out of them, but if he ran out he would wait till the next morning to reload. His wife, as usual, sat and scowled and undermined his efforts.

On a subsequent visit, when he said he was down to five cigarettes, she laughed and said he was lying; he was smoking in the closet, in the car, wherever he could when she wasn’t looking—especially in the garage. Yet, some how I believed him. Maybe.

Before he came under my care Mr. Q also had been diagnosed with cirrhosis. I warned him many times about his need to stop drinking. I gave him lurid descriptions of esophageal varices and exsanguination, and other hepatic complications too fierce to mention. He always asserted that he didn’t drink anymore, with a large wink; his wife squirming in her chair. She snorted and said he should tell that to the keg in the garage. She said he would sit there all night long, drinking and watching the old black and white. I could see him wanting to escape her beady-eyed gaze. Yet I found this harder to believe than the possibility that he’d cut back his smoking.

Over the next year or so I pleaded with him to stop drinking as he developed diabetes. I knew a dozen beers a day couldn’t be helping his condition. I talked about diet and exercise, and he just laughed at me. He said he wasn’t going to exercise much with his lungs and remarked that if I’d tasted his wife’s cooking, diet wouldn’t be an issue. I marveled at what strange, attractive force held these two people together. Mutual hatred seemed the answer.

Two months later I admitted him to the hospital with a cardiac arrhythmia. He’d popped into atrial fibrillation. His wife grumbled that her husband hadn’t been out of the garage in a week. A diagnosis immediately came to mind: holiday heart. He’d drunk himself into an arrhythmia.

I got his heart rate under control but was frustrated with my seemingly fruitless efforts to control his drinking. His wife stormed out of his hospital room. The first time I was alone with him, I asked him why he’d never stopped drinking. He looked at me and laughed bitterly. He said he knew I wouldn’t believe him but that he had not had a drink in three years. The keg had been dry all that time, he just liked to sit in the garage and pretend he was having a few to keep away from his wife. He enjoyed his garage, the tools he was too sick to use, and his old black-and-white television.

How could this be? The history and exam did not jibe with this at all. He looked and acted like an alcoholic. Yet if his story were true, how could I explain his current condition? I wanted to believe him, but his persistent liver dysfunction, diabetes, and new arrhythmia argued against it. I looked at him. He was a gnarled, emphysematous shell of a man. At least he had a nice tan. I commented on this, mentioning that he must spend some time out of the garage to keep his melanocytes so primed. He looked at me quizzically. He said he never went outside, unless it was to get the newspaper; he hated sitting in the sun.

A light bulb lit in my head, then exploded into a million pieces. What if he really hadn’t been drinking? What else could explain this clinical picture? I was sure I knew the answer now, and a lab test quickly confirmed it. To my chagrin, his ferritin was more than 2,000. Bronze diabetes: his liver abnormalities, diabetes, pseudo-tan, and cardiac arrhythmia were due to iron deposition. He had hemochromatosis!

Several years later, Mr. Q died of complications of COPD. His son found him sitting in a lounge chair in his garage, with the old black and white tuned to his favorite station. He did not die from the diagnosis I had missed. Would his clinical outcome have been any different if the diagnosis had been made earlier? Probably not. Further, if his wife had known he wasn’t drinking, he might have lost his place of refuge. I promised myself that the next time a patient told me how much they drank that I would try to be less cynical in my response.

The day he died I went home and opened a fine merlot and poured myself a glass—then didn’t drink it. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It is standard wisdom that when patients say they drink two beers a day, you should double that amount. Possibly triple it. I’ve had patients tell me they “don’t drink anymore,” meaning any more then they did before.

Though we tend to believe our patients when they recite their litany of pains and woes, when it comes to alcohol (and several other topics such as chronic pain, disability exams, and worker’s compensation) our credulity is often tested.

Mr. Q had been my patient for several years. He was a chain-smoking, hard-drinking Korean War veteran. He was a diminutive, cachectic, dyspneic, but extremely pleasant man. He was always accompanied to my clinic (in my prehospitalist days) with his ever-suffering, massive, and markedly less affable wife in tow.

His COPD was progressively worsening, and one day he told me he was going to quit smoking. His wife laughed unpleasantly, and commented that he’d quit just like he’d quit drinking. He prided himself on the keg of beer he kept in his garage. It was this keg that drove his wife most crazy, and perhaps that was the source of his pride. He went from two packs a day to five cigarettes. He said he planned to wake up every morning and load five in an empty pack, and these would be his five for the day. He would smoke the hell out of them, but if he ran out he would wait till the next morning to reload. His wife, as usual, sat and scowled and undermined his efforts.

On a subsequent visit, when he said he was down to five cigarettes, she laughed and said he was lying; he was smoking in the closet, in the car, wherever he could when she wasn’t looking—especially in the garage. Yet, some how I believed him. Maybe.

Before he came under my care Mr. Q also had been diagnosed with cirrhosis. I warned him many times about his need to stop drinking. I gave him lurid descriptions of esophageal varices and exsanguination, and other hepatic complications too fierce to mention. He always asserted that he didn’t drink anymore, with a large wink; his wife squirming in her chair. She snorted and said he should tell that to the keg in the garage. She said he would sit there all night long, drinking and watching the old black and white. I could see him wanting to escape her beady-eyed gaze. Yet I found this harder to believe than the possibility that he’d cut back his smoking.

Over the next year or so I pleaded with him to stop drinking as he developed diabetes. I knew a dozen beers a day couldn’t be helping his condition. I talked about diet and exercise, and he just laughed at me. He said he wasn’t going to exercise much with his lungs and remarked that if I’d tasted his wife’s cooking, diet wouldn’t be an issue. I marveled at what strange, attractive force held these two people together. Mutual hatred seemed the answer.

Two months later I admitted him to the hospital with a cardiac arrhythmia. He’d popped into atrial fibrillation. His wife grumbled that her husband hadn’t been out of the garage in a week. A diagnosis immediately came to mind: holiday heart. He’d drunk himself into an arrhythmia.

I got his heart rate under control but was frustrated with my seemingly fruitless efforts to control his drinking. His wife stormed out of his hospital room. The first time I was alone with him, I asked him why he’d never stopped drinking. He looked at me and laughed bitterly. He said he knew I wouldn’t believe him but that he had not had a drink in three years. The keg had been dry all that time, he just liked to sit in the garage and pretend he was having a few to keep away from his wife. He enjoyed his garage, the tools he was too sick to use, and his old black-and-white television.

How could this be? The history and exam did not jibe with this at all. He looked and acted like an alcoholic. Yet if his story were true, how could I explain his current condition? I wanted to believe him, but his persistent liver dysfunction, diabetes, and new arrhythmia argued against it. I looked at him. He was a gnarled, emphysematous shell of a man. At least he had a nice tan. I commented on this, mentioning that he must spend some time out of the garage to keep his melanocytes so primed. He looked at me quizzically. He said he never went outside, unless it was to get the newspaper; he hated sitting in the sun.

A light bulb lit in my head, then exploded into a million pieces. What if he really hadn’t been drinking? What else could explain this clinical picture? I was sure I knew the answer now, and a lab test quickly confirmed it. To my chagrin, his ferritin was more than 2,000. Bronze diabetes: his liver abnormalities, diabetes, pseudo-tan, and cardiac arrhythmia were due to iron deposition. He had hemochromatosis!

Several years later, Mr. Q died of complications of COPD. His son found him sitting in a lounge chair in his garage, with the old black and white tuned to his favorite station. He did not die from the diagnosis I had missed. Would his clinical outcome have been any different if the diagnosis had been made earlier? Probably not. Further, if his wife had known he wasn’t drinking, he might have lost his place of refuge. I promised myself that the next time a patient told me how much they drank that I would try to be less cynical in my response.

The day he died I went home and opened a fine merlot and poured myself a glass—then didn’t drink it. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Having finished my family practice residency, and not being tied down by friends or family, I thought a round of working locum tenens would be a good way to see some different styles of practice.

I contacted a company called Locum-motion, filled out my paper work and was on my way. I had graduated from the University of Hamlin a few weeks earlier, armed with stethoscope and hammer. Dr. Claudio Prince (that’s me) was ready to stamp out disease and save lives.

There were several practice options available, but I chose a small hospital in Bremen. The three doctors who ran the hospital were going on a musical cruise for a week, and I would cover the entire facility for that time—ED and floor. I met with Drs. Baker, Butcher, and Maker briefly before they left for a trip. There were only a few inpatients, and one patient in the ICU. Then they were gone, and I was on my own.

My First Patient: I thought I’d start with the inpatients. The first was a Mr. B.B. Wolfe. He had been admitted for myalgia.

I was shocked when I walked into the room. He had severe hypertrichosis, prominent dentition, and proptosis. I briefly considered porphyria. I noted his history of muscle aches, high fever, facial swelling, and visual disturbance. His admit lab had showed a high CPK and LDH.

It sounded like an infestation of Trichinella to me. I questioned him about the ingestion of raw pork. He looked me in the eye and asked if his answer would be part of his medical record. I told him he needed to tell the truth for me to help him. Finally, he admitted he had eaten several portions of uncooked pig. I began to explain to him about the workup, the need for a muscle biopsy, and treatment options like mebendazole or steroids. I described the intestinal stage, which occurs between two and seven days after ingestion, when encysted larvae are liberated from the meat by gastric juices. I told him how the larvae mature into adult worms that burrow into the intestinal mucosa. I described the muscle stage, which develops after the first week and represents the period when adult-derived larvae in the intestines enter the bloodstream and disseminate hematogenously, then enter skeletal muscle causing pain.

He jumped out of bed and said he was leaving AMA; he had an appointment with a red-hooded girl. Whatever. I let him go; not much I could do to prevent his departure.

In the ED: I got a call from the ED about an old lady who had come in, having nearly choked on a bug. She looked fine to me, and I let her go. While down there, another older woman came in—in active labor. She admitted to having taken her friend’s Clomid, and had had little antepartum care secondary to a dearth of health insurance. Before I knew it, we were in the labor suite. First came one boy, then another, then another. I thought I was done, then two girls, another boy, then another girl. Seven babies—incredible! She moaned, not knowing what she was going to do with all these children.

I headed back to the floor to see more patients. The second one for the day was simple: a scrotal burn on a Mr. J.B. Nimble, who had been injured jumping over a flame. He was ready for discharge. The third patient was interesting, a Mrs. Spratt. I had been called by the lab with word that her serum looked like mayonnaise. She had abdominal pain, hepatosplenomegaly, memory loss, dyspnea and eruptive xanthomas. It sounded like type V hyperlipoproteinemia with chylomicronemia syndrome. What an interesting case, probably worse secondary to her very high-fat diet.

I walked down the hall to see my last inpatient, billed as a young man with psychotic depression pending psychiatric placement. I heard him yelling about burning witches and eating the walls. It sounded pretty psychotic. (I learned that his sister had been arraigned on manslaughter charges.) I entered the room and was struck by the smell of his breath, like cherries. A fruity smell, could he be ketotic? I instantly thought about ethylene glycol toxicity, maybe he had been sipping antifreeze, but there were no oxalate crystals in his urine. Was it delirium? I checked an O2 saturation; 95%, that wasn’t it. His blood pressure was 120/60. How about checking his finger-stick glucose? It read >400. This boy was in DKA! I started an insulin drip and hydration. It was only later I learned he had been on a starvation diet for weeks, then had binged on candy. His story about burning an old woman in a stove was unfortunately true. I called child protective services.

The ED pager went off again. That old lady who had swallowed a bug had ingested another, possibly a spider. I was worried about brown recluse or black widow envenomation, but it seemed to have been a simple barn spider, as she was now feeling OK. Again I discharged her with stern warnings to limit her invertebrate consumption. I stopped by the multiparous patient. She was happy to have the children and that they were all healthy, but what was she going to do? Where would she go? I called a social work consult.

ICU Time: I headed to the ICU. A sad story: a 24-year-old woman was unresponsive. She had a living will and did not want prolonged life support. She had choked on a piece of fruit. I walked into a room crowded with her family; it looked like seven very short uncles—one of whom was a doctor. They watched sadly as I pulled the endotracheal tube and the IVs. I told them I’d give them some time with her alone and would be back in an hour. It was a somber and tearful affair. She was so young and so beautiful. What a tragic end.

Another ED call; this bug-swallowing lady was driving them nuts. Now she was claiming she had swallowed a thrush, or maybe had thrush. Either way, she was gone before I got down there to see her.

I met with the social worker. She was dressed in a fancy gown and said she had just been at a party. She heard the story of the lady who had had so many children. She thought for a moment then said she had a few leads to check and would get back to me later that day.

We had a rush in the ED: a boy I thought might have rhinophyma and stiff-man syndrome, a girl with warts on her lips she attributed to kissing a frog, another with a glass splinter in her foot. There was a Mr. W.W. Winkee with hypothermia, and a young girl named Mary who thought she had contracted anthrax from a sheep. There was a boy named Jackie Horner with a tenosynovitis of the thumb.

The old lady came back in again. Now she was complaining of abdominal distention. When I finally laid eyes on her, I noted she certainly had a large abdomen. I grabbed a quick X-ray. Apparently she had taken my warnings against consuming avian and invertebrate entities, as now she had radiographic evidence of a feline skeleton. I planned to send her to a tertiary-care facility; perhaps they could do an endoscopic cat removal. Whatever they did, I was afraid if she kept this up she was bound to die.

I headed back to the ICU. They had dressed the girl, Miss White, in her street clothes and done her hair and makeup, but nothing could hide her severe pallor. She looked so peaceful.

Her “uncles” expectantly greeted me. They said in unison, “Welcome, Dr. Prince.” They were all inappropriately smiling. What was going on here? I went to declare her dead. I held a mirror up to her face, no signs of breathing, no lung sounds with auscultation. I laid my fingers gently across her throat. No pulse, but her skin was strangely pliant and warm.

I stared at her lovely face and the rest of the world suddenly shut itself off from me. I felt like singing. I could not stop myself … how unprofessional. But I bent over and gently kissed her goodbye. Suddenly there was music playing and—even more strangely—woodland animals frolicking at my feet. The uncles, who turned out to be roommates not relatives (had I known that I would never have stopped life support!), danced merrily. I looked back at her, and her eyes were open. She was smiling and gazing at her future husband, me.

Epilogue: The masticatory old lady eventually died from eating tainted horse meat. Mrs. Sprat improved with a low-fat diet. Mr. Wolfe died in a tragic logging accident, killed by the swing of an ax. The housing issues of the old lady with so many kids she did not know what to do was settled by the social worker, who became the septuplets’ godmother and found them housing in a refurbished, oversize shoe. As for Snow and me, we plan on living happily ever after. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Having finished my family practice residency, and not being tied down by friends or family, I thought a round of working locum tenens would be a good way to see some different styles of practice.

I contacted a company called Locum-motion, filled out my paper work and was on my way. I had graduated from the University of Hamlin a few weeks earlier, armed with stethoscope and hammer. Dr. Claudio Prince (that’s me) was ready to stamp out disease and save lives.

There were several practice options available, but I chose a small hospital in Bremen. The three doctors who ran the hospital were going on a musical cruise for a week, and I would cover the entire facility for that time—ED and floor. I met with Drs. Baker, Butcher, and Maker briefly before they left for a trip. There were only a few inpatients, and one patient in the ICU. Then they were gone, and I was on my own.

My First Patient: I thought I’d start with the inpatients. The first was a Mr. B.B. Wolfe. He had been admitted for myalgia.

I was shocked when I walked into the room. He had severe hypertrichosis, prominent dentition, and proptosis. I briefly considered porphyria. I noted his history of muscle aches, high fever, facial swelling, and visual disturbance. His admit lab had showed a high CPK and LDH.

It sounded like an infestation of Trichinella to me. I questioned him about the ingestion of raw pork. He looked me in the eye and asked if his answer would be part of his medical record. I told him he needed to tell the truth for me to help him. Finally, he admitted he had eaten several portions of uncooked pig. I began to explain to him about the workup, the need for a muscle biopsy, and treatment options like mebendazole or steroids. I described the intestinal stage, which occurs between two and seven days after ingestion, when encysted larvae are liberated from the meat by gastric juices. I told him how the larvae mature into adult worms that burrow into the intestinal mucosa. I described the muscle stage, which develops after the first week and represents the period when adult-derived larvae in the intestines enter the bloodstream and disseminate hematogenously, then enter skeletal muscle causing pain.

He jumped out of bed and said he was leaving AMA; he had an appointment with a red-hooded girl. Whatever. I let him go; not much I could do to prevent his departure.

In the ED: I got a call from the ED about an old lady who had come in, having nearly choked on a bug. She looked fine to me, and I let her go. While down there, another older woman came in—in active labor. She admitted to having taken her friend’s Clomid, and had had little antepartum care secondary to a dearth of health insurance. Before I knew it, we were in the labor suite. First came one boy, then another, then another. I thought I was done, then two girls, another boy, then another girl. Seven babies—incredible! She moaned, not knowing what she was going to do with all these children.

