Michael J. Pistoria, DO

I do not like to shave.

There are multiple reasons for this. I do not like the extra time it takes in the morning. Too often, I wind up with one or two cuts. I happen to like a little bit of stubble. My attitude toward shaving softened somewhat 2 years ago when my wife got me a wonderful gift – an old-fashioned shaving kit. I now use shaving soap with the cool shaving brush instead of squirting lotion out of a can. The process has become more fun, but I only shave slightly more frequently than I did before the gift.

Why am I writing about this? Not too long ago, a JAMA article examined the relationship between physician grooming and attire and patient/family perceptions of those physicians. The study was done in an intensive care unit (ICU) setting and demonstrated that neat grooming, professional dress and wearing a name tag were important considerations on the part of respondents. More than 300 family members of critically ill patients were asked to rate the importance of ten factors related to physician appearance. They were also showed four photos of physicians in various styles of dress and asked to select the best physician from those photos.

In rating the physician-related factors, nearly 80% of family members thought an easy to read name tag was important. Neat grooming was of major importance to 65% of those surveyed, while 59% wanted to see professional attire. In this portion of the study, only 32% felt a while coat was important. However, when presented with the various photographs of physicians, 52% of respondents thought the physician wearing the white coat was the best physician.

I have several inflection points on my growth curve pertaining to grooming and dress as a physician. My first occurred as a senior resident in the ICU. I felt I had earned a certain amount of respect and latitude based upon my performance as an intern. Thus, when I was on call during the weekend, I would wear jeans with a scrub top instead of just plain scrubs. One of the first times I did this, a nurse literally berated me for wearing jeans. I was told it was not a professional look – my patients deserved better.

I took her advice under consideration and ignored it. I continued to wear jeans (with a nice button down shirt, sometimes with a sweater) as an attending when I was doing weekend rounds. Several years ago, I had risen to positions of some prominence within my former hospital. I thought of that conversation with the nurse, and it dawned on me that I should always look the part of a physician – especially a physician leader. The jeans went back to the closet, only to be worn outside of work.

The second inflection point is courtesy of my former CEO. During the time we worked together, he was always meticulously dressed and groomed. One day, he related an incident that occurred to him during his residency. He was post call and, in the interest of several extra minutes of sleep, had neglected to shave. He had his continuity clinic that day and one of his favorite patients – a woman in her 70s – was on his schedule. On that day, she had brought her grandson with her to the visit. She hoped to inspire the grandson to pursue something more with his life.

After the visit, she asked her grandson to wait outside the exam room for a moment. After he stepped out of the room, she proceeded to inform my former CEO that she expected more of him – that he should look like a doctor at all times. She brought her grandson to see her physician and not an unshaven individual who – in her mind – did not look the part. It was an important lesson for him and clearly changed his attitude toward dress and grooming.

This study is a reminder of the importance of our appearance as physicians and health care providers. As that ICU nurse pointed out to me many years ago, our patients deserve our best – let us give it to them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

I do not like to shave.

There are multiple reasons for this. I do not like the extra time it takes in the morning. Too often, I wind up with one or two cuts. I happen to like a little bit of stubble. My attitude toward shaving softened somewhat 2 years ago when my wife got me a wonderful gift – an old-fashioned shaving kit. I now use shaving soap with the cool shaving brush instead of squirting lotion out of a can. The process has become more fun, but I only shave slightly more frequently than I did before the gift.

Why am I writing about this? Not too long ago, a JAMA article examined the relationship between physician grooming and attire and patient/family perceptions of those physicians. The study was done in an intensive care unit (ICU) setting and demonstrated that neat grooming, professional dress and wearing a name tag were important considerations on the part of respondents. More than 300 family members of critically ill patients were asked to rate the importance of ten factors related to physician appearance. They were also showed four photos of physicians in various styles of dress and asked to select the best physician from those photos.

In rating the physician-related factors, nearly 80% of family members thought an easy to read name tag was important. Neat grooming was of major importance to 65% of those surveyed, while 59% wanted to see professional attire. In this portion of the study, only 32% felt a while coat was important. However, when presented with the various photographs of physicians, 52% of respondents thought the physician wearing the white coat was the best physician.