I headed back to the floor to see more patients. The second one for the day was simple: a scrotal burn on a Mr. J.B. Nimble, who had been injured jumping over a flame. He was ready for discharge. The third patient was interesting, a Mrs. Spratt. I had been called by the lab with word that her serum looked like mayonnaise. She had abdominal pain, hepatosplenomegaly, memory loss, dyspnea and eruptive xanthomas. It sounded like type V hyperlipoproteinemia with chylomicronemia syndrome. What an interesting case, probably worse secondary to her very high-fat diet.

I walked down the hall to see my last inpatient, billed as a young man with psychotic depression pending psychiatric placement. I heard him yelling about burning witches and eating the walls. It sounded pretty psychotic. (I learned that his sister had been arraigned on manslaughter charges.) I entered the room and was struck by the smell of his breath, like cherries. A fruity smell, could he be ketotic? I instantly thought about ethylene glycol toxicity, maybe he had been sipping antifreeze, but there were no oxalate crystals in his urine. Was it delirium? I checked an O2 saturation; 95%, that wasn’t it. His blood pressure was 120/60. How about checking his finger-stick glucose? It read >400. This boy was in DKA! I started an insulin drip and hydration. It was only later I learned he had been on a starvation diet for weeks, then had binged on candy. His story about burning an old woman in a stove was unfortunately true. I called child protective services.

The ED pager went off again. That old lady who had swallowed a bug had ingested another, possibly a spider. I was worried about brown recluse or black widow envenomation, but it seemed to have been a simple barn spider, as she was now feeling OK. Again I discharged her with stern warnings to limit her invertebrate consumption. I stopped by the multiparous patient. She was happy to have the children and that they were all healthy, but what was she going to do? Where would she go? I called a social work consult.

ICU Time: I headed to the ICU. A sad story: a 24-year-old woman was unresponsive. She had a living will and did not want prolonged life support. She had choked on a piece of fruit. I walked into a room crowded with her family; it looked like seven very short uncles—one of whom was a doctor. They watched sadly as I pulled the endotracheal tube and the IVs. I told them I’d give them some time with her alone and would be back in an hour. It was a somber and tearful affair. She was so young and so beautiful. What a tragic end.

Another ED call; this bug-swallowing lady was driving them nuts. Now she was claiming she had swallowed a thrush, or maybe had thrush. Either way, she was gone before I got down there to see her.

I met with the social worker. She was dressed in a fancy gown and said she had just been at a party. She heard the story of the lady who had had so many children. She thought for a moment then said she had a few leads to check and would get back to me later that day.

We had a rush in the ED: a boy I thought might have rhinophyma and stiff-man syndrome, a girl with warts on her lips she attributed to kissing a frog, another with a glass splinter in her foot. There was a Mr. W.W. Winkee with hypothermia, and a young girl named Mary who thought she had contracted anthrax from a sheep. There was a boy named Jackie Horner with a tenosynovitis of the thumb.

The old lady came back in again. Now she was complaining of abdominal distention. When I finally laid eyes on her, I noted she certainly had a large abdomen. I grabbed a quick X-ray. Apparently she had taken my warnings against consuming avian and invertebrate entities, as now she had radiographic evidence of a feline skeleton. I planned to send her to a tertiary-care facility; perhaps they could do an endoscopic cat removal. Whatever they did, I was afraid if she kept this up she was bound to die.

I headed back to the ICU. They had dressed the girl, Miss White, in her street clothes and done her hair and makeup, but nothing could hide her severe pallor. She looked so peaceful.

Her “uncles” expectantly greeted me. They said in unison, “Welcome, Dr. Prince.” They were all inappropriately smiling. What was going on here? I went to declare her dead. I held a mirror up to her face, no signs of breathing, no lung sounds with auscultation. I laid my fingers gently across her throat. No pulse, but her skin was strangely pliant and warm.

I stared at her lovely face and the rest of the world suddenly shut itself off from me. I felt like singing. I could not stop myself … how unprofessional. But I bent over and gently kissed her goodbye. Suddenly there was music playing and—even more strangely—woodland animals frolicking at my feet. The uncles, who turned out to be roommates not relatives (had I known that I would never have stopped life support!), danced merrily. I looked back at her, and her eyes were open. She was smiling and gazing at her future husband, me.

Epilogue: The masticatory old lady eventually died from eating tainted horse meat. Mrs. Sprat improved with a low-fat diet. Mr. Wolfe died in a tragic logging accident, killed by the swing of an ax. The housing issues of the old lady with so many kids she did not know what to do was settled by the social worker, who became the septuplets’ godmother and found them housing in a refurbished, oversize shoe. As for Snow and me, we plan on living happily ever after. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Having finished my family practice residency, and not being tied down by friends or family, I thought a round of working locum tenens would be a good way to see some different styles of practice.

I contacted a company called Locum-motion, filled out my paper work and was on my way. I had graduated from the University of Hamlin a few weeks earlier, armed with stethoscope and hammer. Dr. Claudio Prince (that’s me) was ready to stamp out disease and save lives.

There were several practice options available, but I chose a small hospital in Bremen. The three doctors who ran the hospital were going on a musical cruise for a week, and I would cover the entire facility for that time—ED and floor. I met with Drs. Baker, Butcher, and Maker briefly before they left for a trip. There were only a few inpatients, and one patient in the ICU. Then they were gone, and I was on my own.

My First Patient: I thought I’d start with the inpatients. The first was a Mr. B.B. Wolfe. He had been admitted for myalgia.

I was shocked when I walked into the room. He had severe hypertrichosis, prominent dentition, and proptosis. I briefly considered porphyria. I noted his history of muscle aches, high fever, facial swelling, and visual disturbance. His admit lab had showed a high CPK and LDH.

It sounded like an infestation of Trichinella to me. I questioned him about the ingestion of raw pork. He looked me in the eye and asked if his answer would be part of his medical record. I told him he needed to tell the truth for me to help him. Finally, he admitted he had eaten several portions of uncooked pig. I began to explain to him about the workup, the need for a muscle biopsy, and treatment options like mebendazole or steroids. I described the intestinal stage, which occurs between two and seven days after ingestion, when encysted larvae are liberated from the meat by gastric juices. I told him how the larvae mature into adult worms that burrow into the intestinal mucosa. I described the muscle stage, which develops after the first week and represents the period when adult-derived larvae in the intestines enter the bloodstream and disseminate hematogenously, then enter skeletal muscle causing pain.

He jumped out of bed and said he was leaving AMA; he had an appointment with a red-hooded girl. Whatever. I let him go; not much I could do to prevent his departure.

In the ED: I got a call from the ED about an old lady who had come in, having nearly choked on a bug. She looked fine to me, and I let her go. While down there, another older woman came in—in active labor. She admitted to having taken her friend’s Clomid, and had had little antepartum care secondary to a dearth of health insurance. Before I knew it, we were in the labor suite. First came one boy, then another, then another. I thought I was done, then two girls, another boy, then another girl. Seven babies—incredible! She moaned, not knowing what she was going to do with all these children.

I headed back to the floor to see more patients. The second one for the day was simple: a scrotal burn on a Mr. J.B. Nimble, who had been injured jumping over a flame. He was ready for discharge. The third patient was interesting, a Mrs. Spratt. I had been called by the lab with word that her serum looked like mayonnaise. She had abdominal pain, hepatosplenomegaly, memory loss, dyspnea and eruptive xanthomas. It sounded like type V hyperlipoproteinemia with chylomicronemia syndrome. What an interesting case, probably worse secondary to her very high-fat diet.

I walked down the hall to see my last inpatient, billed as a young man with psychotic depression pending psychiatric placement. I heard him yelling about burning witches and eating the walls. It sounded pretty psychotic. (I learned that his sister had been arraigned on manslaughter charges.) I entered the room and was struck by the smell of his breath, like cherries. A fruity smell, could he be ketotic? I instantly thought about ethylene glycol toxicity, maybe he had been sipping antifreeze, but there were no oxalate crystals in his urine. Was it delirium? I checked an O2 saturation; 95%, that wasn’t it. His blood pressure was 120/60. How about checking his finger-stick glucose? It read >400. This boy was in DKA! I started an insulin drip and hydration. It was only later I learned he had been on a starvation diet for weeks, then had binged on candy. His story about burning an old woman in a stove was unfortunately true. I called child protective services.

The ED pager went off again. That old lady who had swallowed a bug had ingested another, possibly a spider. I was worried about brown recluse or black widow envenomation, but it seemed to have been a simple barn spider, as she was now feeling OK. Again I discharged her with stern warnings to limit her invertebrate consumption. I stopped by the multiparous patient. She was happy to have the children and that they were all healthy, but what was she going to do? Where would she go? I called a social work consult.

ICU Time: I headed to the ICU. A sad story: a 24-year-old woman was unresponsive. She had a living will and did not want prolonged life support. She had choked on a piece of fruit. I walked into a room crowded with her family; it looked like seven very short uncles—one of whom was a doctor. They watched sadly as I pulled the endotracheal tube and the IVs. I told them I’d give them some time with her alone and would be back in an hour. It was a somber and tearful affair. She was so young and so beautiful. What a tragic end.

Another ED call; this bug-swallowing lady was driving them nuts. Now she was claiming she had swallowed a thrush, or maybe had thrush. Either way, she was gone before I got down there to see her.

I met with the social worker. She was dressed in a fancy gown and said she had just been at a party. She heard the story of the lady who had had so many children. She thought for a moment then said she had a few leads to check and would get back to me later that day.

We had a rush in the ED: a boy I thought might have rhinophyma and stiff-man syndrome, a girl with warts on her lips she attributed to kissing a frog, another with a glass splinter in her foot. There was a Mr. W.W. Winkee with hypothermia, and a young girl named Mary who thought she had contracted anthrax from a sheep. There was a boy named Jackie Horner with a tenosynovitis of the thumb.

The old lady came back in again. Now she was complaining of abdominal distention. When I finally laid eyes on her, I noted she certainly had a large abdomen. I grabbed a quick X-ray. Apparently she had taken my warnings against consuming avian and invertebrate entities, as now she had radiographic evidence of a feline skeleton. I planned to send her to a tertiary-care facility; perhaps they could do an endoscopic cat removal. Whatever they did, I was afraid if she kept this up she was bound to die.

I headed back to the ICU. They had dressed the girl, Miss White, in her street clothes and done her hair and makeup, but nothing could hide her severe pallor. She looked so peaceful.

Her “uncles” expectantly greeted me. They said in unison, “Welcome, Dr. Prince.” They were all inappropriately smiling. What was going on here? I went to declare her dead. I held a mirror up to her face, no signs of breathing, no lung sounds with auscultation. I laid my fingers gently across her throat. No pulse, but her skin was strangely pliant and warm.

I stared at her lovely face and the rest of the world suddenly shut itself off from me. I felt like singing. I could not stop myself … how unprofessional. But I bent over and gently kissed her goodbye. Suddenly there was music playing and—even more strangely—woodland animals frolicking at my feet. The uncles, who turned out to be roommates not relatives (had I known that I would never have stopped life support!), danced merrily. I looked back at her, and her eyes were open. She was smiling and gazing at her future husband, me.

Epilogue: The masticatory old lady eventually died from eating tainted horse meat. Mrs. Sprat improved with a low-fat diet. Mr. Wolfe died in a tragic logging accident, killed by the swing of an ax. The housing issues of the old lady with so many kids she did not know what to do was settled by the social worker, who became the septuplets’ godmother and found them housing in a refurbished, oversize shoe. As for Snow and me, we plan on living happily ever after. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It’s snowing outside, and the logs are burning in the fireplace. It’s a February blizzard. By the time you read this I’ll be thawed. I guess you know I’m not in San Diego. Despite Rochester’s well-earned reputation as the sizzling hot spot of the Minnesota-Iowa border, it seems like a cool night to think about renting some movies. But what are the best movies for a hospitalist? What are the absolute clunkers? Here are some suggestions.

“The Hospital” (1971)

This is my number one choice, no doubt about it. If you trained in New York City, it’s a bonus. This is a strange, dark comedy starring George C. Scott. His most famous, Oscar-winning role was in “Patton,” but I loved him in this medically titled-but-distinctly-different-from-“Dr. Strangelove” movie. In this flick, he plays the suicidal, alcoholic chief of internal medicine in a dysfunctional, deteriorating New York teaching hospital. On the edge of self-destruction, he meets the alluring yet bizarre Diana Rigg.

If you are at least as old as me—over 25, that is—you might remember her as Mrs. Emma Peel of the Avengers, the proto-feminist kickboxing genius in a leather body suit. Together, they try to solve a mystery involving unexpected deaths, in an atmosphere of abuse, lack of professionalism, and general mayhem. The Joint Commission would have a field day in this facility. See this movie with your hospital’s safety officer!

“No Way Out” (1950)

Next on my list is a movie that glorifies the doctor and his oath but still explores the politics of hospitals and race relations. This is another of my absolute favorite medical movies. It is Sidney Poitier’s first film. He plays the intern taking care of Richard Widmark and his brother—both of whom are rabid racists. When the brother dies following a lumbar puncture, a chain of events is set off that plunges the city into a race riot. Can Dr. Brooks clear his name by getting an autopsy before Ray Biddle hunts him down? This is a great movie to watch with a group of students—a conversation starter.

“Panic in the Streets” (1950)

Yup, it’s 1950 and Richard Widmark again. This time, he’s a public health officer who uncovers a case of plague in a very noir film-noir New Orleans. He must catch a killer who has been exposed to plague. The villain turns out to be Walter “Jack” Palance in his first movie. Watch Dr. Clint Reed chase Blackie through some scenes of New Orleans you won’t forget. Then play poker.

“Mother, Jugs & Speed” (1976)

Oh my, what is this doing on my list? I must be slipping. Bill Cosby and Raquel Welch star (guess which one is Jugs). Any movie with Dick Butkus and Larry Hagman in it can’t be all bad, can it? Yes, it can. Crazed ambulance drivers tear up the streets of L.A. when a new law decrees that whoever gets to the accident first gets the transport. Who says competition in the medical world isn’t good? This is just a modified version of pay for performance; too bad that, in this case (again), the performances are terrible!

“Fantastic Voyage” (1966)

I can’t stop thinking about Raquel Welch. In this movie she is a decade younger, an earnest young medical researcher who gets attacked by leukocytes. Watching her ultra-tight dive suit get covered in giant plastic antibodies almost made me want to go into immunology. The crew gets shrunk and injected into a diplomat’s body to dissolve a clot in his brain. Too bad they didn’t have tissue plasminogen activator (TPA). “The Simpsons” did a cover on this one that’s worth checking out.

“The Island of Lost Souls” (1933)

Watch this one with your favorite geneticist. In remakes, it’s called “The Island of Dr. Moreau,” the name of the book this movie was adapted from. Charles Laughton—the quintessential Quasimodo—creates beings that are half man/half beast, with the help of Bela Lugosi (sans pointy teeth and bats) and “the panther woman.” Her name is Lola. I think Dr. Moreau may have met her in a club down in old Soho. I guess you’ll have to drink champagne that tastes just like Coca-Cola with this one. Sorry, I couldn’t help myself.

“Le Roi de Coeur” (King of Hearts) (1966)

Many people consider this their favorite movie. Most of them went to college on the East Coast in the early 1980s and didn’t go home alone the night they saw this one. It involves some kind of operant conditioning. I just saw this movie again last week for the first time in 25 years, and I wasn’t disappointed. A Scottish ornithologist is taken for a bomb expert, and the denizens of a psychiatric hospital take over a small French town. It’s a love story and an anti-war movie. Watch this one with someone you love—or want to.

“The Cabinet of Dr. Caligari” (1920)

My sister Roberta told me about this one, so I knew it would be freaky. The first horror movie ever made, it’s a silent film. One of my favorite things about this film is its expressionist sets. It’s a must see for film buffs, but not one to watch with the kids. If you want to see another of my sister’s horror picks, try “Dead Ringers” (1988)—it’s about twin homicidal gynecologists. Not for the faint of heart.

“Flatliners” (1990)

Kiefer Sutherland, Kevin Bacon, Julia Roberts—yeah, that sounds like my medical school class. Actually, my class was more John Cleese, Marty Feldman, and Ruth Buzzi. In this film, medical students put themselves into cardiac arrest and then resuscitate one another at the last minute.

“M*A*S*H” (1970)

Still one of my favorites, and I loved the book even more. Anti-war, anti-bureaucracy, hilarious. Donald Sutherland and Elliott Gould are excellent as Hawkeye and Trapper John, and Sally Kellerman is the best Hot Lips. This is somewhat different from the series and is worth watching.

There are so many other movies I have enjoyed. There are Gregory Peck in “Captain Newman, MD” and Robin Williams in “Awakenings.” I even like Patrick Swayze in “City of Joy.” Also worth mentioning: “And the Band Played On,” “Coma,” “The Cider House Rules,” “The Unbearable Lightness of Being,” and “The Elephant Man.”

There are dozens more; some are great depictions of medicine, and some are total trash. Got a favorite I didn’t list? Send the name and a paragraph about why you like it to me at newman.james@mayo.edu.

OK, I need to get out more. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It’s snowing outside, and the logs are burning in the fireplace. It’s a February blizzard. By the time you read this I’ll be thawed. I guess you know I’m not in San Diego. Despite Rochester’s well-earned reputation as the sizzling hot spot of the Minnesota-Iowa border, it seems like a cool night to think about renting some movies. But what are the best movies for a hospitalist? What are the absolute clunkers? Here are some suggestions.

“The Hospital” (1971)

This is my number one choice, no doubt about it. If you trained in New York City, it’s a bonus. This is a strange, dark comedy starring George C. Scott. His most famous, Oscar-winning role was in “Patton,” but I loved him in this medically titled-but-distinctly-different-from-“Dr. Strangelove” movie. In this flick, he plays the suicidal, alcoholic chief of internal medicine in a dysfunctional, deteriorating New York teaching hospital. On the edge of self-destruction, he meets the alluring yet bizarre Diana Rigg.

If you are at least as old as me—over 25, that is—you might remember her as Mrs. Emma Peel of the Avengers, the proto-feminist kickboxing genius in a leather body suit. Together, they try to solve a mystery involving unexpected deaths, in an atmosphere of abuse, lack of professionalism, and general mayhem. The Joint Commission would have a field day in this facility. See this movie with your hospital’s safety officer!

“No Way Out” (1950)

Next on my list is a movie that glorifies the doctor and his oath but still explores the politics of hospitals and race relations. This is another of my absolute favorite medical movies. It is Sidney Poitier’s first film. He plays the intern taking care of Richard Widmark and his brother—both of whom are rabid racists. When the brother dies following a lumbar puncture, a chain of events is set off that plunges the city into a race riot. Can Dr. Brooks clear his name by getting an autopsy before Ray Biddle hunts him down? This is a great movie to watch with a group of students—a conversation starter.

“Panic in the Streets” (1950)

Yup, it’s 1950 and Richard Widmark again. This time, he’s a public health officer who uncovers a case of plague in a very noir film-noir New Orleans. He must catch a killer who has been exposed to plague. The villain turns out to be Walter “Jack” Palance in his first movie. Watch Dr. Clint Reed chase Blackie through some scenes of New Orleans you won’t forget. Then play poker.

“Mother, Jugs & Speed” (1976)

Oh my, what is this doing on my list? I must be slipping. Bill Cosby and Raquel Welch star (guess which one is Jugs). Any movie with Dick Butkus and Larry Hagman in it can’t be all bad, can it? Yes, it can. Crazed ambulance drivers tear up the streets of L.A. when a new law decrees that whoever gets to the accident first gets the transport. Who says competition in the medical world isn’t good? This is just a modified version of pay for performance; too bad that, in this case (again), the performances are terrible!

“Fantastic Voyage” (1966)

I can’t stop thinking about Raquel Welch. In this movie she is a decade younger, an earnest young medical researcher who gets attacked by leukocytes. Watching her ultra-tight dive suit get covered in giant plastic antibodies almost made me want to go into immunology. The crew gets shrunk and injected into a diplomat’s body to dissolve a clot in his brain. Too bad they didn’t have tissue plasminogen activator (TPA). “The Simpsons” did a cover on this one that’s worth checking out.

“The Island of Lost Souls” (1933)

Watch this one with your favorite geneticist. In remakes, it’s called “The Island of Dr. Moreau,” the name of the book this movie was adapted from. Charles Laughton—the quintessential Quasimodo—creates beings that are half man/half beast, with the help of Bela Lugosi (sans pointy teeth and bats) and “the panther woman.” Her name is Lola. I think Dr. Moreau may have met her in a club down in old Soho. I guess you’ll have to drink champagne that tastes just like Coca-Cola with this one. Sorry, I couldn’t help myself.

“Le Roi de Coeur” (King of Hearts) (1966)

Many people consider this their favorite movie. Most of them went to college on the East Coast in the early 1980s and didn’t go home alone the night they saw this one. It involves some kind of operant conditioning. I just saw this movie again last week for the first time in 25 years, and I wasn’t disappointed. A Scottish ornithologist is taken for a bomb expert, and the denizens of a psychiatric hospital take over a small French town. It’s a love story and an anti-war movie. Watch this one with someone you love—or want to.

“The Cabinet of Dr. Caligari” (1920)

My sister Roberta told me about this one, so I knew it would be freaky. The first horror movie ever made, it’s a silent film. One of my favorite things about this film is its expressionist sets. It’s a must see for film buffs, but not one to watch with the kids. If you want to see another of my sister’s horror picks, try “Dead Ringers” (1988)—it’s about twin homicidal gynecologists. Not for the faint of heart.

“Flatliners” (1990)

Kiefer Sutherland, Kevin Bacon, Julia Roberts—yeah, that sounds like my medical school class. Actually, my class was more John Cleese, Marty Feldman, and Ruth Buzzi. In this film, medical students put themselves into cardiac arrest and then resuscitate one another at the last minute.

“M*A*S*H” (1970)

Still one of my favorites, and I loved the book even more. Anti-war, anti-bureaucracy, hilarious. Donald Sutherland and Elliott Gould are excellent as Hawkeye and Trapper John, and Sally Kellerman is the best Hot Lips. This is somewhat different from the series and is worth watching.

There are so many other movies I have enjoyed. There are Gregory Peck in “Captain Newman, MD” and Robin Williams in “Awakenings.” I even like Patrick Swayze in “City of Joy.” Also worth mentioning: “And the Band Played On,” “Coma,” “The Cider House Rules,” “The Unbearable Lightness of Being,” and “The Elephant Man.”

There are dozens more; some are great depictions of medicine, and some are total trash. Got a favorite I didn’t list? Send the name and a paragraph about why you like it to me at newman.james@mayo.edu.

OK, I need to get out more. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It’s snowing outside, and the logs are burning in the fireplace. It’s a February blizzard. By the time you read this I’ll be thawed. I guess you know I’m not in San Diego. Despite Rochester’s well-earned reputation as the sizzling hot spot of the Minnesota-Iowa border, it seems like a cool night to think about renting some movies. But what are the best movies for a hospitalist? What are the absolute clunkers? Here are some suggestions.

“The Hospital” (1971)

This is my number one choice, no doubt about it. If you trained in New York City, it’s a bonus. This is a strange, dark comedy starring George C. Scott. His most famous, Oscar-winning role was in “Patton,” but I loved him in this medically titled-but-distinctly-different-from-“Dr. Strangelove” movie. In this flick, he plays the suicidal, alcoholic chief of internal medicine in a dysfunctional, deteriorating New York teaching hospital. On the edge of self-destruction, he meets the alluring yet bizarre Diana Rigg.

If you are at least as old as me—over 25, that is—you might remember her as Mrs. Emma Peel of the Avengers, the proto-feminist kickboxing genius in a leather body suit. Together, they try to solve a mystery involving unexpected deaths, in an atmosphere of abuse, lack of professionalism, and general mayhem. The Joint Commission would have a field day in this facility. See this movie with your hospital’s safety officer!

“No Way Out” (1950)

Next on my list is a movie that glorifies the doctor and his oath but still explores the politics of hospitals and race relations. This is another of my absolute favorite medical movies. It is Sidney Poitier’s first film. He plays the intern taking care of Richard Widmark and his brother—both of whom are rabid racists. When the brother dies following a lumbar puncture, a chain of events is set off that plunges the city into a race riot. Can Dr. Brooks clear his name by getting an autopsy before Ray Biddle hunts him down? This is a great movie to watch with a group of students—a conversation starter.

“Panic in the Streets” (1950)

Yup, it’s 1950 and Richard Widmark again. This time, he’s a public health officer who uncovers a case of plague in a very noir film-noir New Orleans. He must catch a killer who has been exposed to plague. The villain turns out to be Walter “Jack” Palance in his first movie. Watch Dr. Clint Reed chase Blackie through some scenes of New Orleans you won’t forget. Then play poker.

“Mother, Jugs & Speed” (1976)

Oh my, what is this doing on my list? I must be slipping. Bill Cosby and Raquel Welch star (guess which one is Jugs). Any movie with Dick Butkus and Larry Hagman in it can’t be all bad, can it? Yes, it can. Crazed ambulance drivers tear up the streets of L.A. when a new law decrees that whoever gets to the accident first gets the transport. Who says competition in the medical world isn’t good? This is just a modified version of pay for performance; too bad that, in this case (again), the performances are terrible!

“Fantastic Voyage” (1966)

I can’t stop thinking about Raquel Welch. In this movie she is a decade younger, an earnest young medical researcher who gets attacked by leukocytes. Watching her ultra-tight dive suit get covered in giant plastic antibodies almost made me want to go into immunology. The crew gets shrunk and injected into a diplomat’s body to dissolve a clot in his brain. Too bad they didn’t have tissue plasminogen activator (TPA). “The Simpsons” did a cover on this one that’s worth checking out.

“The Island of Lost Souls” (1933)

Watch this one with your favorite geneticist. In remakes, it’s called “The Island of Dr. Moreau,” the name of the book this movie was adapted from. Charles Laughton—the quintessential Quasimodo—creates beings that are half man/half beast, with the help of Bela Lugosi (sans pointy teeth and bats) and “the panther woman.” Her name is Lola. I think Dr. Moreau may have met her in a club down in old Soho. I guess you’ll have to drink champagne that tastes just like Coca-Cola with this one. Sorry, I couldn’t help myself.

“Le Roi de Coeur” (King of Hearts) (1966)

Many people consider this their favorite movie. Most of them went to college on the East Coast in the early 1980s and didn’t go home alone the night they saw this one. It involves some kind of operant conditioning. I just saw this movie again last week for the first time in 25 years, and I wasn’t disappointed. A Scottish ornithologist is taken for a bomb expert, and the denizens of a psychiatric hospital take over a small French town. It’s a love story and an anti-war movie. Watch this one with someone you love—or want to.

“The Cabinet of Dr. Caligari” (1920)

My sister Roberta told me about this one, so I knew it would be freaky. The first horror movie ever made, it’s a silent film. One of my favorite things about this film is its expressionist sets. It’s a must see for film buffs, but not one to watch with the kids. If you want to see another of my sister’s horror picks, try “Dead Ringers” (1988)—it’s about twin homicidal gynecologists. Not for the faint of heart.

“Flatliners” (1990)

Kiefer Sutherland, Kevin Bacon, Julia Roberts—yeah, that sounds like my medical school class. Actually, my class was more John Cleese, Marty Feldman, and Ruth Buzzi. In this film, medical students put themselves into cardiac arrest and then resuscitate one another at the last minute.

“M*A*S*H” (1970)

Still one of my favorites, and I loved the book even more. Anti-war, anti-bureaucracy, hilarious. Donald Sutherland and Elliott Gould are excellent as Hawkeye and Trapper John, and Sally Kellerman is the best Hot Lips. This is somewhat different from the series and is worth watching.

There are so many other movies I have enjoyed. There are Gregory Peck in “Captain Newman, MD” and Robin Williams in “Awakenings.” I even like Patrick Swayze in “City of Joy.” Also worth mentioning: “And the Band Played On,” “Coma,” “The Cider House Rules,” “The Unbearable Lightness of Being,” and “The Elephant Man.”

There are dozens more; some are great depictions of medicine, and some are total trash. Got a favorite I didn’t list? Send the name and a paragraph about why you like it to me at newman.james@mayo.edu.

OK, I need to get out more. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

My father was a god; my grandfather was a god. My aunt killed my mother, and my grandfather plans on killing me. I guess you might call us a dysfunctional family. Some people also say I am a god, but I don’t see it that way. There’s no accounting for what people believe in. The ancient Greeks and Romans liked to make up stories about me; sometimes even I am not sure what is truth and what is fiction. I thought I’d take this chance to tell you about myself. If you are a modern-day proponent of the healing arts, perhaps you will find this of interest.

Dear Old Dad

My father was Apollo, son of Jupiter. He wasn’t a great dad; he was more interested in his godly duties and romantic liaisons than in my upbringing. My mother was a nymph named Coronis. I never met her. She was obviously beautiful and alluring; it’s a nymph thing. She met Apollo, and they spent many happy days in the olive groves. I was conceived on a beautiful hillside above the Aegean Sea.

Apollo soon lost interest in Coronis; he was busy with the family business: causing plagues, driving the chariot of fire across the sky, and so on. Coronis discovered she was pregnant and met a heroic mortal, Ischys; together, they tried to start a new life. There was no way Apollo was going to go along with this. No one leaves a god; it’s supposed to be the other way around. Apollo killed the mortal Ischys and had his sister Diana shoot an arrow into Coronis’ heart. As my mother’s body burned on a funeral pyre, Apollo had a fit of remorse and cut me from my mother’s womb—the first of what would eventually be called cesarean sections. Welcome to my life.

The Early Years

My home was on Mount Pelion. Chiron, a centaur, was my nanny and mentor. He was an expert hunter and was well versed in medicine and music. He was always horsing around. His daughter, Ocyrhoe, prophesied that I would become a great healer; with my heritage, it seemed a safe bet. When Chiron died, years later, Jupiter placed him in the sky; you might recognize him as Sagittarius. One day, millennia later, a company would take his name and would have trouble making influenza vaccine. I grew up under his tutelage and, in time, became an adequate healer myself.

The Wife and Kids

When I grew older, it was time to take a wife. I found a woman with an interest in botanicals. Her name was Epione. We had many children together, but things eroded in our relationship after that. It might have been a postpartum thing, or maybe I spent too much time at work. I’ll never know. She became more interested in soporifics—mandrake especially. She started spending a lot of time in her cave. She and Bacchus were always sitting around our home partying and listening to Pluto’s underworld band, The Dead, and enjoying their favorite song, “The Deadly Nightshade.”

I did pretty well with my children; they all went into the family healing business. My first daughter was named Hygeia. She was always by my side and a great help in my practice. She specialized in preventing disease. My second daughter was Panacea. She was pretty good with a cure and was always in high demand. She started hanging around with some chick named Placebo. Her name in Latin means “I will please,” and she always did. Two of my sons, Machaon and Podalirius, became naval surgeons; one was wounded at Troy but survived. My third son, Telosophorus, was born a dwarf and specialized in rehabilitation.

Things Take a Turn for the Worse

Life was going pretty well until I was lured into the shadowy realms of life and death. I had always believed that if the gods decided a patient was to get better, then I must use my skill to aid in this endeavor. If the Fates had decreed a patient was to die, there was little I could do against the will of the gods. Then events occurred that would enable me to take things to a whole new level, and—once again—it was because of sex.

Theseus was the king of Athens. He became king when his father committed suicide, thinking wrongly that Theseus was dead. This was not an auspicious start for a ruler. When Theseus’ first wife died, he married the princess Phaedra, daughter of the Cretan King Minos—a truly freaky chick. Theseus had a grown son, Hippolytus, who had rugged good looks and a bright future, a real stud. Phaedra decided Hippolytus would be a better husband for her than his father, but Hippolytus spurned her advances. Phaedra, in her wrath, turned Theseus against his son. Theseus used his own godly contacts and convinced Neptune to deal with Hippolytus. While Hippolytus was driving a chariot along a coastal road, Neptune set a sea monster to rise up from the ocean, scaring Theseus’ horse, which led to a fatal crash.

The goddess Diana, my aunt, came to me and taught me the secret to reviving the dead. Don’t expect me to share it with you. No “see one, do one, teach one” from me. I’ll just say it involves very small thunderbolts. I would have been better off without the knowledge. Using the new technique, I revived Hippolytus, who spent the rest of his days in Italy with a water nymph named Egeria. Not a bad afterlife. My trouble, on the other hand, had just begun. Pluto, god of the underworld, was furious. He thought no man should remove the dead from his realm. It was a classic turf battle, and I lost. Jupiter, my grandfather, was forced to put me to death with a thunderbolt.

Life after Death

My name lived on. The earliest places of healing were temples of Aesculapius; the Iatros, who worked there, were the earliest physicians. Yes, they did make me a god, but it’s not like I could stop them. On the island of Kós, my thousandth grandson was named Hippocrates—you may have heard of him. Another of my descendants, Galen, trained at my temple in Pergamon.

It’s been a few thousand years since all of this happened. Don’t ask how you can be reading my words—it’s a mythology thing. Things did not go well for Apollo after I died. When he heard I had been killed, my father lost his temper and took out his wrath on the cyclops who had made Jupiter’s thunderbolts on Mount Aetna. His punishment for that temper tantrum was to serve a mortal, Admetus, for a year. Admetus fell ill; near death, he convinced Apollo to appeal to the Fates. They agreed that someone would take his place. Nobody in the kingdom volunteered for this duty, not even his elderly parents. Finally his wife Alcestis volunteered, and her fate was set. When Death came for her, Hercules, who was passing through, seized Death and would not let him go until she was spared.