I have several inflection points on my growth curve pertaining to grooming and dress as a physician. My first occurred as a senior resident in the ICU. I felt I had earned a certain amount of respect and latitude based upon my performance as an intern. Thus, when I was on call during the weekend, I would wear jeans with a scrub top instead of just plain scrubs. One of the first times I did this, a nurse literally berated me for wearing jeans. I was told it was not a professional look – my patients deserved better.

I took her advice under consideration and ignored it. I continued to wear jeans (with a nice button down shirt, sometimes with a sweater) as an attending when I was doing weekend rounds. Several years ago, I had risen to positions of some prominence within my former hospital. I thought of that conversation with the nurse, and it dawned on me that I should always look the part of a physician – especially a physician leader. The jeans went back to the closet, only to be worn outside of work.

The second inflection point is courtesy of my former CEO. During the time we worked together, he was always meticulously dressed and groomed. One day, he related an incident that occurred to him during his residency. He was post call and, in the interest of several extra minutes of sleep, had neglected to shave. He had his continuity clinic that day and one of his favorite patients – a woman in her 70s – was on his schedule. On that day, she had brought her grandson with her to the visit. She hoped to inspire the grandson to pursue something more with his life.

After the visit, she asked her grandson to wait outside the exam room for a moment. After he stepped out of the room, she proceeded to inform my former CEO that she expected more of him – that he should look like a doctor at all times. She brought her grandson to see her physician and not an unshaven individual who – in her mind – did not look the part. It was an important lesson for him and clearly changed his attitude toward dress and grooming.

This study is a reminder of the importance of our appearance as physicians and health care providers. As that ICU nurse pointed out to me many years ago, our patients deserve our best – let us give it to them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

I do not like to shave.

There are multiple reasons for this. I do not like the extra time it takes in the morning. Too often, I wind up with one or two cuts. I happen to like a little bit of stubble. My attitude toward shaving softened somewhat 2 years ago when my wife got me a wonderful gift – an old-fashioned shaving kit. I now use shaving soap with the cool shaving brush instead of squirting lotion out of a can. The process has become more fun, but I only shave slightly more frequently than I did before the gift.

Why am I writing about this? Not too long ago, a JAMA article examined the relationship between physician grooming and attire and patient/family perceptions of those physicians. The study was done in an intensive care unit (ICU) setting and demonstrated that neat grooming, professional dress and wearing a name tag were important considerations on the part of respondents. More than 300 family members of critically ill patients were asked to rate the importance of ten factors related to physician appearance. They were also showed four photos of physicians in various styles of dress and asked to select the best physician from those photos.

In rating the physician-related factors, nearly 80% of family members thought an easy to read name tag was important. Neat grooming was of major importance to 65% of those surveyed, while 59% wanted to see professional attire. In this portion of the study, only 32% felt a while coat was important. However, when presented with the various photographs of physicians, 52% of respondents thought the physician wearing the white coat was the best physician.

I have several inflection points on my growth curve pertaining to grooming and dress as a physician. My first occurred as a senior resident in the ICU. I felt I had earned a certain amount of respect and latitude based upon my performance as an intern. Thus, when I was on call during the weekend, I would wear jeans with a scrub top instead of just plain scrubs. One of the first times I did this, a nurse literally berated me for wearing jeans. I was told it was not a professional look – my patients deserved better.

I took her advice under consideration and ignored it. I continued to wear jeans (with a nice button down shirt, sometimes with a sweater) as an attending when I was doing weekend rounds. Several years ago, I had risen to positions of some prominence within my former hospital. I thought of that conversation with the nurse, and it dawned on me that I should always look the part of a physician – especially a physician leader. The jeans went back to the closet, only to be worn outside of work.