Lessons from the Past

You, the modern hospitalist, may read this tale and wonder what it has to do with modern-day medicine and why it is in this publication. Perhaps the Fates have had their way with the medical editor—hence this topic in this publication. Some parts of the tale are of etymological interest: Panacea, Hygeia, Iatros, Aesculapius, Chiron, and Aetna, to name a few. The bigger issue is the question of how your medical forefathers looked at life and death. Perhaps a patient might be healed, but if not, it was the gods’ will. Death was not easily cheated. Ademetus was saved by his wife’s sacrifice; she was willing to donate her life for his. There is something in this tale about futile resuscitation as well. And of course, the most important message: It never pays to get involved in sex or politics. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

My father was a god; my grandfather was a god. My aunt killed my mother, and my grandfather plans on killing me. I guess you might call us a dysfunctional family. Some people also say I am a god, but I don’t see it that way. There’s no accounting for what people believe in. The ancient Greeks and Romans liked to make up stories about me; sometimes even I am not sure what is truth and what is fiction. I thought I’d take this chance to tell you about myself. If you are a modern-day proponent of the healing arts, perhaps you will find this of interest.

Dear Old Dad

My father was Apollo, son of Jupiter. He wasn’t a great dad; he was more interested in his godly duties and romantic liaisons than in my upbringing. My mother was a nymph named Coronis. I never met her. She was obviously beautiful and alluring; it’s a nymph thing. She met Apollo, and they spent many happy days in the olive groves. I was conceived on a beautiful hillside above the Aegean Sea.

Apollo soon lost interest in Coronis; he was busy with the family business: causing plagues, driving the chariot of fire across the sky, and so on. Coronis discovered she was pregnant and met a heroic mortal, Ischys; together, they tried to start a new life. There was no way Apollo was going to go along with this. No one leaves a god; it’s supposed to be the other way around. Apollo killed the mortal Ischys and had his sister Diana shoot an arrow into Coronis’ heart. As my mother’s body burned on a funeral pyre, Apollo had a fit of remorse and cut me from my mother’s womb—the first of what would eventually be called cesarean sections. Welcome to my life.

The Early Years

My home was on Mount Pelion. Chiron, a centaur, was my nanny and mentor. He was an expert hunter and was well versed in medicine and music. He was always horsing around. His daughter, Ocyrhoe, prophesied that I would become a great healer; with my heritage, it seemed a safe bet. When Chiron died, years later, Jupiter placed him in the sky; you might recognize him as Sagittarius. One day, millennia later, a company would take his name and would have trouble making influenza vaccine. I grew up under his tutelage and, in time, became an adequate healer myself.

The Wife and Kids

When I grew older, it was time to take a wife. I found a woman with an interest in botanicals. Her name was Epione. We had many children together, but things eroded in our relationship after that. It might have been a postpartum thing, or maybe I spent too much time at work. I’ll never know. She became more interested in soporifics—mandrake especially. She started spending a lot of time in her cave. She and Bacchus were always sitting around our home partying and listening to Pluto’s underworld band, The Dead, and enjoying their favorite song, “The Deadly Nightshade.”

I did pretty well with my children; they all went into the family healing business. My first daughter was named Hygeia. She was always by my side and a great help in my practice. She specialized in preventing disease. My second daughter was Panacea. She was pretty good with a cure and was always in high demand. She started hanging around with some chick named Placebo. Her name in Latin means “I will please,” and she always did. Two of my sons, Machaon and Podalirius, became naval surgeons; one was wounded at Troy but survived. My third son, Telosophorus, was born a dwarf and specialized in rehabilitation.

Things Take a Turn for the Worse

Life was going pretty well until I was lured into the shadowy realms of life and death. I had always believed that if the gods decided a patient was to get better, then I must use my skill to aid in this endeavor. If the Fates had decreed a patient was to die, there was little I could do against the will of the gods. Then events occurred that would enable me to take things to a whole new level, and—once again—it was because of sex.

Theseus was the king of Athens. He became king when his father committed suicide, thinking wrongly that Theseus was dead. This was not an auspicious start for a ruler. When Theseus’ first wife died, he married the princess Phaedra, daughter of the Cretan King Minos—a truly freaky chick. Theseus had a grown son, Hippolytus, who had rugged good looks and a bright future, a real stud. Phaedra decided Hippolytus would be a better husband for her than his father, but Hippolytus spurned her advances. Phaedra, in her wrath, turned Theseus against his son. Theseus used his own godly contacts and convinced Neptune to deal with Hippolytus. While Hippolytus was driving a chariot along a coastal road, Neptune set a sea monster to rise up from the ocean, scaring Theseus’ horse, which led to a fatal crash.

The goddess Diana, my aunt, came to me and taught me the secret to reviving the dead. Don’t expect me to share it with you. No “see one, do one, teach one” from me. I’ll just say it involves very small thunderbolts. I would have been better off without the knowledge. Using the new technique, I revived Hippolytus, who spent the rest of his days in Italy with a water nymph named Egeria. Not a bad afterlife. My trouble, on the other hand, had just begun. Pluto, god of the underworld, was furious. He thought no man should remove the dead from his realm. It was a classic turf battle, and I lost. Jupiter, my grandfather, was forced to put me to death with a thunderbolt.

Life after Death

My name lived on. The earliest places of healing were temples of Aesculapius; the Iatros, who worked there, were the earliest physicians. Yes, they did make me a god, but it’s not like I could stop them. On the island of Kós, my thousandth grandson was named Hippocrates—you may have heard of him. Another of my descendants, Galen, trained at my temple in Pergamon.

It’s been a few thousand years since all of this happened. Don’t ask how you can be reading my words—it’s a mythology thing. Things did not go well for Apollo after I died. When he heard I had been killed, my father lost his temper and took out his wrath on the cyclops who had made Jupiter’s thunderbolts on Mount Aetna. His punishment for that temper tantrum was to serve a mortal, Admetus, for a year. Admetus fell ill; near death, he convinced Apollo to appeal to the Fates. They agreed that someone would take his place. Nobody in the kingdom volunteered for this duty, not even his elderly parents. Finally his wife Alcestis volunteered, and her fate was set. When Death came for her, Hercules, who was passing through, seized Death and would not let him go until she was spared.

Lessons from the Past

You, the modern hospitalist, may read this tale and wonder what it has to do with modern-day medicine and why it is in this publication. Perhaps the Fates have had their way with the medical editor—hence this topic in this publication. Some parts of the tale are of etymological interest: Panacea, Hygeia, Iatros, Aesculapius, Chiron, and Aetna, to name a few. The bigger issue is the question of how your medical forefathers looked at life and death. Perhaps a patient might be healed, but if not, it was the gods’ will. Death was not easily cheated. Ademetus was saved by his wife’s sacrifice; she was willing to donate her life for his. There is something in this tale about futile resuscitation as well. And of course, the most important message: It never pays to get involved in sex or politics. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

My father was a god; my grandfather was a god. My aunt killed my mother, and my grandfather plans on killing me. I guess you might call us a dysfunctional family. Some people also say I am a god, but I don’t see it that way. There’s no accounting for what people believe in. The ancient Greeks and Romans liked to make up stories about me; sometimes even I am not sure what is truth and what is fiction. I thought I’d take this chance to tell you about myself. If you are a modern-day proponent of the healing arts, perhaps you will find this of interest.

Dear Old Dad

My father was Apollo, son of Jupiter. He wasn’t a great dad; he was more interested in his godly duties and romantic liaisons than in my upbringing. My mother was a nymph named Coronis. I never met her. She was obviously beautiful and alluring; it’s a nymph thing. She met Apollo, and they spent many happy days in the olive groves. I was conceived on a beautiful hillside above the Aegean Sea.

Apollo soon lost interest in Coronis; he was busy with the family business: causing plagues, driving the chariot of fire across the sky, and so on. Coronis discovered she was pregnant and met a heroic mortal, Ischys; together, they tried to start a new life. There was no way Apollo was going to go along with this. No one leaves a god; it’s supposed to be the other way around. Apollo killed the mortal Ischys and had his sister Diana shoot an arrow into Coronis’ heart. As my mother’s body burned on a funeral pyre, Apollo had a fit of remorse and cut me from my mother’s womb—the first of what would eventually be called cesarean sections. Welcome to my life.

The Early Years

My home was on Mount Pelion. Chiron, a centaur, was my nanny and mentor. He was an expert hunter and was well versed in medicine and music. He was always horsing around. His daughter, Ocyrhoe, prophesied that I would become a great healer; with my heritage, it seemed a safe bet. When Chiron died, years later, Jupiter placed him in the sky; you might recognize him as Sagittarius. One day, millennia later, a company would take his name and would have trouble making influenza vaccine. I grew up under his tutelage and, in time, became an adequate healer myself.

The Wife and Kids

When I grew older, it was time to take a wife. I found a woman with an interest in botanicals. Her name was Epione. We had many children together, but things eroded in our relationship after that. It might have been a postpartum thing, or maybe I spent too much time at work. I’ll never know. She became more interested in soporifics—mandrake especially. She started spending a lot of time in her cave. She and Bacchus were always sitting around our home partying and listening to Pluto’s underworld band, The Dead, and enjoying their favorite song, “The Deadly Nightshade.”

I did pretty well with my children; they all went into the family healing business. My first daughter was named Hygeia. She was always by my side and a great help in my practice. She specialized in preventing disease. My second daughter was Panacea. She was pretty good with a cure and was always in high demand. She started hanging around with some chick named Placebo. Her name in Latin means “I will please,” and she always did. Two of my sons, Machaon and Podalirius, became naval surgeons; one was wounded at Troy but survived. My third son, Telosophorus, was born a dwarf and specialized in rehabilitation.

Things Take a Turn for the Worse

Life was going pretty well until I was lured into the shadowy realms of life and death. I had always believed that if the gods decided a patient was to get better, then I must use my skill to aid in this endeavor. If the Fates had decreed a patient was to die, there was little I could do against the will of the gods. Then events occurred that would enable me to take things to a whole new level, and—once again—it was because of sex.

Theseus was the king of Athens. He became king when his father committed suicide, thinking wrongly that Theseus was dead. This was not an auspicious start for a ruler. When Theseus’ first wife died, he married the princess Phaedra, daughter of the Cretan King Minos—a truly freaky chick. Theseus had a grown son, Hippolytus, who had rugged good looks and a bright future, a real stud. Phaedra decided Hippolytus would be a better husband for her than his father, but Hippolytus spurned her advances. Phaedra, in her wrath, turned Theseus against his son. Theseus used his own godly contacts and convinced Neptune to deal with Hippolytus. While Hippolytus was driving a chariot along a coastal road, Neptune set a sea monster to rise up from the ocean, scaring Theseus’ horse, which led to a fatal crash.

The goddess Diana, my aunt, came to me and taught me the secret to reviving the dead. Don’t expect me to share it with you. No “see one, do one, teach one” from me. I’ll just say it involves very small thunderbolts. I would have been better off without the knowledge. Using the new technique, I revived Hippolytus, who spent the rest of his days in Italy with a water nymph named Egeria. Not a bad afterlife. My trouble, on the other hand, had just begun. Pluto, god of the underworld, was furious. He thought no man should remove the dead from his realm. It was a classic turf battle, and I lost. Jupiter, my grandfather, was forced to put me to death with a thunderbolt.

Life after Death

My name lived on. The earliest places of healing were temples of Aesculapius; the Iatros, who worked there, were the earliest physicians. Yes, they did make me a god, but it’s not like I could stop them. On the island of Kós, my thousandth grandson was named Hippocrates—you may have heard of him. Another of my descendants, Galen, trained at my temple in Pergamon.

It’s been a few thousand years since all of this happened. Don’t ask how you can be reading my words—it’s a mythology thing. Things did not go well for Apollo after I died. When he heard I had been killed, my father lost his temper and took out his wrath on the cyclops who had made Jupiter’s thunderbolts on Mount Aetna. His punishment for that temper tantrum was to serve a mortal, Admetus, for a year. Admetus fell ill; near death, he convinced Apollo to appeal to the Fates. They agreed that someone would take his place. Nobody in the kingdom volunteered for this duty, not even his elderly parents. Finally his wife Alcestis volunteered, and her fate was set. When Death came for her, Hercules, who was passing through, seized Death and would not let him go until she was spared.

Lessons from the Past

You, the modern hospitalist, may read this tale and wonder what it has to do with modern-day medicine and why it is in this publication. Perhaps the Fates have had their way with the medical editor—hence this topic in this publication. Some parts of the tale are of etymological interest: Panacea, Hygeia, Iatros, Aesculapius, Chiron, and Aetna, to name a few. The bigger issue is the question of how your medical forefathers looked at life and death. Perhaps a patient might be healed, but if not, it was the gods’ will. Death was not easily cheated. Ademetus was saved by his wife’s sacrifice; she was willing to donate her life for his. There is something in this tale about futile resuscitation as well. And of course, the most important message: It never pays to get involved in sex or politics. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It was 8 p.m. on a cold Minnesota night, and my vision was obscured by flurries of snow and decomposing wiper blades. I was late for home. When I arrived, 11 sets of eyes turned toward me. (Twelve, really, counting my boxer Chocky Locky). They were sitting in the dining room, and the evening meal had just started. I washed quickly and took my seat at the table.

We have a large dining table that seats 12, but our current dish service—due to an unforeseen disaster—has only 11 settings. Thus, our service was at its maximum capacity. Tonight’s crowd included my wife and me, a grandmother, four offspring of various genders and a female teenager of unknown origin, a male preteen well-known to the household, and two young females who had sat at the table before.

As per standard operating procedure, each person at the table began to speak at the same time. Eventually order was established, though this was at best a transitory phenomenon. We received reports on each participant’s day, with highlights of lunch hour mayhem, recess riots, and general curricular boredom.

I began to question the unknown teen: name, age, place of origin, habits, and so on, but my history taking was interrupted. My younger son wanted to relay the results of an important test he had taken. He had passed and was now certified to use punctuation. I turned to resume my history taking, but made the important physical exam observation of intense eye rolling on the part of my daughter and her friend. This is a well-known physical finding in this age group and one that generally signals a pre-seizure threshold that I did not want to further induce.

After an intense nutritional session that included all major food groups and several minor ones, there were several short, unscheduled presentations. The grandmother gave a long and interesting family history with highlights of a great-great grandfather, who had been a freelance horse thief for both the Polish and Russian armies, and his son, who had been—alternatively—a gambler, a rabbi, a communist, and a union organizer.

After this history lesson, we received a fascinating report from one of my male offspring entitled, “proper placement of the hand and axillae, combined with repetitive flapping movements of the arm, to elicit an auditory stimulus similar to flatulence.” Much hilarity ensued.

It was unclear whose turn it was to clear the table. The schedule was not available, and several of the offspring cited work limits they would hate to see abused. Eventually the job was done with only minimal threats of withdrawal of privileges. As I prepared to resume my reading, a call went out for transportation services. It was time to discharge one of the visiting children to her abode. I was happy to decrease the numbers in house, though I would have been happier to see our numbers go even lower. Our length of stay seemed to be rising daily. As I attempted to initiate the transportation home, I realized we had to go through the checklist. Do you have your scarf, your gloves, and your shoes? Did you have a good time? I considered a policy of no readmission in 30 days, but it was voted down in a team meeting.

I returned from transportation duties, and I sat quietly for a moment and looked at the Times and the Post-Bulletin. These were papers I had been waiting to review—especially the comics. But something always seems to come up when one has papers to review. My youngest daughter and her friends needed my guidance on an art project. I had hoped they would see one, do one, teach one, but I had to repeatedly sketch the face outlines for them to color.

As I sat down again to the papers, the doorbell rang. Nobody else appeared to be on doorbell duty, so I went to the front of the house. There was a young man in a white shirt and black tie. He was proselytizing for a religious group. I informed him that our house had adopted a “no religious rep policy.” This helps us to avoid being unduly influenced by reps, though I must admit I still use my Taoist pen. It’s a Zen-Pen: one side writes, the other doesn’t.

Finally, I returned to my seat. At that point, the room plunged into darkness. A moment of panic. Quickly, I took my own pulse, a technique I had learned from the medical literature. Once calmed, I went through the differential. The power might be out for the whole city or just the house. Perhaps a fuse had blown from one too many electronic entertainment devices. Or maybe mice had chewed through a power cable. As I pondered my next course of diagnostic action and reviewed my alternatives in an evidence-based and allorhythmic approach, I auscultated a series of breath sounds that might be interpreted as gasps or giggles.

I intuitively realized that it was a severe case of “little girls playing a joke on Dad by switching off the light.” I had two choices. The first was to be crabby and bellow for them to quit playing with the switch. I felt this to be a harsh choice with bad potential side effects. Instead, I ducked under the table and silently hid. When proper lighting was restored, they were amazed to see I had vanished, and when they came to investigate, I revealed myself and uttered the key phrase: “Boo!” A riotous wrestling match ensued, which led to the injury of a family heirloom and my spine.

It was time for bed, despite my elder son’s complaint of a type of chronic insomnia only remediable by late-night cartoon observation. Evening reading began. Such important journals as Click Clack Moo, P.J. Funnybunny Camps Out, and the Stinky Cheese Man and Other Fairly Stupid Tales were on the agenda.

As I drifted off to sleep, the phone rang. It was a wrong number. Several hours later, an emergency call for supplemental H2O was answered. Two hours after that, I awoke to a hideous scream; it was a nightmare. My alarm rang at 6:15, and I jumped from bed refreshed. No, that’s a lie. I stumbled from bed after hitting the snooze button four times. Morning nutrition rounds were a stale toaster pastry and coffee. Team Newman noted that there were last-minute reports not finished for school and preparation for a day of testing.

I drove to work exhausted after a night of Home. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It was 8 p.m. on a cold Minnesota night, and my vision was obscured by flurries of snow and decomposing wiper blades. I was late for home. When I arrived, 11 sets of eyes turned toward me. (Twelve, really, counting my boxer Chocky Locky). They were sitting in the dining room, and the evening meal had just started. I washed quickly and took my seat at the table.

We have a large dining table that seats 12, but our current dish service—due to an unforeseen disaster—has only 11 settings. Thus, our service was at its maximum capacity. Tonight’s crowd included my wife and me, a grandmother, four offspring of various genders and a female teenager of unknown origin, a male preteen well-known to the household, and two young females who had sat at the table before.

As per standard operating procedure, each person at the table began to speak at the same time. Eventually order was established, though this was at best a transitory phenomenon. We received reports on each participant’s day, with highlights of lunch hour mayhem, recess riots, and general curricular boredom.

I began to question the unknown teen: name, age, place of origin, habits, and so on, but my history taking was interrupted. My younger son wanted to relay the results of an important test he had taken. He had passed and was now certified to use punctuation. I turned to resume my history taking, but made the important physical exam observation of intense eye rolling on the part of my daughter and her friend. This is a well-known physical finding in this age group and one that generally signals a pre-seizure threshold that I did not want to further induce.

After an intense nutritional session that included all major food groups and several minor ones, there were several short, unscheduled presentations. The grandmother gave a long and interesting family history with highlights of a great-great grandfather, who had been a freelance horse thief for both the Polish and Russian armies, and his son, who had been—alternatively—a gambler, a rabbi, a communist, and a union organizer.

After this history lesson, we received a fascinating report from one of my male offspring entitled, “proper placement of the hand and axillae, combined with repetitive flapping movements of the arm, to elicit an auditory stimulus similar to flatulence.” Much hilarity ensued.

It was unclear whose turn it was to clear the table. The schedule was not available, and several of the offspring cited work limits they would hate to see abused. Eventually the job was done with only minimal threats of withdrawal of privileges. As I prepared to resume my reading, a call went out for transportation services. It was time to discharge one of the visiting children to her abode. I was happy to decrease the numbers in house, though I would have been happier to see our numbers go even lower. Our length of stay seemed to be rising daily. As I attempted to initiate the transportation home, I realized we had to go through the checklist. Do you have your scarf, your gloves, and your shoes? Did you have a good time? I considered a policy of no readmission in 30 days, but it was voted down in a team meeting.

I returned from transportation duties, and I sat quietly for a moment and looked at the Times and the Post-Bulletin. These were papers I had been waiting to review—especially the comics. But something always seems to come up when one has papers to review. My youngest daughter and her friends needed my guidance on an art project. I had hoped they would see one, do one, teach one, but I had to repeatedly sketch the face outlines for them to color.

As I sat down again to the papers, the doorbell rang. Nobody else appeared to be on doorbell duty, so I went to the front of the house. There was a young man in a white shirt and black tie. He was proselytizing for a religious group. I informed him that our house had adopted a “no religious rep policy.” This helps us to avoid being unduly influenced by reps, though I must admit I still use my Taoist pen. It’s a Zen-Pen: one side writes, the other doesn’t.

Finally, I returned to my seat. At that point, the room plunged into darkness. A moment of panic. Quickly, I took my own pulse, a technique I had learned from the medical literature. Once calmed, I went through the differential. The power might be out for the whole city or just the house. Perhaps a fuse had blown from one too many electronic entertainment devices. Or maybe mice had chewed through a power cable. As I pondered my next course of diagnostic action and reviewed my alternatives in an evidence-based and allorhythmic approach, I auscultated a series of breath sounds that might be interpreted as gasps or giggles.

I intuitively realized that it was a severe case of “little girls playing a joke on Dad by switching off the light.” I had two choices. The first was to be crabby and bellow for them to quit playing with the switch. I felt this to be a harsh choice with bad potential side effects. Instead, I ducked under the table and silently hid. When proper lighting was restored, they were amazed to see I had vanished, and when they came to investigate, I revealed myself and uttered the key phrase: “Boo!” A riotous wrestling match ensued, which led to the injury of a family heirloom and my spine.

It was time for bed, despite my elder son’s complaint of a type of chronic insomnia only remediable by late-night cartoon observation. Evening reading began. Such important journals as Click Clack Moo, P.J. Funnybunny Camps Out, and the Stinky Cheese Man and Other Fairly Stupid Tales were on the agenda.

As I drifted off to sleep, the phone rang. It was a wrong number. Several hours later, an emergency call for supplemental H2O was answered. Two hours after that, I awoke to a hideous scream; it was a nightmare. My alarm rang at 6:15, and I jumped from bed refreshed. No, that’s a lie. I stumbled from bed after hitting the snooze button four times. Morning nutrition rounds were a stale toaster pastry and coffee. Team Newman noted that there were last-minute reports not finished for school and preparation for a day of testing.

I drove to work exhausted after a night of Home. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

It was 8 p.m. on a cold Minnesota night, and my vision was obscured by flurries of snow and decomposing wiper blades. I was late for home. When I arrived, 11 sets of eyes turned toward me. (Twelve, really, counting my boxer Chocky Locky). They were sitting in the dining room, and the evening meal had just started. I washed quickly and took my seat at the table.

We have a large dining table that seats 12, but our current dish service—due to an unforeseen disaster—has only 11 settings. Thus, our service was at its maximum capacity. Tonight’s crowd included my wife and me, a grandmother, four offspring of various genders and a female teenager of unknown origin, a male preteen well-known to the household, and two young females who had sat at the table before.

As per standard operating procedure, each person at the table began to speak at the same time. Eventually order was established, though this was at best a transitory phenomenon. We received reports on each participant’s day, with highlights of lunch hour mayhem, recess riots, and general curricular boredom.

I began to question the unknown teen: name, age, place of origin, habits, and so on, but my history taking was interrupted. My younger son wanted to relay the results of an important test he had taken. He had passed and was now certified to use punctuation. I turned to resume my history taking, but made the important physical exam observation of intense eye rolling on the part of my daughter and her friend. This is a well-known physical finding in this age group and one that generally signals a pre-seizure threshold that I did not want to further induce.

After an intense nutritional session that included all major food groups and several minor ones, there were several short, unscheduled presentations. The grandmother gave a long and interesting family history with highlights of a great-great grandfather, who had been a freelance horse thief for both the Polish and Russian armies, and his son, who had been—alternatively—a gambler, a rabbi, a communist, and a union organizer.

After this history lesson, we received a fascinating report from one of my male offspring entitled, “proper placement of the hand and axillae, combined with repetitive flapping movements of the arm, to elicit an auditory stimulus similar to flatulence.” Much hilarity ensued.

It was unclear whose turn it was to clear the table. The schedule was not available, and several of the offspring cited work limits they would hate to see abused. Eventually the job was done with only minimal threats of withdrawal of privileges. As I prepared to resume my reading, a call went out for transportation services. It was time to discharge one of the visiting children to her abode. I was happy to decrease the numbers in house, though I would have been happier to see our numbers go even lower. Our length of stay seemed to be rising daily. As I attempted to initiate the transportation home, I realized we had to go through the checklist. Do you have your scarf, your gloves, and your shoes? Did you have a good time? I considered a policy of no readmission in 30 days, but it was voted down in a team meeting.

I returned from transportation duties, and I sat quietly for a moment and looked at the Times and the Post-Bulletin. These were papers I had been waiting to review—especially the comics. But something always seems to come up when one has papers to review. My youngest daughter and her friends needed my guidance on an art project. I had hoped they would see one, do one, teach one, but I had to repeatedly sketch the face outlines for them to color.

As I sat down again to the papers, the doorbell rang. Nobody else appeared to be on doorbell duty, so I went to the front of the house. There was a young man in a white shirt and black tie. He was proselytizing for a religious group. I informed him that our house had adopted a “no religious rep policy.” This helps us to avoid being unduly influenced by reps, though I must admit I still use my Taoist pen. It’s a Zen-Pen: one side writes, the other doesn’t.

Finally, I returned to my seat. At that point, the room plunged into darkness. A moment of panic. Quickly, I took my own pulse, a technique I had learned from the medical literature. Once calmed, I went through the differential. The power might be out for the whole city or just the house. Perhaps a fuse had blown from one too many electronic entertainment devices. Or maybe mice had chewed through a power cable. As I pondered my next course of diagnostic action and reviewed my alternatives in an evidence-based and allorhythmic approach, I auscultated a series of breath sounds that might be interpreted as gasps or giggles.

I intuitively realized that it was a severe case of “little girls playing a joke on Dad by switching off the light.” I had two choices. The first was to be crabby and bellow for them to quit playing with the switch. I felt this to be a harsh choice with bad potential side effects. Instead, I ducked under the table and silently hid. When proper lighting was restored, they were amazed to see I had vanished, and when they came to investigate, I revealed myself and uttered the key phrase: “Boo!” A riotous wrestling match ensued, which led to the injury of a family heirloom and my spine.

It was time for bed, despite my elder son’s complaint of a type of chronic insomnia only remediable by late-night cartoon observation. Evening reading began. Such important journals as Click Clack Moo, P.J. Funnybunny Camps Out, and the Stinky Cheese Man and Other Fairly Stupid Tales were on the agenda.

As I drifted off to sleep, the phone rang. It was a wrong number. Several hours later, an emergency call for supplemental H2O was answered. Two hours after that, I awoke to a hideous scream; it was a nightmare. My alarm rang at 6:15, and I jumped from bed refreshed. No, that’s a lie. I stumbled from bed after hitting the snooze button four times. Morning nutrition rounds were a stale toaster pastry and coffee. Team Newman noted that there were last-minute reports not finished for school and preparation for a day of testing.

I drove to work exhausted after a night of Home. TH

Dr. Newman is the physician editor of The Hospitalist. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Among the newest fields in medicine, the specialty “hospitology” applies the precepts of the hospitality industry to the hospital environment.

Introduction

The hospitology industry celebrated its fifth birthday this year. The term was coined by health consumer advocate Katy Ericson and was actualized by the daughter of a hotel industry mogul, Marseilles Hyatt. Like their colleagues in other new specialties, including forensic proctology and cosmetic gynecology, “hospitologists” have organized and worked hard to define their specialty and are working toward board certification.

Scope of Practice

Hospitologists have expertise in making the “visitors” feel welcome in the hospital environment. (Hospitologists prefer to refer to patients as “visitors,” though they also use the term “customer.”) As the visitor arrives from admissions, the hospitologist is waiting at bedside. The hospitologist assures the visitor that all his needs will be met in his personalized care suite.

Subsequent to the greeting, the hospitologist assists in the selection of an appropriate gown, termed “hospital attire.” There are several modish alternatives from designers such as Yves Saint Levaquin, Pierre Cardiac, and Club Medicare.

Obtaining a history and completing a physical remain a necessary part of the hospitalization experience, and hospitologists know how to establish a peaceful rapport. Previous review of material excludes the need to spend time on such distractions as past medical history or medication list, though many patients wish to discuss these at excruciating length. If this is the case, the hospitologist is ready to sit quietly while the visitor reviews any or all details of medical encounters—tangential or otherwise.

Prior to a physical exam, the patient may opt for a massage or a nap, either of which can be arranged for an extra charge.

Physical exams by hospitologists are soothing and precise, though not strictly required. Studies show that the physical exam is of low sensitivity and specificity. Nonetheless, the use of a stethoscope is encouraged to create the sense of clinical competence that visitors prefer in care providers, though having the gadget draped around one’s neck is, in most cases, sufficient.

Admission orders are a true art form. Administer adequate narcotics, benzodiazepines, and an antidepressant to visitors—whether they truly need them or not. Gently encourage smokers to quit; however, if they choose not to, then a selection of fine brands should be available for purchase and delivery to the care suite. Most modern hospitology programs offer online ordering through the in-care suite entertainment system, which features a selection of cigarettes, alcohol, and other needed substances, for a small additional fee. The concierge may be of help as well.

When it comes to diagnostic testing, there is no provider more adept at meeting a visitor’s needs than a hospitologist. Whether the visitor desires a barium enema or a PET scan, the test will be arranged immediately. Lab work may also be ordered. Though it is often difficult to obtain blood without a phlebotomy and a needle, the hospitologist will at bedside to hold the visitor’s hand, and (if need be) can offer her own blood if the visitor cannot bear the thought of “getting stuck.” There is an extra fee for this service, however.

Hospitologists command the full range of therapeutic maneuvers including heavy water hydrotherapy, splenic massage, and isotope enemas.

At time of discharge the hospitologist will have the visitor ready to go—both medically and spiritually. If he has no ride or it’s just too rainy, discharge on an alternate night is always an option. Visitors are always welcomed back, even if it’s within 30 days and with the same diagnosis.

Hospitologist Metrics

Length of stay (LOS) is an important metric for any hospitologist. LOS less than eight days may be a measure of poor performance, though we frequently see a four-day, three-night weekend admission for the busy executive.

The 30-day readmission rate is also worth following, as a happy visitor will want to return to the healing environment.

Cost per admission is of no importance; hospitologists live to serve, and finances are just a distraction from our duties. Money is the root of all evil, and hospitologists are well rooted.

Hospitologists rely heavily on EBM—experience-based medicine. Statistics can lie, but a happy smiling patient remains the proof in the hospitologist’s pudding. (Multiple flavors are available; see the menu.)

Organized Medicine and Certification

Like all good practitioners of new specialties, the hospitologists of America are well represented. The original organization was called Hospitology Organization of Haversend, Ohio (HOHO), which merged with the Hospitologist Organization of Rybeck, N.Y., (HORNY), to form the American Clinical Hospitology Organization (ACHOO), Gesundheit.

The current CEO of ACHOO Gesundheit is Moe Larryundcurly. He has represented the organization for several years and has been acknowledged by his peers to be “outstanding,” though at the time, they were all “in” and “sitting.”

The move for Bored Certification is in the air for ACHOO Gesundheit. Every hospitology program wants to have certified hospitologists. The ABIM (American Bored of Internal Medicine) and the ACP (Association of Credentialed Persons) have generally been supportive of Bored Certification, despite distraction from rival groups, such as the Socialist Generic Inpatient Medicos and other nefarious organizations.

Criteria for Bored Certification includes the following: Being bored at committee meetings, providing room and board for me when I visit, and the ability to tolerate being bored stiff, to death, and to tears.

The Future

The future is bright for hospitologists. Changes in Medicare billing, support from the hotel industry, and association with other “ologists,” such as cosmetologists and herpetologists, will only make the group stronger. Major threats to the specialty include tort law, outcomes analysis, and my brother Seymour, the crooked shyster lawyer.

Next time you go to the hospital to be “healed,” ask for a hospitologist! TH

*Hospitologist in practice

Conflict of interest statement: Dr. Newman does not own 25% of common shares of Hospitologists Incorporated (HI), although his wife does.

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Among the newest fields in medicine, the specialty “hospitology” applies the precepts of the hospitality industry to the hospital environment.

Introduction

The hospitology industry celebrated its fifth birthday this year. The term was coined by health consumer advocate Katy Ericson and was actualized by the daughter of a hotel industry mogul, Marseilles Hyatt. Like their colleagues in other new specialties, including forensic proctology and cosmetic gynecology, “hospitologists” have organized and worked hard to define their specialty and are working toward board certification.

Scope of Practice

Hospitologists have expertise in making the “visitors” feel welcome in the hospital environment. (Hospitologists prefer to refer to patients as “visitors,” though they also use the term “customer.”) As the visitor arrives from admissions, the hospitologist is waiting at bedside. The hospitologist assures the visitor that all his needs will be met in his personalized care suite.

Subsequent to the greeting, the hospitologist assists in the selection of an appropriate gown, termed “hospital attire.” There are several modish alternatives from designers such as Yves Saint Levaquin, Pierre Cardiac, and Club Medicare.

Obtaining a history and completing a physical remain a necessary part of the hospitalization experience, and hospitologists know how to establish a peaceful rapport. Previous review of material excludes the need to spend time on such distractions as past medical history or medication list, though many patients wish to discuss these at excruciating length. If this is the case, the hospitologist is ready to sit quietly while the visitor reviews any or all details of medical encounters—tangential or otherwise.

Prior to a physical exam, the patient may opt for a massage or a nap, either of which can be arranged for an extra charge.

Physical exams by hospitologists are soothing and precise, though not strictly required. Studies show that the physical exam is of low sensitivity and specificity. Nonetheless, the use of a stethoscope is encouraged to create the sense of clinical competence that visitors prefer in care providers, though having the gadget draped around one’s neck is, in most cases, sufficient.

Admission orders are a true art form. Administer adequate narcotics, benzodiazepines, and an antidepressant to visitors—whether they truly need them or not. Gently encourage smokers to quit; however, if they choose not to, then a selection of fine brands should be available for purchase and delivery to the care suite. Most modern hospitology programs offer online ordering through the in-care suite entertainment system, which features a selection of cigarettes, alcohol, and other needed substances, for a small additional fee. The concierge may be of help as well.