The second inflection point is courtesy of my former CEO. During the time we worked together, he was always meticulously dressed and groomed. One day, he related an incident that occurred to him during his residency. He was post call and, in the interest of several extra minutes of sleep, had neglected to shave. He had his continuity clinic that day and one of his favorite patients – a woman in her 70s – was on his schedule. On that day, she had brought her grandson with her to the visit. She hoped to inspire the grandson to pursue something more with his life.

After the visit, she asked her grandson to wait outside the exam room for a moment. After he stepped out of the room, she proceeded to inform my former CEO that she expected more of him – that he should look like a doctor at all times. She brought her grandson to see her physician and not an unshaven individual who – in her mind – did not look the part. It was an important lesson for him and clearly changed his attitude toward dress and grooming.

This study is a reminder of the importance of our appearance as physicians and health care providers. As that ICU nurse pointed out to me many years ago, our patients deserve our best – let us give it to them.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

My name is Mike – Michael, technically. I was named after my aunt’s son, who tragically died at a young age. As a child, I loved being called Michael and swore that I would never go by Mike. Times change, and Mike quickly became my preference. At this point, only family members and a handful of close friends call me Michael.

At work, I am Dr. Pistoria, and that has bothered me for years. In my former job (where I had spent almost 17 years) enough people had become comfortable enough with me to call me Mike. However, nearly all of the nursing staff and case management staff on the floor I used to work called me Dr. Pistoria. This was despite the fact that we had worked together on a daily basis for the better part of 3 years. With few exceptions, I was unable to get people to use my given name.

In my new job, I again work very closely with a relatively small group of people. After several months on the job, I asked people to feel free to use my given name. Almost universally, the response was “I can’t do that.” When queried for a reason, most people thought it was a matter of respect. I had worked hard to become a physician, and I deserved the respect of being referred to as “Doctor.”

When I introduce myself to patients, I use my full name and tell them I am the hospital medicine physician who will be caring for them. I do not use “Doctor.” The same applies when I identify myself over the telephone at work – I am Mike Pistoria, a physician at Coordinated Health, and never Dr. Pistoria.

My thoughts on this were recently challenged at a conference where there was some discussion about the power differential involved with being a physician. Physicians, in almost any professional relationship, either do or are perceived to hold the lion’s share of power. The conversation turned to respecting that power differential and avoiding anything that might be perceived as leveling the playing field and possibly putting the physician at risk for boundary issues with patients, staff, and others.

It was an interesting discussion. I made clear my preference to be called by my given name. I spoke of the value of caring for patients in high-functioning interdisciplinary teams. I recognized that while every team must have a captain, I pushed back against the argument that the captain – in this instance – must be referred to as “Doctor.” Others disagreed sharply. They either wanted the respect they felt they deserved or had concerns about minimizing the power differential and the potential for boundary violations.

The whole discussion prompted a reevaluation of my viewpoint. As I heard from people who had been impacted by boundary violations – they had allowed people to get too close to them and had been taken advantage of or had blurred the line between professional and personal relationships – I started to question my stand. I have not fully resolved this issue for myself yet, but I do think I will stop pushing so much for people to use my given name.

I think I can learn to live with people calling me “Doctor.” I think I can effectively continue to lead interdisciplinary teams in a meaningful way, generating a true sense of team, while people demonstrate the respect they believe I deserve. I think if people want to be a little more informal with me, “Dr. Mike” will work in the future.

Now, if I can just find a way to stop people from calling me “sir”…

Dr. Mike is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

My name is Mike – Michael, technically. I was named after my aunt’s son, who tragically died at a young age. As a child, I loved being called Michael and swore that I would never go by Mike. Times change, and Mike quickly became my preference. At this point, only family members and a handful of close friends call me Michael.

At work, I am Dr. Pistoria, and that has bothered me for years. In my former job (where I had spent almost 17 years) enough people had become comfortable enough with me to call me Mike. However, nearly all of the nursing staff and case management staff on the floor I used to work called me Dr. Pistoria. This was despite the fact that we had worked together on a daily basis for the better part of 3 years. With few exceptions, I was unable to get people to use my given name.