When it comes to diagnostic testing, there is no provider more adept at meeting a visitor’s needs than a hospitologist. Whether the visitor desires a barium enema or a PET scan, the test will be arranged immediately. Lab work may also be ordered. Though it is often difficult to obtain blood without a phlebotomy and a needle, the hospitologist will at bedside to hold the visitor’s hand, and (if need be) can offer her own blood if the visitor cannot bear the thought of “getting stuck.” There is an extra fee for this service, however.

Hospitologists command the full range of therapeutic maneuvers including heavy water hydrotherapy, splenic massage, and isotope enemas.

At time of discharge the hospitologist will have the visitor ready to go—both medically and spiritually. If he has no ride or it’s just too rainy, discharge on an alternate night is always an option. Visitors are always welcomed back, even if it’s within 30 days and with the same diagnosis.

Hospitologist Metrics

Length of stay (LOS) is an important metric for any hospitologist. LOS less than eight days may be a measure of poor performance, though we frequently see a four-day, three-night weekend admission for the busy executive.

The 30-day readmission rate is also worth following, as a happy visitor will want to return to the healing environment.

Cost per admission is of no importance; hospitologists live to serve, and finances are just a distraction from our duties. Money is the root of all evil, and hospitologists are well rooted.

Hospitologists rely heavily on EBM—experience-based medicine. Statistics can lie, but a happy smiling patient remains the proof in the hospitologist’s pudding. (Multiple flavors are available; see the menu.)

Organized Medicine and Certification

Like all good practitioners of new specialties, the hospitologists of America are well represented. The original organization was called Hospitology Organization of Haversend, Ohio (HOHO), which merged with the Hospitologist Organization of Rybeck, N.Y., (HORNY), to form the American Clinical Hospitology Organization (ACHOO), Gesundheit.

The current CEO of ACHOO Gesundheit is Moe Larryundcurly. He has represented the organization for several years and has been acknowledged by his peers to be “outstanding,” though at the time, they were all “in” and “sitting.”

The move for Bored Certification is in the air for ACHOO Gesundheit. Every hospitology program wants to have certified hospitologists. The ABIM (American Bored of Internal Medicine) and the ACP (Association of Credentialed Persons) have generally been supportive of Bored Certification, despite distraction from rival groups, such as the Socialist Generic Inpatient Medicos and other nefarious organizations.

Criteria for Bored Certification includes the following: Being bored at committee meetings, providing room and board for me when I visit, and the ability to tolerate being bored stiff, to death, and to tears.

The Future

The future is bright for hospitologists. Changes in Medicare billing, support from the hotel industry, and association with other “ologists,” such as cosmetologists and herpetologists, will only make the group stronger. Major threats to the specialty include tort law, outcomes analysis, and my brother Seymour, the crooked shyster lawyer.

Next time you go to the hospital to be “healed,” ask for a hospitologist! TH

*Hospitologist in practice

Conflict of interest statement: Dr. Newman does not own 25% of common shares of Hospitologists Incorporated (HI), although his wife does.

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

Among the newest fields in medicine, the specialty “hospitology” applies the precepts of the hospitality industry to the hospital environment.

Introduction

The hospitology industry celebrated its fifth birthday this year. The term was coined by health consumer advocate Katy Ericson and was actualized by the daughter of a hotel industry mogul, Marseilles Hyatt. Like their colleagues in other new specialties, including forensic proctology and cosmetic gynecology, “hospitologists” have organized and worked hard to define their specialty and are working toward board certification.

Scope of Practice

Hospitologists have expertise in making the “visitors” feel welcome in the hospital environment. (Hospitologists prefer to refer to patients as “visitors,” though they also use the term “customer.”) As the visitor arrives from admissions, the hospitologist is waiting at bedside. The hospitologist assures the visitor that all his needs will be met in his personalized care suite.

Subsequent to the greeting, the hospitologist assists in the selection of an appropriate gown, termed “hospital attire.” There are several modish alternatives from designers such as Yves Saint Levaquin, Pierre Cardiac, and Club Medicare.

Obtaining a history and completing a physical remain a necessary part of the hospitalization experience, and hospitologists know how to establish a peaceful rapport. Previous review of material excludes the need to spend time on such distractions as past medical history or medication list, though many patients wish to discuss these at excruciating length. If this is the case, the hospitologist is ready to sit quietly while the visitor reviews any or all details of medical encounters—tangential or otherwise.

Prior to a physical exam, the patient may opt for a massage or a nap, either of which can be arranged for an extra charge.

Physical exams by hospitologists are soothing and precise, though not strictly required. Studies show that the physical exam is of low sensitivity and specificity. Nonetheless, the use of a stethoscope is encouraged to create the sense of clinical competence that visitors prefer in care providers, though having the gadget draped around one’s neck is, in most cases, sufficient.

Admission orders are a true art form. Administer adequate narcotics, benzodiazepines, and an antidepressant to visitors—whether they truly need them or not. Gently encourage smokers to quit; however, if they choose not to, then a selection of fine brands should be available for purchase and delivery to the care suite. Most modern hospitology programs offer online ordering through the in-care suite entertainment system, which features a selection of cigarettes, alcohol, and other needed substances, for a small additional fee. The concierge may be of help as well.

When it comes to diagnostic testing, there is no provider more adept at meeting a visitor’s needs than a hospitologist. Whether the visitor desires a barium enema or a PET scan, the test will be arranged immediately. Lab work may also be ordered. Though it is often difficult to obtain blood without a phlebotomy and a needle, the hospitologist will at bedside to hold the visitor’s hand, and (if need be) can offer her own blood if the visitor cannot bear the thought of “getting stuck.” There is an extra fee for this service, however.

Hospitologists command the full range of therapeutic maneuvers including heavy water hydrotherapy, splenic massage, and isotope enemas.

At time of discharge the hospitologist will have the visitor ready to go—both medically and spiritually. If he has no ride or it’s just too rainy, discharge on an alternate night is always an option. Visitors are always welcomed back, even if it’s within 30 days and with the same diagnosis.

Hospitologist Metrics

Length of stay (LOS) is an important metric for any hospitologist. LOS less than eight days may be a measure of poor performance, though we frequently see a four-day, three-night weekend admission for the busy executive.

The 30-day readmission rate is also worth following, as a happy visitor will want to return to the healing environment.

Cost per admission is of no importance; hospitologists live to serve, and finances are just a distraction from our duties. Money is the root of all evil, and hospitologists are well rooted.

Hospitologists rely heavily on EBM—experience-based medicine. Statistics can lie, but a happy smiling patient remains the proof in the hospitologist’s pudding. (Multiple flavors are available; see the menu.)

Organized Medicine and Certification

Like all good practitioners of new specialties, the hospitologists of America are well represented. The original organization was called Hospitology Organization of Haversend, Ohio (HOHO), which merged with the Hospitologist Organization of Rybeck, N.Y., (HORNY), to form the American Clinical Hospitology Organization (ACHOO), Gesundheit.

The current CEO of ACHOO Gesundheit is Moe Larryundcurly. He has represented the organization for several years and has been acknowledged by his peers to be “outstanding,” though at the time, they were all “in” and “sitting.”

The move for Bored Certification is in the air for ACHOO Gesundheit. Every hospitology program wants to have certified hospitologists. The ABIM (American Bored of Internal Medicine) and the ACP (Association of Credentialed Persons) have generally been supportive of Bored Certification, despite distraction from rival groups, such as the Socialist Generic Inpatient Medicos and other nefarious organizations.

Criteria for Bored Certification includes the following: Being bored at committee meetings, providing room and board for me when I visit, and the ability to tolerate being bored stiff, to death, and to tears.

The Future

The future is bright for hospitologists. Changes in Medicare billing, support from the hotel industry, and association with other “ologists,” such as cosmetologists and herpetologists, will only make the group stronger. Major threats to the specialty include tort law, outcomes analysis, and my brother Seymour, the crooked shyster lawyer.

Next time you go to the hospital to be “healed,” ask for a hospitologist! TH

*Hospitologist in practice

Conflict of interest statement: Dr. Newman does not own 25% of common shares of Hospitologists Incorporated (HI), although his wife does.

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

(Circle the appropriate answers.)

HISTORY OF PRESENT ILLNESS

This (0-109)-year-old (Asian, Black, Caucasian, Aleutian, Venusian) (male, female, other) presents with a (1, 7, 100)-(second, minute, day, year, century) history of (pain, swelling, itching, enlargement) of the (arm, chest, scrotum, uvula, pineal gland). (She/He/It) rates it as (11, 12, 20) out of 10. It is aggravated by (breathing, thinking, hang gliding, vigorous dancing, ennui) and alleviated by (acetaminophen, chocolate, high-dose morphine).

PAST MEDICAL HISTORY

Diabetes, hypertension, pineal insufficiency, Kluver-Bucy syndrome, rectal prolapse, Chagas disease, visceral larval migrans, ichthyosis, all of the above

PAST SURGICAL HISTORY

• Transplant of the (heart, kidney, pancreas, amygdala, pineal gland)
• ORIF of (humerus, femur, rear axle)
• Hemorrhoidectomy, cholecystectomy, pancreatectomy, cerumen removal, all of the above

ALLERGIES

(Penicillin, sulfa, every known drug in existence except Demerol)

CURRENT MEDICATION

• Insulin, metformin, Gila monster venom
• Alpha blocker, calcium blocker, beta blocker, blocker blocker
• Amoxicillin, “gorillacillin,” maggot extract, “mickeymycin”
• SSRI, MAOI, TRIAD, ECT, DOA
• (Thyroid, adrenal, pineal) gland extract

FAMILY HISTORY

Adopted, old age, some kind of cancer

SOCIAL HISTORY

• Alcohol: (teetotaler, tippler, boozer, lush, no alcohol—only beer)—multiply by 10
• Smoking: (never; three packs a day; not tobacco; old stogies I have found, short but not too big around)
• Drugs: (Is this confidential?, Freon, whatever I can get my hands on)
• Employment: (meter maid, sewer maintenance worker, JCAHO auditor, forensic proctologist, hospitologist)

REVIEW OF SYMPTOMS

• (Chest pain, more chest pain, even more chest pain), (rectal, urinary, salivary) incontinence, (ears itch with urination, nose runs with defecation, small bugs crawling out of my skin), (short of breath, short of patience)
• Stool is (sticky, floating, malodorous, frequent, shaped like the Statue of Liberty)
• Double vision, tunnel vision, television, hyperacusis, hearing loss, could you repeat that?, halitosis, dysgeusia, dysphonia, “datphonia”
• Abdominal (pain, cramping, crunches)

PHYSICAL EXAM

• BP (0, 90, 140, 230, 290)/(0, 3, 90, 160)
• Pulse (absent, irregularly irregularly irregular, tachycardic, tacky dresser) rate (0, 3, 84, 112, 190, 280)
• Temperature (32.2, 36.8, 25 minutes at 450—baste often)
• Normocephalic/atraumatic, bullet-headed, pointy-headed, hatchet in skull
• Eyes (PERRLA, anisocoria, bloodshot, pinpoint dude)
• Fundus exam (never can see them, cotton wool spots, cotton candy)
• Ears (present, “hyperceruminic,” absent)
• Mouth (macroglossia, foot in mouth, black hairy tongue, halitotic, skin of the teeth, wooden teeth)
• Neck (supple without adenopathy, thick, multiple hickies, red)
• Lungs (clear to auscultation and percussion—OK, I never really percussed; Velcro rales; egophonic; wheezy)
• Heart (systolic, 5/6, even a medical student can hear) murmur (no, pericardial, aye there’s the) rub
• Abdomen (scaphoid, pendulous, six-pack); bowel sounds (absent—was that you?)
• Umbilicus (surgically absent, Sister Mary Joseph nodule, high lint content)
• Extremities (extreme, all six present, night-clubbing)

NEURO EXAM

• Reflexes (cremaster positive, anal wink intact)
• Mentation (alert and oriented x3, catatonic, dogatonic)
• Psychiatric (appropriate, psychotic, truly weird, bipolar, tripolar)
• Skin (present, hideous thing growing on the patient’s face)

LABORATORY FINDINGS

Results of (CBC, ionized calcium, “citrulated ceruloplasmin,” complement levels, insult levels, saliva electrophoresis, urinary zinc level, melatonin level, and protein Q) all markedly abnormal.

IMAGING

(CAT scan, PET scan, DOG scan, plain film, complex film, KUB, IVP, XYZ, molybdenum scan, Afghaniscan)—all suggest need for further imaging.

ASSESSMENT AND PLAN

1. “Hyperlabemia:” Likely iatrogenic etiology, or not. Correct with supplemental lab results.
2. Pain: Source unclear but probably malingering. Treat with excessive narcotics, thereby causing problems 3 and 4 (see below).
3. Bowel obstruction: Discontinue narcotics. Place (NG tube, rectal tube, boob tube, multiple consults).
4. Altered mental status: Baseline worsened by narcotics. Give benzodiazepines, antipsychotics, antihistamine, more narcotics; then intubate.
5. Discharge planning: The patient is a rock and will be on service forever.
6. Abnormal imaging: Perform further scans.
7. Code status: (Full code, no code, Morse code)
8. Pineal: Gland abnormal—consult the pineal gland service TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

(Circle the appropriate answers.)

HISTORY OF PRESENT ILLNESS

This (0-109)-year-old (Asian, Black, Caucasian, Aleutian, Venusian) (male, female, other) presents with a (1, 7, 100)-(second, minute, day, year, century) history of (pain, swelling, itching, enlargement) of the (arm, chest, scrotum, uvula, pineal gland). (She/He/It) rates it as (11, 12, 20) out of 10. It is aggravated by (breathing, thinking, hang gliding, vigorous dancing, ennui) and alleviated by (acetaminophen, chocolate, high-dose morphine).

PAST MEDICAL HISTORY

Diabetes, hypertension, pineal insufficiency, Kluver-Bucy syndrome, rectal prolapse, Chagas disease, visceral larval migrans, ichthyosis, all of the above

PAST SURGICAL HISTORY

• Transplant of the (heart, kidney, pancreas, amygdala, pineal gland)
• ORIF of (humerus, femur, rear axle)
• Hemorrhoidectomy, cholecystectomy, pancreatectomy, cerumen removal, all of the above

ALLERGIES

(Penicillin, sulfa, every known drug in existence except Demerol)

CURRENT MEDICATION

• Insulin, metformin, Gila monster venom
• Alpha blocker, calcium blocker, beta blocker, blocker blocker
• Amoxicillin, “gorillacillin,” maggot extract, “mickeymycin”
• SSRI, MAOI, TRIAD, ECT, DOA
• (Thyroid, adrenal, pineal) gland extract

FAMILY HISTORY

Adopted, old age, some kind of cancer

SOCIAL HISTORY

• Alcohol: (teetotaler, tippler, boozer, lush, no alcohol—only beer)—multiply by 10
• Smoking: (never; three packs a day; not tobacco; old stogies I have found, short but not too big around)
• Drugs: (Is this confidential?, Freon, whatever I can get my hands on)
• Employment: (meter maid, sewer maintenance worker, JCAHO auditor, forensic proctologist, hospitologist)

REVIEW OF SYMPTOMS

• (Chest pain, more chest pain, even more chest pain), (rectal, urinary, salivary) incontinence, (ears itch with urination, nose runs with defecation, small bugs crawling out of my skin), (short of breath, short of patience)
• Stool is (sticky, floating, malodorous, frequent, shaped like the Statue of Liberty)
• Double vision, tunnel vision, television, hyperacusis, hearing loss, could you repeat that?, halitosis, dysgeusia, dysphonia, “datphonia”
• Abdominal (pain, cramping, crunches)

PHYSICAL EXAM

• BP (0, 90, 140, 230, 290)/(0, 3, 90, 160)
• Pulse (absent, irregularly irregularly irregular, tachycardic, tacky dresser) rate (0, 3, 84, 112, 190, 280)
• Temperature (32.2, 36.8, 25 minutes at 450—baste often)
• Normocephalic/atraumatic, bullet-headed, pointy-headed, hatchet in skull
• Eyes (PERRLA, anisocoria, bloodshot, pinpoint dude)
• Fundus exam (never can see them, cotton wool spots, cotton candy)
• Ears (present, “hyperceruminic,” absent)
• Mouth (macroglossia, foot in mouth, black hairy tongue, halitotic, skin of the teeth, wooden teeth)
• Neck (supple without adenopathy, thick, multiple hickies, red)
• Lungs (clear to auscultation and percussion—OK, I never really percussed; Velcro rales; egophonic; wheezy)
• Heart (systolic, 5/6, even a medical student can hear) murmur (no, pericardial, aye there’s the) rub
• Abdomen (scaphoid, pendulous, six-pack); bowel sounds (absent—was that you?)
• Umbilicus (surgically absent, Sister Mary Joseph nodule, high lint content)
• Extremities (extreme, all six present, night-clubbing)

NEURO EXAM

• Reflexes (cremaster positive, anal wink intact)
• Mentation (alert and oriented x3, catatonic, dogatonic)
• Psychiatric (appropriate, psychotic, truly weird, bipolar, tripolar)
• Skin (present, hideous thing growing on the patient’s face)

LABORATORY FINDINGS

Results of (CBC, ionized calcium, “citrulated ceruloplasmin,” complement levels, insult levels, saliva electrophoresis, urinary zinc level, melatonin level, and protein Q) all markedly abnormal.

IMAGING

(CAT scan, PET scan, DOG scan, plain film, complex film, KUB, IVP, XYZ, molybdenum scan, Afghaniscan)—all suggest need for further imaging.

ASSESSMENT AND PLAN

1. “Hyperlabemia:” Likely iatrogenic etiology, or not. Correct with supplemental lab results.
2. Pain: Source unclear but probably malingering. Treat with excessive narcotics, thereby causing problems 3 and 4 (see below).
3. Bowel obstruction: Discontinue narcotics. Place (NG tube, rectal tube, boob tube, multiple consults).
4. Altered mental status: Baseline worsened by narcotics. Give benzodiazepines, antipsychotics, antihistamine, more narcotics; then intubate.
5. Discharge planning: The patient is a rock and will be on service forever.
6. Abnormal imaging: Perform further scans.
7. Code status: (Full code, no code, Morse code)
8. Pineal: Gland abnormal—consult the pineal gland service TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

(Circle the appropriate answers.)

HISTORY OF PRESENT ILLNESS

This (0-109)-year-old (Asian, Black, Caucasian, Aleutian, Venusian) (male, female, other) presents with a (1, 7, 100)-(second, minute, day, year, century) history of (pain, swelling, itching, enlargement) of the (arm, chest, scrotum, uvula, pineal gland). (She/He/It) rates it as (11, 12, 20) out of 10. It is aggravated by (breathing, thinking, hang gliding, vigorous dancing, ennui) and alleviated by (acetaminophen, chocolate, high-dose morphine).

PAST MEDICAL HISTORY

Diabetes, hypertension, pineal insufficiency, Kluver-Bucy syndrome, rectal prolapse, Chagas disease, visceral larval migrans, ichthyosis, all of the above

PAST SURGICAL HISTORY

• Transplant of the (heart, kidney, pancreas, amygdala, pineal gland)
• ORIF of (humerus, femur, rear axle)
• Hemorrhoidectomy, cholecystectomy, pancreatectomy, cerumen removal, all of the above

ALLERGIES

(Penicillin, sulfa, every known drug in existence except Demerol)

CURRENT MEDICATION

• Insulin, metformin, Gila monster venom
• Alpha blocker, calcium blocker, beta blocker, blocker blocker
• Amoxicillin, “gorillacillin,” maggot extract, “mickeymycin”
• SSRI, MAOI, TRIAD, ECT, DOA
• (Thyroid, adrenal, pineal) gland extract

FAMILY HISTORY

Adopted, old age, some kind of cancer

SOCIAL HISTORY

• Alcohol: (teetotaler, tippler, boozer, lush, no alcohol—only beer)—multiply by 10
• Smoking: (never; three packs a day; not tobacco; old stogies I have found, short but not too big around)
• Drugs: (Is this confidential?, Freon, whatever I can get my hands on)
• Employment: (meter maid, sewer maintenance worker, JCAHO auditor, forensic proctologist, hospitologist)

REVIEW OF SYMPTOMS

• (Chest pain, more chest pain, even more chest pain), (rectal, urinary, salivary) incontinence, (ears itch with urination, nose runs with defecation, small bugs crawling out of my skin), (short of breath, short of patience)
• Stool is (sticky, floating, malodorous, frequent, shaped like the Statue of Liberty)
• Double vision, tunnel vision, television, hyperacusis, hearing loss, could you repeat that?, halitosis, dysgeusia, dysphonia, “datphonia”
• Abdominal (pain, cramping, crunches)

PHYSICAL EXAM

• BP (0, 90, 140, 230, 290)/(0, 3, 90, 160)
• Pulse (absent, irregularly irregularly irregular, tachycardic, tacky dresser) rate (0, 3, 84, 112, 190, 280)
• Temperature (32.2, 36.8, 25 minutes at 450—baste often)
• Normocephalic/atraumatic, bullet-headed, pointy-headed, hatchet in skull
• Eyes (PERRLA, anisocoria, bloodshot, pinpoint dude)
• Fundus exam (never can see them, cotton wool spots, cotton candy)
• Ears (present, “hyperceruminic,” absent)
• Mouth (macroglossia, foot in mouth, black hairy tongue, halitotic, skin of the teeth, wooden teeth)
• Neck (supple without adenopathy, thick, multiple hickies, red)
• Lungs (clear to auscultation and percussion—OK, I never really percussed; Velcro rales; egophonic; wheezy)
• Heart (systolic, 5/6, even a medical student can hear) murmur (no, pericardial, aye there’s the) rub
• Abdomen (scaphoid, pendulous, six-pack); bowel sounds (absent—was that you?)
• Umbilicus (surgically absent, Sister Mary Joseph nodule, high lint content)
• Extremities (extreme, all six present, night-clubbing)

NEURO EXAM

• Reflexes (cremaster positive, anal wink intact)
• Mentation (alert and oriented x3, catatonic, dogatonic)
• Psychiatric (appropriate, psychotic, truly weird, bipolar, tripolar)
• Skin (present, hideous thing growing on the patient’s face)

LABORATORY FINDINGS

Results of (CBC, ionized calcium, “citrulated ceruloplasmin,” complement levels, insult levels, saliva electrophoresis, urinary zinc level, melatonin level, and protein Q) all markedly abnormal.

IMAGING

(CAT scan, PET scan, DOG scan, plain film, complex film, KUB, IVP, XYZ, molybdenum scan, Afghaniscan)—all suggest need for further imaging.

ASSESSMENT AND PLAN

1. “Hyperlabemia:” Likely iatrogenic etiology, or not. Correct with supplemental lab results.
2. Pain: Source unclear but probably malingering. Treat with excessive narcotics, thereby causing problems 3 and 4 (see below).
3. Bowel obstruction: Discontinue narcotics. Place (NG tube, rectal tube, boob tube, multiple consults).
4. Altered mental status: Baseline worsened by narcotics. Give benzodiazepines, antipsychotics, antihistamine, more narcotics; then intubate.
5. Discharge planning: The patient is a rock and will be on service forever.
6. Abnormal imaging: Perform further scans.
7. Code status: (Full code, no code, Morse code)
8. Pineal: Gland abnormal—consult the pineal gland service TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

The Prescriptionist

Birthdate: January 1-February 21

Symbol: Rx

There is a disease for every drug. If it’s new, you’re on it. You’re on the pharmacy and therapeutics committee, and when you get journals you read the ads first. You’ve never met a drug rep you didn’t like. You are willing to experiment on yourself if need be; you would have made a great hippie. You like to hang with double Helixes, but you also like to hang heparin, fentanyl, ephedrine, and anything else that will fit in a bag of D5W.

The Statistician

Birthdate: February 22-April 19 (+/-two days)

Symbol: 1A

Evidence-based medicine is your mantra. You will do nothing without a double-blind, randomized multicenter control study. You are a therapeutic nihilist. You read Sherlock Holmes as a child. As you are reading this, you are wondering why you were assigned this month and how they know that this horoscope is correct. What was the control group? Is it a horoscopic placebo effect? You will submit an article to a major journal and have it rejected because your sample size was too small.

The Sentinel

Birthdate: April 20-May 20

Symbol: The Guardsman

You are always alert, but somehow bad things still happen to your patients. Delirious octogenarians fall out of bed and fracture their femurs; mistaken medications are administered, leading to adverse consequences. You admitted a diabetic patient for a below-the-knee amputation. The surgeon did a wonderful job and took off the left leg—too bad it was the wrong patient. The patient who was due for the amputation had an inadvertent orchiectomy. You cannot stop using abbreviations. A JCAHO survey is in your future; perhaps it is a good time for a vacation.

Hirudis

Birthdate: May 21-June 20

Symbol: The Leach

You love to order tests: CAT scans. PET Scans. Ultrasounds and Dopplers. You want contrast? That’s no problem! We’ll just Mucomyst and bicarb the patient. You especially love phlebotomy. Every patient gets full lab every day. You would not want to miss a drop in hemoglobin, even if you caused it with excessive phlebotomy. If the patient is a tough stick, you’ll give it a try. You once found a vein on a particularly cicatricial heroin addict and you are still talking about it. You love Bela Lugosi movies.

The Chairman

Birthdate: June 21-July 20

Symbol: The Gavel

You love committees. Face it—there is not one you don’t want to be on. You like to know what’s going on and want to be involved. You don’t want someone to surprise you. You prefer to run the meeting and talk more than anyone else. As you read this, you think it could have been written more concisely, and you advise the formation of an ad hoc committee for wordsmithing, after which it will be sent to the communications committee, then on to exec. SHM has a place for you.

Nimbus

Birthdate: July 21–August 20 and August 22–September 20

Symbol: The Black Cloud

When you have been on hospital duty, nobody wants to take over the service from you. You always have the most patients. When you are on nights, you have 27 admissions when other people don’t get any. Your patients always get chest pain as you are about to roll over the pager, and it’s guaranteed not to be gas. Your post-op patients get to the floor very late, and they always have ileus, urinary retention, and delirium. You are paged constantly, even on your day off. The computer system just crashed; you must be on call. Your patients love you because you are always there.

The Dumpster

Birthdate: August 21

Symbol: The Garbage Can

You never mind leaving some work for your colleagues; you would not want them to be bored. You are going on vacation and need to leave early to pack, you have a headache and are home sick, or your dog has the flu, can somebody cover? Your discharge summaries are sketchy; you like to have residents so that they can do your paperwork for you. You are on good terms with Inertias and always seem to be changing call nights with Nimbuses.

The Geneticist

Birthdate: September 21-October 20

Symbol: The Double Helix

Face it—you’re twisted, dude. You like things to align nicely; your clothing always matches your shoes. You love consanguinity and the interesting diseases that develop. Nobody knows what you are talking about at parties. You hear hoofbeats (it’s not a horse). Bad news: They just discovered that Linus Pauling was right. DNA is a triple helix.

Inertia

Birthdate: October 21–November 19

Symbol: The Snail

You think the world is changing too fast. You were right about HMOs and still think LBJ made a mistake when he signed Medicare into law. When you are on a committee, you always find something that needs a rewrite. You always want a second review.

If it was good enough for you, it’s good enough for those who follow you. You still write notes by hand and are damned if you’ll learn how to operate a computer.

You are a natural bureaucrat. You love to block Chairmen from getting anything done.

The Techie

Birthdate: November 20 at 6 a.m.-December 31 at 11:59p.m.

Symbol: The Palm Pilot

You are first to embrace a new technology. If it’s embedded, you’ll root it out. You get your news from a podcast, and you have a Blackberry and a Blueberry. You don’t understand how anyone could not like having an electronic health record. Your entire medical school education is saved on a memory card, though you are not sure where it is. Your secret shame: Your vintage VCR still has a blinking red light. You get along well with Chairmen as long as they move your technology request through the committees. You would like to see all Inertias implode. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

The Prescriptionist

Birthdate: January 1-February 21

Symbol: Rx

There is a disease for every drug. If it’s new, you’re on it. You’re on the pharmacy and therapeutics committee, and when you get journals you read the ads first. You’ve never met a drug rep you didn’t like. You are willing to experiment on yourself if need be; you would have made a great hippie. You like to hang with double Helixes, but you also like to hang heparin, fentanyl, ephedrine, and anything else that will fit in a bag of D5W.

The Statistician

Birthdate: February 22-April 19 (+/-two days)

Symbol: 1A

Evidence-based medicine is your mantra. You will do nothing without a double-blind, randomized multicenter control study. You are a therapeutic nihilist. You read Sherlock Holmes as a child. As you are reading this, you are wondering why you were assigned this month and how they know that this horoscope is correct. What was the control group? Is it a horoscopic placebo effect? You will submit an article to a major journal and have it rejected because your sample size was too small.

The Sentinel

Birthdate: April 20-May 20

Symbol: The Guardsman

You are always alert, but somehow bad things still happen to your patients. Delirious octogenarians fall out of bed and fracture their femurs; mistaken medications are administered, leading to adverse consequences. You admitted a diabetic patient for a below-the-knee amputation. The surgeon did a wonderful job and took off the left leg—too bad it was the wrong patient. The patient who was due for the amputation had an inadvertent orchiectomy. You cannot stop using abbreviations. A JCAHO survey is in your future; perhaps it is a good time for a vacation.

Hirudis

Birthdate: May 21-June 20

Symbol: The Leach

You love to order tests: CAT scans. PET Scans. Ultrasounds and Dopplers. You want contrast? That’s no problem! We’ll just Mucomyst and bicarb the patient. You especially love phlebotomy. Every patient gets full lab every day. You would not want to miss a drop in hemoglobin, even if you caused it with excessive phlebotomy. If the patient is a tough stick, you’ll give it a try. You once found a vein on a particularly cicatricial heroin addict and you are still talking about it. You love Bela Lugosi movies.

The Chairman

Birthdate: June 21-July 20

Symbol: The Gavel

You love committees. Face it—there is not one you don’t want to be on. You like to know what’s going on and want to be involved. You don’t want someone to surprise you. You prefer to run the meeting and talk more than anyone else. As you read this, you think it could have been written more concisely, and you advise the formation of an ad hoc committee for wordsmithing, after which it will be sent to the communications committee, then on to exec. SHM has a place for you.

Nimbus

Birthdate: July 21–August 20 and August 22–September 20

Symbol: The Black Cloud

When you have been on hospital duty, nobody wants to take over the service from you. You always have the most patients. When you are on nights, you have 27 admissions when other people don’t get any. Your patients always get chest pain as you are about to roll over the pager, and it’s guaranteed not to be gas. Your post-op patients get to the floor very late, and they always have ileus, urinary retention, and delirium. You are paged constantly, even on your day off. The computer system just crashed; you must be on call. Your patients love you because you are always there.

The Dumpster

Birthdate: August 21

Symbol: The Garbage Can

You never mind leaving some work for your colleagues; you would not want them to be bored. You are going on vacation and need to leave early to pack, you have a headache and are home sick, or your dog has the flu, can somebody cover? Your discharge summaries are sketchy; you like to have residents so that they can do your paperwork for you. You are on good terms with Inertias and always seem to be changing call nights with Nimbuses.

The Geneticist

Birthdate: September 21-October 20

Symbol: The Double Helix

Face it—you’re twisted, dude. You like things to align nicely; your clothing always matches your shoes. You love consanguinity and the interesting diseases that develop. Nobody knows what you are talking about at parties. You hear hoofbeats (it’s not a horse). Bad news: They just discovered that Linus Pauling was right. DNA is a triple helix.

Inertia

Birthdate: October 21–November 19

Symbol: The Snail

You think the world is changing too fast. You were right about HMOs and still think LBJ made a mistake when he signed Medicare into law. When you are on a committee, you always find something that needs a rewrite. You always want a second review.

If it was good enough for you, it’s good enough for those who follow you. You still write notes by hand and are damned if you’ll learn how to operate a computer.

You are a natural bureaucrat. You love to block Chairmen from getting anything done.

The Techie

Birthdate: November 20 at 6 a.m.-December 31 at 11:59p.m.

Symbol: The Palm Pilot

You are first to embrace a new technology. If it’s embedded, you’ll root it out. You get your news from a podcast, and you have a Blackberry and a Blueberry. You don’t understand how anyone could not like having an electronic health record. Your entire medical school education is saved on a memory card, though you are not sure where it is. Your secret shame: Your vintage VCR still has a blinking red light. You get along well with Chairmen as long as they move your technology request through the committees. You would like to see all Inertias implode. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

The Prescriptionist

Birthdate: January 1-February 21

Symbol: Rx

There is a disease for every drug. If it’s new, you’re on it. You’re on the pharmacy and therapeutics committee, and when you get journals you read the ads first. You’ve never met a drug rep you didn’t like. You are willing to experiment on yourself if need be; you would have made a great hippie. You like to hang with double Helixes, but you also like to hang heparin, fentanyl, ephedrine, and anything else that will fit in a bag of D5W.

The Statistician

Birthdate: February 22-April 19 (+/-two days)

Symbol: 1A

Evidence-based medicine is your mantra. You will do nothing without a double-blind, randomized multicenter control study. You are a therapeutic nihilist. You read Sherlock Holmes as a child. As you are reading this, you are wondering why you were assigned this month and how they know that this horoscope is correct. What was the control group? Is it a horoscopic placebo effect? You will submit an article to a major journal and have it rejected because your sample size was too small.

The Sentinel

Birthdate: April 20-May 20

Symbol: The Guardsman

You are always alert, but somehow bad things still happen to your patients. Delirious octogenarians fall out of bed and fracture their femurs; mistaken medications are administered, leading to adverse consequences. You admitted a diabetic patient for a below-the-knee amputation. The surgeon did a wonderful job and took off the left leg—too bad it was the wrong patient. The patient who was due for the amputation had an inadvertent orchiectomy. You cannot stop using abbreviations. A JCAHO survey is in your future; perhaps it is a good time for a vacation.