In my new job, I again work very closely with a relatively small group of people. After several months on the job, I asked people to feel free to use my given name. Almost universally, the response was “I can’t do that.” When queried for a reason, most people thought it was a matter of respect. I had worked hard to become a physician, and I deserved the respect of being referred to as “Doctor.”

When I introduce myself to patients, I use my full name and tell them I am the hospital medicine physician who will be caring for them. I do not use “Doctor.” The same applies when I identify myself over the telephone at work – I am Mike Pistoria, a physician at Coordinated Health, and never Dr. Pistoria.

My thoughts on this were recently challenged at a conference where there was some discussion about the power differential involved with being a physician. Physicians, in almost any professional relationship, either do or are perceived to hold the lion’s share of power. The conversation turned to respecting that power differential and avoiding anything that might be perceived as leveling the playing field and possibly putting the physician at risk for boundary issues with patients, staff, and others.

It was an interesting discussion. I made clear my preference to be called by my given name. I spoke of the value of caring for patients in high-functioning interdisciplinary teams. I recognized that while every team must have a captain, I pushed back against the argument that the captain – in this instance – must be referred to as “Doctor.” Others disagreed sharply. They either wanted the respect they felt they deserved or had concerns about minimizing the power differential and the potential for boundary violations.

The whole discussion prompted a reevaluation of my viewpoint. As I heard from people who had been impacted by boundary violations – they had allowed people to get too close to them and had been taken advantage of or had blurred the line between professional and personal relationships – I started to question my stand. I have not fully resolved this issue for myself yet, but I do think I will stop pushing so much for people to use my given name.

I think I can learn to live with people calling me “Doctor.” I think I can effectively continue to lead interdisciplinary teams in a meaningful way, generating a true sense of team, while people demonstrate the respect they believe I deserve. I think if people want to be a little more informal with me, “Dr. Mike” will work in the future.

Now, if I can just find a way to stop people from calling me “sir”…

Dr. Mike is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

My name is Mike – Michael, technically. I was named after my aunt’s son, who tragically died at a young age. As a child, I loved being called Michael and swore that I would never go by Mike. Times change, and Mike quickly became my preference. At this point, only family members and a handful of close friends call me Michael.

At work, I am Dr. Pistoria, and that has bothered me for years. In my former job (where I had spent almost 17 years) enough people had become comfortable enough with me to call me Mike. However, nearly all of the nursing staff and case management staff on the floor I used to work called me Dr. Pistoria. This was despite the fact that we had worked together on a daily basis for the better part of 3 years. With few exceptions, I was unable to get people to use my given name.

In my new job, I again work very closely with a relatively small group of people. After several months on the job, I asked people to feel free to use my given name. Almost universally, the response was “I can’t do that.” When queried for a reason, most people thought it was a matter of respect. I had worked hard to become a physician, and I deserved the respect of being referred to as “Doctor.”

When I introduce myself to patients, I use my full name and tell them I am the hospital medicine physician who will be caring for them. I do not use “Doctor.” The same applies when I identify myself over the telephone at work – I am Mike Pistoria, a physician at Coordinated Health, and never Dr. Pistoria.

My thoughts on this were recently challenged at a conference where there was some discussion about the power differential involved with being a physician. Physicians, in almost any professional relationship, either do or are perceived to hold the lion’s share of power. The conversation turned to respecting that power differential and avoiding anything that might be perceived as leveling the playing field and possibly putting the physician at risk for boundary issues with patients, staff, and others.

It was an interesting discussion. I made clear my preference to be called by my given name. I spoke of the value of caring for patients in high-functioning interdisciplinary teams. I recognized that while every team must have a captain, I pushed back against the argument that the captain – in this instance – must be referred to as “Doctor.” Others disagreed sharply. They either wanted the respect they felt they deserved or had concerns about minimizing the power differential and the potential for boundary violations.

The whole discussion prompted a reevaluation of my viewpoint. As I heard from people who had been impacted by boundary violations – they had allowed people to get too close to them and had been taken advantage of or had blurred the line between professional and personal relationships – I started to question my stand. I have not fully resolved this issue for myself yet, but I do think I will stop pushing so much for people to use my given name.