Hirudis

Birthdate: May 21-June 20

Symbol: The Leach

You love to order tests: CAT scans. PET Scans. Ultrasounds and Dopplers. You want contrast? That’s no problem! We’ll just Mucomyst and bicarb the patient. You especially love phlebotomy. Every patient gets full lab every day. You would not want to miss a drop in hemoglobin, even if you caused it with excessive phlebotomy. If the patient is a tough stick, you’ll give it a try. You once found a vein on a particularly cicatricial heroin addict and you are still talking about it. You love Bela Lugosi movies.

The Chairman

Birthdate: June 21-July 20

Symbol: The Gavel

You love committees. Face it—there is not one you don’t want to be on. You like to know what’s going on and want to be involved. You don’t want someone to surprise you. You prefer to run the meeting and talk more than anyone else. As you read this, you think it could have been written more concisely, and you advise the formation of an ad hoc committee for wordsmithing, after which it will be sent to the communications committee, then on to exec. SHM has a place for you.

Nimbus

Birthdate: July 21–August 20 and August 22–September 20

Symbol: The Black Cloud

When you have been on hospital duty, nobody wants to take over the service from you. You always have the most patients. When you are on nights, you have 27 admissions when other people don’t get any. Your patients always get chest pain as you are about to roll over the pager, and it’s guaranteed not to be gas. Your post-op patients get to the floor very late, and they always have ileus, urinary retention, and delirium. You are paged constantly, even on your day off. The computer system just crashed; you must be on call. Your patients love you because you are always there.

The Dumpster

Birthdate: August 21

Symbol: The Garbage Can

You never mind leaving some work for your colleagues; you would not want them to be bored. You are going on vacation and need to leave early to pack, you have a headache and are home sick, or your dog has the flu, can somebody cover? Your discharge summaries are sketchy; you like to have residents so that they can do your paperwork for you. You are on good terms with Inertias and always seem to be changing call nights with Nimbuses.

The Geneticist

Birthdate: September 21-October 20

Symbol: The Double Helix

Face it—you’re twisted, dude. You like things to align nicely; your clothing always matches your shoes. You love consanguinity and the interesting diseases that develop. Nobody knows what you are talking about at parties. You hear hoofbeats (it’s not a horse). Bad news: They just discovered that Linus Pauling was right. DNA is a triple helix.

Inertia

Birthdate: October 21–November 19

Symbol: The Snail

You think the world is changing too fast. You were right about HMOs and still think LBJ made a mistake when he signed Medicare into law. When you are on a committee, you always find something that needs a rewrite. You always want a second review.

If it was good enough for you, it’s good enough for those who follow you. You still write notes by hand and are damned if you’ll learn how to operate a computer.

You are a natural bureaucrat. You love to block Chairmen from getting anything done.

The Techie

Birthdate: November 20 at 6 a.m.-December 31 at 11:59p.m.

Symbol: The Palm Pilot

You are first to embrace a new technology. If it’s embedded, you’ll root it out. You get your news from a podcast, and you have a Blackberry and a Blueberry. You don’t understand how anyone could not like having an electronic health record. Your entire medical school education is saved on a memory card, though you are not sure where it is. Your secret shame: Your vintage VCR still has a blinking red light. You get along well with Chairmen as long as they move your technology request through the committees. You would like to see all Inertias implode. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.

I always loved the game Hot Potato. A more stationary version of musical chairs, it involves the passing of the spud as the music plays or the clock ticks, then the last-minute handoff; the excitement of that game trained me for a life of brinkmanship.

The earliest version of the game involved passing a lit candle, with the loser holding the extinguished taper. I always enjoyed my cold war version, a wind-up fake bomb passed around the circle. Hot Potato was the name of a terrible Jim Kelly martial arts movie in 1976, and an even worse short-lived NBC game show in 1984. It is even a poorly rated video game. The newest “Hot Potato” is a computer routing system.

In the game Hot Potato, you never want to be the one with the spud when the music stops. Unfortunately, sometimes patients become that hot potato.

When I was a first-year medical student, I wanted my own patients. I shared the clinical experience with others grudgingly. Someone else would always ask the question I wanted to; they routinely heard the murmur first. Every patient was a new mystery to be solved, a reminder of how little I knew (and still don’t know). By my senior year of school, I still wanted my own patients, but I wanted the most exotic and difficult cases I could find, as a matter of principle.

By internship that glory had faded. I was harassed, sleep deprived, overworked, and underpaid, but otherwise I was OK. If I could avoid another admission, I was happy. New terminology entered my vocabulary. Expressions like “He’s a sieve” or “She’s a wall” described my coworkers in the emergency department (ED). Why would they admit that patient, were they crazy? Your chief resident was strong or weak based on turfing prowess. What could be sweeter than a bounce back to the other service?

Maybe Spud ended up on your service for a reason?

As a resident, I perfected what Samuel Shem (a.k.a., Stephen Bergman, MD) described in the classic The House of God as the “buff and turf.” Transfer to surgery, no problem. Patient wants to leave AMA, just have him sign the paperwork. This negative attitude was pervasive. A team was judged by the strength of the resident, and measured by the relative size of the census. Of course, residents today would never feel this way, given work hour limits. That was in the old days.

As a newly minted private practice internist, I wanted all the patients I could see. I took every ED admit, opened all my slots. I was building my practice. I was on a productivity formula and wanted to surpass my targets. I was incentivized. It seemed odd to be working so hard to get patients when I had done the opposite just one year earlier. My colleagues looked on in amazement as I said yes to everything. The best advice I was ever given was to say no, but I did not heed it.

After a few years in practice, I was well stocked with patients. I still accepted all Medicare patients; at the time, I was the only one in private practice who would do so secondary to the lower pay rate. I didn’t mind because of my interest in geriatrics. I enjoyed these old folks, plus they brought in the best homegrown produce. My kids grew sick of okra.

When the HMOs came to town, with their IPAs and IPOs, along with other alphabetic acronyms too fierce to mention, I was once again incentivized to not see patients. It was fine for me to capture their PMPM (per member per month) fee, but I wasn’t encouraged to actually see them, and hospitalization involved a tremendous amount of paperwork and psychological conflict with my IPA handlers. “Do you really need that MRI?” was the question of the day.

I spent a brief and disastrous year in the world of practice management groups, where patients were subsidiary to stock value and practice acquisition. I emerged bent but not broken. Well, maybe slightly broken. Yes, money is the root of all evil.

Next, I began to work for a community-based university practice, on a straight salary. My financial incentives were eliminated, I saw as many as I comfortably could, and I forgot about the money. Life was good. I had a few medical students and an intern. We saw a large but comfortable volume of patients, mostly geriatric. I always tried to see the people who needed to be seen, but not so many that a visit was too brief.

The dark side reared its head again when I got a new boss who wanted the community university practice to go on productivity. Once again I was back to the bean counting rat race: see more patients and squeeze in an extra three this afternoon. “What do you mean you want a day off?”

But then I became a hospitalist and all was right with the world again. It was an excellent consultative practice with ample opportunities for teaching and research. Unfortunately, when the resident hours rules began, we found ourselves staffing services formerly run by teaching teams. We also found ourselves in rotation with the remaining teams.

This was the moment of truth. Would I return to my long abandoned roots? Would I begin once again to order the “surf and turf” platter? Happily, the answer has been “No.” The fullness of time has helped me to realize that patients are not hot potatoes. There are days when I find myself watching the admit board intently or wondering why one service or another is not taking their bounce backs. I have found, however, that the mental energy that is wasted in playing Hot Potato is needed to care for the patients who seek our help. Would I want my mother sitting in an ED while three services did their best to not have her on their lists? OK, in my mom’s case, I could understand. (Just joking, Arlene.)

So, the next time you get the call from the ED and find yourself wondering what that patient is doing on your service, think about the game of Hot Potato. Perhaps when the music stops, you are the right one to have the spud in hand. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

I always loved the game Hot Potato. A more stationary version of musical chairs, it involves the passing of the spud as the music plays or the clock ticks, then the last-minute handoff; the excitement of that game trained me for a life of brinkmanship.

The earliest version of the game involved passing a lit candle, with the loser holding the extinguished taper. I always enjoyed my cold war version, a wind-up fake bomb passed around the circle. Hot Potato was the name of a terrible Jim Kelly martial arts movie in 1976, and an even worse short-lived NBC game show in 1984. It is even a poorly rated video game. The newest “Hot Potato” is a computer routing system.

In the game Hot Potato, you never want to be the one with the spud when the music stops. Unfortunately, sometimes patients become that hot potato.

When I was a first-year medical student, I wanted my own patients. I shared the clinical experience with others grudgingly. Someone else would always ask the question I wanted to; they routinely heard the murmur first. Every patient was a new mystery to be solved, a reminder of how little I knew (and still don’t know). By my senior year of school, I still wanted my own patients, but I wanted the most exotic and difficult cases I could find, as a matter of principle.

By internship that glory had faded. I was harassed, sleep deprived, overworked, and underpaid, but otherwise I was OK. If I could avoid another admission, I was happy. New terminology entered my vocabulary. Expressions like “He’s a sieve” or “She’s a wall” described my coworkers in the emergency department (ED). Why would they admit that patient, were they crazy? Your chief resident was strong or weak based on turfing prowess. What could be sweeter than a bounce back to the other service?

Maybe Spud ended up on your service for a reason?

As a resident, I perfected what Samuel Shem (a.k.a., Stephen Bergman, MD) described in the classic The House of God as the “buff and turf.” Transfer to surgery, no problem. Patient wants to leave AMA, just have him sign the paperwork. This negative attitude was pervasive. A team was judged by the strength of the resident, and measured by the relative size of the census. Of course, residents today would never feel this way, given work hour limits. That was in the old days.

As a newly minted private practice internist, I wanted all the patients I could see. I took every ED admit, opened all my slots. I was building my practice. I was on a productivity formula and wanted to surpass my targets. I was incentivized. It seemed odd to be working so hard to get patients when I had done the opposite just one year earlier. My colleagues looked on in amazement as I said yes to everything. The best advice I was ever given was to say no, but I did not heed it.

After a few years in practice, I was well stocked with patients. I still accepted all Medicare patients; at the time, I was the only one in private practice who would do so secondary to the lower pay rate. I didn’t mind because of my interest in geriatrics. I enjoyed these old folks, plus they brought in the best homegrown produce. My kids grew sick of okra.

When the HMOs came to town, with their IPAs and IPOs, along with other alphabetic acronyms too fierce to mention, I was once again incentivized to not see patients. It was fine for me to capture their PMPM (per member per month) fee, but I wasn’t encouraged to actually see them, and hospitalization involved a tremendous amount of paperwork and psychological conflict with my IPA handlers. “Do you really need that MRI?” was the question of the day.

I spent a brief and disastrous year in the world of practice management groups, where patients were subsidiary to stock value and practice acquisition. I emerged bent but not broken. Well, maybe slightly broken. Yes, money is the root of all evil.

Next, I began to work for a community-based university practice, on a straight salary. My financial incentives were eliminated, I saw as many as I comfortably could, and I forgot about the money. Life was good. I had a few medical students and an intern. We saw a large but comfortable volume of patients, mostly geriatric. I always tried to see the people who needed to be seen, but not so many that a visit was too brief.

The dark side reared its head again when I got a new boss who wanted the community university practice to go on productivity. Once again I was back to the bean counting rat race: see more patients and squeeze in an extra three this afternoon. “What do you mean you want a day off?”

But then I became a hospitalist and all was right with the world again. It was an excellent consultative practice with ample opportunities for teaching and research. Unfortunately, when the resident hours rules began, we found ourselves staffing services formerly run by teaching teams. We also found ourselves in rotation with the remaining teams.

This was the moment of truth. Would I return to my long abandoned roots? Would I begin once again to order the “surf and turf” platter? Happily, the answer has been “No.” The fullness of time has helped me to realize that patients are not hot potatoes. There are days when I find myself watching the admit board intently or wondering why one service or another is not taking their bounce backs. I have found, however, that the mental energy that is wasted in playing Hot Potato is needed to care for the patients who seek our help. Would I want my mother sitting in an ED while three services did their best to not have her on their lists? OK, in my mom’s case, I could understand. (Just joking, Arlene.)

So, the next time you get the call from the ED and find yourself wondering what that patient is doing on your service, think about the game of Hot Potato. Perhaps when the music stops, you are the right one to have the spud in hand. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

I always loved the game Hot Potato. A more stationary version of musical chairs, it involves the passing of the spud as the music plays or the clock ticks, then the last-minute handoff; the excitement of that game trained me for a life of brinkmanship.

The earliest version of the game involved passing a lit candle, with the loser holding the extinguished taper. I always enjoyed my cold war version, a wind-up fake bomb passed around the circle. Hot Potato was the name of a terrible Jim Kelly martial arts movie in 1976, and an even worse short-lived NBC game show in 1984. It is even a poorly rated video game. The newest “Hot Potato” is a computer routing system.

In the game Hot Potato, you never want to be the one with the spud when the music stops. Unfortunately, sometimes patients become that hot potato.

When I was a first-year medical student, I wanted my own patients. I shared the clinical experience with others grudgingly. Someone else would always ask the question I wanted to; they routinely heard the murmur first. Every patient was a new mystery to be solved, a reminder of how little I knew (and still don’t know). By my senior year of school, I still wanted my own patients, but I wanted the most exotic and difficult cases I could find, as a matter of principle.

By internship that glory had faded. I was harassed, sleep deprived, overworked, and underpaid, but otherwise I was OK. If I could avoid another admission, I was happy. New terminology entered my vocabulary. Expressions like “He’s a sieve” or “She’s a wall” described my coworkers in the emergency department (ED). Why would they admit that patient, were they crazy? Your chief resident was strong or weak based on turfing prowess. What could be sweeter than a bounce back to the other service?

Maybe Spud ended up on your service for a reason?

As a resident, I perfected what Samuel Shem (a.k.a., Stephen Bergman, MD) described in the classic The House of God as the “buff and turf.” Transfer to surgery, no problem. Patient wants to leave AMA, just have him sign the paperwork. This negative attitude was pervasive. A team was judged by the strength of the resident, and measured by the relative size of the census. Of course, residents today would never feel this way, given work hour limits. That was in the old days.

As a newly minted private practice internist, I wanted all the patients I could see. I took every ED admit, opened all my slots. I was building my practice. I was on a productivity formula and wanted to surpass my targets. I was incentivized. It seemed odd to be working so hard to get patients when I had done the opposite just one year earlier. My colleagues looked on in amazement as I said yes to everything. The best advice I was ever given was to say no, but I did not heed it.

After a few years in practice, I was well stocked with patients. I still accepted all Medicare patients; at the time, I was the only one in private practice who would do so secondary to the lower pay rate. I didn’t mind because of my interest in geriatrics. I enjoyed these old folks, plus they brought in the best homegrown produce. My kids grew sick of okra.

When the HMOs came to town, with their IPAs and IPOs, along with other alphabetic acronyms too fierce to mention, I was once again incentivized to not see patients. It was fine for me to capture their PMPM (per member per month) fee, but I wasn’t encouraged to actually see them, and hospitalization involved a tremendous amount of paperwork and psychological conflict with my IPA handlers. “Do you really need that MRI?” was the question of the day.

I spent a brief and disastrous year in the world of practice management groups, where patients were subsidiary to stock value and practice acquisition. I emerged bent but not broken. Well, maybe slightly broken. Yes, money is the root of all evil.

Next, I began to work for a community-based university practice, on a straight salary. My financial incentives were eliminated, I saw as many as I comfortably could, and I forgot about the money. Life was good. I had a few medical students and an intern. We saw a large but comfortable volume of patients, mostly geriatric. I always tried to see the people who needed to be seen, but not so many that a visit was too brief.

The dark side reared its head again when I got a new boss who wanted the community university practice to go on productivity. Once again I was back to the bean counting rat race: see more patients and squeeze in an extra three this afternoon. “What do you mean you want a day off?”

But then I became a hospitalist and all was right with the world again. It was an excellent consultative practice with ample opportunities for teaching and research. Unfortunately, when the resident hours rules began, we found ourselves staffing services formerly run by teaching teams. We also found ourselves in rotation with the remaining teams.

This was the moment of truth. Would I return to my long abandoned roots? Would I begin once again to order the “surf and turf” platter? Happily, the answer has been “No.” The fullness of time has helped me to realize that patients are not hot potatoes. There are days when I find myself watching the admit board intently or wondering why one service or another is not taking their bounce backs. I have found, however, that the mental energy that is wasted in playing Hot Potato is needed to care for the patients who seek our help. Would I want my mother sitting in an ED while three services did their best to not have her on their lists? OK, in my mom’s case, I could understand. (Just joking, Arlene.)

So, the next time you get the call from the ED and find yourself wondering what that patient is doing on your service, think about the game of Hot Potato. Perhaps when the music stops, you are the right one to have the spud in hand. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.