I think I can learn to live with people calling me “Doctor.” I think I can effectively continue to lead interdisciplinary teams in a meaningful way, generating a true sense of team, while people demonstrate the respect they believe I deserve. I think if people want to be a little more informal with me, “Dr. Mike” will work in the future.

Now, if I can just find a way to stop people from calling me “sir”…

Dr. Mike is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

"Well, I was wondering if you would be my family doctor."

The question completely surprised me. Minutes earlier, I had been called to the main lobby of our hospital. A patient I briefly cared for more than 2 days was asking to see me. I went to the lobby uncertain of the reason for the visit, but happy to see the man – we had developed a nice bond during our brief physician-patient relationship.

"I really liked the fact that you sat down and talked with me and taught me things about my diabetes. I actually understood what you were saying, and I thought you would help keep me on the path to getting healthier."

I felt a surge of emotion – almost to the point where my eyes welled up. Thankfully, I caught the surge and channeled it into an appreciative smile. I was genuinely touched that he felt comfortable with me and trusted me enough to ask me to partner with him for his health.

"I was just over at Dr. Q’s and showed him my blood sugars – they are doing much better and I already feel clearer. I figured I would just pop in here and ask you."

He had been a direct admission from the endocrinologist’s office where his blood glucose was well over 500 mg/dL. He demonstrated no evidence of acidosis or hyperosmolar state – he was simply a poorly controlled diabetic. He had previously seen a different endocrinologist and they had clearly not clicked for a variety of reasons. Based upon my initial interview with him, he also was not enamored with his primary care physician.

"You know, since my diabetes doctor is here and my cardiologist is joining you guys, I thought it would be great to have all of my doctors here."

I admired his recognition that having his physicians under one roof should lead to improved coordination of care. My new hospital is in a relatively small integrated network, allowing for prompt communication among providers regarding our patients. However, I could not take him on as a patient.

"I’m so flattered that you are asking me to be your primary care physician. Unfortunately, I’m not going to be able to do it. My practice is limited to the hospital, so unless you want to get admitted to the hospital periodically, I’m not going to be able to see you."

As much as I did not mesh with outpatient medicine as a resident and during my first year as an attending (when I had a small office practice), I was sad that I could not take him on as a patient. Part of me misses the longitudinal relationships with patients. I like hearing about life events and milestones, the everyday comings and goings. The truth is, as a hospitalist, we are generally not happy to see our "frequent fliers." They either have diseases that we cannot fix – only temporize – or they come into the hospital for questionable secondary issues that stress us and raise our anxiety level.

I firmly believe one of the underlying currents behind the slow creep of hospital medicine into skilled nursing facilities, discharge clinics, and the development of "extensivists," is the desire to have that bond with our patients. We meet and treat patients when they are at their sickest. Our relationships are therefore intense, but brief. I think we want to have longer and deeper interactions with our patients than we are able to achieve in the present model. It will be interesting to see how the model evolves to accommodate the more traditional physician-patient relationship.

"I understand, Doc. As much as I like you, I don’t really want to have to come back here to see you. Maybe at the grocery store or something like that instead."

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.

My attention was drawn to a recent headline in a local newspaper: "Doctors die differently than their patients." The article discussed the fact that physicians often do not request complicated treatment and life-sustaining therapies. It referenced a February 2012 piece in the Wall Street Journal by Dr. Ken Murray. Dr. Murray discussed some of the available evidence supporting the different decisions physicians reach regarding end-of-life care.

He quoted a 2003 article by Joseph Gallo and associates, who surveyed participants in the Johns Hopkins Precursors Study, which covered physicians graduating from Hopkins between 1948 and 1964. The investigators obtained responses from nearly 800 physicians regarding their end-of-life decisions. Compared with 20% of the general public, 64% of physician respondents had created an advanced directive. Additionally, nearly 90% of the physicians did not want CPR if they were in a chronic coma. This contrasts with about 25% of the general public not desiring "heroic measures." Clearly, physicians were taking the initiative and outlining the care that they did and did not want to receive in the setting of advanced medical illness.

Murray also mentioned a 1996 study that examined how CPR was portrayed in television shows and the potential impact it may have on patients’ decision making. In that paper, CPR was successful in 75% of the TV cases, with 67% of patients ultimately being discharged from the hospital (N. Engl. J. Med. 1996;334:1578-82).

Compare this with what we know to be true. CPR rarely works. A 2010 study that evaluated the impact of 95,000 cases of CPR in Japan demonstrated that clearly. Only 8% of patients who had received CPR survived for more than 1 month. Of those who survived, only 3% were able to lead "normal" lives.

Based upon our experiences, we are able to make objective assessments of the likelihood of success of various therapies in our patients. As hospitalists, we are often placed in the position of helping explain therapies provided by other specialists – cardiologists, oncologists, surgeons. I know that there have been times when I have seen patients receiving treatments I considered futile. I believe many of us have been in similar situations. Patients do not fully understand the risks and benefits of their therapy. Once the big picture is made clear to them, they often opt for more conservative therapy aimed at improving quality of life.

I believe we have an obligation to our patients to share with them the reality of the care they receive. We need to check in with our patients and understand what is important to them. Do they want to exhaust every medical option available? Are they looking to live long enough to attend a graduation or wedding? Do they value comfort and quality time above all else? We need to ask these questions and fully understand our patients and their desires.

I wrote previously about my former colleague Darlene. Had I not known her desires regarding continued therapy, she would have received care she did not want. I am certain of this because she was in the process of being transferred to the intensive care unit when I intervened at the behest of a mutual friend. She would have received several days of great, high-tech care in the ICU – and ultimately died despite that care, care that she did not want in the first place.

We, as hospitalists, must talk with our patients about their wishes. We must educate them about the likelihood of success of their therapies and of CPR. We must act as their advocates with subspecialists who too often focus on their specific portion of the patient, losing sight of the bigger picture. We need to do better. We need to ask the question: Should doctors die differently?

If advanced directives and dying in comfort are good enough for us, they should be good enough for our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal. 

My attention was drawn to a recent headline in a local newspaper: "Doctors die differently than their patients." The article discussed the fact that physicians often do not request complicated treatment and life-sustaining therapies. It referenced a February 2012 piece in the Wall Street Journal by Dr. Ken Murray. Dr. Murray discussed some of the available evidence supporting the different decisions physicians reach regarding end-of-life care.

He quoted a 2003 article by Joseph Gallo and associates, who surveyed participants in the Johns Hopkins Precursors Study, which covered physicians graduating from Hopkins between 1948 and 1964. The investigators obtained responses from nearly 800 physicians regarding their end-of-life decisions. Compared with 20% of the general public, 64% of physician respondents had created an advanced directive. Additionally, nearly 90% of the physicians did not want CPR if they were in a chronic coma. This contrasts with about 25% of the general public not desiring "heroic measures." Clearly, physicians were taking the initiative and outlining the care that they did and did not want to receive in the setting of advanced medical illness.

Murray also mentioned a 1996 study that examined how CPR was portrayed in television shows and the potential impact it may have on patients’ decision making. In that paper, CPR was successful in 75% of the TV cases, with 67% of patients ultimately being discharged from the hospital (N. Engl. J. Med. 1996;334:1578-82).

Compare this with what we know to be true. CPR rarely works. A 2010 study that evaluated the impact of 95,000 cases of CPR in Japan demonstrated that clearly. Only 8% of patients who had received CPR survived for more than 1 month. Of those who survived, only 3% were able to lead "normal" lives.

Based upon our experiences, we are able to make objective assessments of the likelihood of success of various therapies in our patients. As hospitalists, we are often placed in the position of helping explain therapies provided by other specialists – cardiologists, oncologists, surgeons. I know that there have been times when I have seen patients receiving treatments I considered futile. I believe many of us have been in similar situations. Patients do not fully understand the risks and benefits of their therapy. Once the big picture is made clear to them, they often opt for more conservative therapy aimed at improving quality of life.

I believe we have an obligation to our patients to share with them the reality of the care they receive. We need to check in with our patients and understand what is important to them. Do they want to exhaust every medical option available? Are they looking to live long enough to attend a graduation or wedding? Do they value comfort and quality time above all else? We need to ask these questions and fully understand our patients and their desires.

I wrote previously about my former colleague Darlene. Had I not known her desires regarding continued therapy, she would have received care she did not want. I am certain of this because she was in the process of being transferred to the intensive care unit when I intervened at the behest of a mutual friend. She would have received several days of great, high-tech care in the ICU – and ultimately died despite that care, care that she did not want in the first place.

We, as hospitalists, must talk with our patients about their wishes. We must educate them about the likelihood of success of their therapies and of CPR. We must act as their advocates with subspecialists who too often focus on their specific portion of the patient, losing sight of the bigger picture. We need to do better. We need to ask the question: Should doctors die differently?

If advanced directives and dying in comfort are good enough for us, they should be good enough for our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal. 

My attention was drawn to a recent headline in a local newspaper: "Doctors die differently than their patients." The article discussed the fact that physicians often do not request complicated treatment and life-sustaining therapies. It referenced a February 2012 piece in the Wall Street Journal by Dr. Ken Murray. Dr. Murray discussed some of the available evidence supporting the different decisions physicians reach regarding end-of-life care.

He quoted a 2003 article by Joseph Gallo and associates, who surveyed participants in the Johns Hopkins Precursors Study, which covered physicians graduating from Hopkins between 1948 and 1964. The investigators obtained responses from nearly 800 physicians regarding their end-of-life decisions. Compared with 20% of the general public, 64% of physician respondents had created an advanced directive. Additionally, nearly 90% of the physicians did not want CPR if they were in a chronic coma. This contrasts with about 25% of the general public not desiring "heroic measures." Clearly, physicians were taking the initiative and outlining the care that they did and did not want to receive in the setting of advanced medical illness.

Murray also mentioned a 1996 study that examined how CPR was portrayed in television shows and the potential impact it may have on patients’ decision making. In that paper, CPR was successful in 75% of the TV cases, with 67% of patients ultimately being discharged from the hospital (N. Engl. J. Med. 1996;334:1578-82).

Compare this with what we know to be true. CPR rarely works. A 2010 study that evaluated the impact of 95,000 cases of CPR in Japan demonstrated that clearly. Only 8% of patients who had received CPR survived for more than 1 month. Of those who survived, only 3% were able to lead "normal" lives.

Based upon our experiences, we are able to make objective assessments of the likelihood of success of various therapies in our patients. As hospitalists, we are often placed in the position of helping explain therapies provided by other specialists – cardiologists, oncologists, surgeons. I know that there have been times when I have seen patients receiving treatments I considered futile. I believe many of us have been in similar situations. Patients do not fully understand the risks and benefits of their therapy. Once the big picture is made clear to them, they often opt for more conservative therapy aimed at improving quality of life.

I believe we have an obligation to our patients to share with them the reality of the care they receive. We need to check in with our patients and understand what is important to them. Do they want to exhaust every medical option available? Are they looking to live long enough to attend a graduation or wedding? Do they value comfort and quality time above all else? We need to ask these questions and fully understand our patients and their desires.

I wrote previously about my former colleague Darlene. Had I not known her desires regarding continued therapy, she would have received care she did not want. I am certain of this because she was in the process of being transferred to the intensive care unit when I intervened at the behest of a mutual friend. She would have received several days of great, high-tech care in the ICU – and ultimately died despite that care, care that she did not want in the first place.

We, as hospitalists, must talk with our patients about their wishes. We must educate them about the likelihood of success of their therapies and of CPR. We must act as their advocates with subspecialists who too often focus on their specific portion of the patient, losing sight of the bigger picture. We need to do better. We need to ask the question: Should doctors die differently?

If advanced directives and dying in comfort are good enough for us, they should be good enough for our patients.

Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa. He believes that the best care is always personal.