Steve Pantilat, MD

M­y mind has been very much on New Orleans and the Gulf Coast the past couple of weeks. The utter devastation wrought by Hurricane Katrina, and the horrific images of stranded people clinging to rooftops, are shocking. Sitting in San Francisco it was hard to imagine just how terrifying and chaotic it could be.

What a different image than the one I had during my first visit to New Orleans in 1999 for the 2nd Annual Meeting of the National Association of Inpatient Physicians. I remember being enchanted by New Orleans and thinking how it seemed more European than American and the most foreign of any American city I had visited.

I brought my family to the meeting, and we had a wonderful visit. We stayed near the convention center and enjoyed strolling the streets of the French Quarter, eating beignets, and riding the streetcar. I had an unforgettable dinner at Emeril’s that still ranks among the finest I’ve ever had. These memories are completely at odds with the images in the newspaper and on television. Some of the most vivid stories I read of Hurricane Katrina were e-mails from hospitalists on the ground in New Orleans and from others helping to care for sick patients evacuated from hospitals in Louisiana.

The first-hand accounts from hospitalists in New Orleans were gripping. I read the now-familiar stories of trying to live in a city with no electricity, no safe drinking water, no sewer system, and no government. I read of one physician entering a darkened pharmacy under police escort so that he could gather life-saving medicines for people whose prescriptions were destroyed along with their homes. Steve Deitzelsweig, MD, FACP, a hospitalist at Ochsner Clinic in New Orleans described the fear of epidemics in the Wall Street Journal, as well as in The Hospitalist (see October, p. 1). The possibility of a typhoid outbreak in 21st century America seemed more like a plot from a bad movie than a headline in a major newspaper. Even hospitalists far from New Orleans enlisted in aiding evacuees.

E-mail dispatches from Pat Cawley, MD, in South Carolina and others described hospitalists helping care for the sick airlifted from Louisiana, Mississippi, and Alabama. Jeanne Huddleston, MD, SHM’s immediate past president, described her role leading a team of doctors from Mayo Clinic who went to Louisiana to care for the sick and injured.

Perhaps the most frightening images were of doctors and nurses caring for critically ill patients without the help of monitors, ventilators, or other equipment when the emergency power went out. The images of patients waiting for helicopters to airlift them to safety were harrowing. Also striking were reports from hospitalists whose families had been evacuated, their homes destroyed—and they were at the hospital caring for those who were sick prior to and because of the hurricane.

My gratitude and admiration go out to all of the doctors, nurses, respiratory therapists, pharmacists, social workers, chaplains, and others in the hurricane-devastated regions and elsewhere who worked so valiantly to help patients in the face of chaos. As president of SHM I am proud of the efforts of our members and of all hospitalists who continue to assist in the face of this tragedy.

The medical crisis caused by Hurricane Katrina is perhaps most noteworthy because it happened in America. Of course, physicians and nurses struggle to help their patients under similar or worse conditions every day across the world without the ability to airlift their patients anywhere. Nonetheless, to watch this happen in New Orleans was shocking and offered insights into what it must be like in war zones and the developing world.

In addition, this was the fist time I recall hospitalists playing a prominent role in the medical response (see “Tours of Duty,” p. 1 and “The Red Badge of Katrina,” p. 13). To be sure, hospitals and healthcare personnel responded actively to tragedies like this one before hospitalists. But to the many advantages we bring as hospitalists, we can now add being in place—in the hospital—when disaster strikes. I do not pretend that this reason will convince many hospitals to start hospitalist programs—there are better and more pressing reasons to do so. But the ability to respond to disaster is clearly a benefit of a hospitalist program.

Included among the many e-mails circulating on the SHM listserv and among hospitalists was the question of whether hospitalists were included in official disaster response plans including those by FEMA and other agencies. After Hurricane Katrina, we will be.

Dire Inequities

Among the many tragedies revealed by Hurricane Katrina perhaps none was so striking as the inequities in our society. Even if we are willing to accept that in a free-market society some have more than others, the desperate situation faced by so many in New Orleans who were left behind is an indictment of a system that pays too little attention to those who have no resources.

We are aware of inequities in healthcare evidenced in part by the fact that millions of Americans have no health insurance. This tragedy showed that, in addition to not having health insurance, being poor exposes you to the brunt of a natural disaster that those with money can escape. The buses that arrived days after Hurricane Katrina to take people to Houston and elsewhere should have been there days before the hurricane.

What role do we play in changing this system? I can’t say that I have easy answers. Many of us contributed our skills after the tragedy to help those in need. Some of us farther away contributed money or goods to assist those affected by the hurricane. Some of us will begin or continue to advocate for a more just system.

While some of these issues are beyond the scope of SHM, during our planned legislative day preceding the 2006 Annual Meeting in Washington, D.C., we will have the opportunity to meet with our elected representatives to tell them about hospitalists and hospital medicine. We should share with them our experience from the frontline of American healthcare: Every day we care for many people who present to the hospital with illnesses that could have been prevented or significantly ameliorated by earlier intervention if they had only had access to healthcare. We are direct witnesses to what befalls those who lack health insurance and have poor access to healthcare. I hope that one of the messages we bring to Congress is that all Americans should have access to healthcare with health insurance.

The scenes of the hurricane-ravaged Gulf Coast also led me to reflect on the fragility of life and its precarious balance. Here in San Francisco we are safe from hurricanes, but at the mercy of earthquakes. It is still true that anyone who experienced the 1989 earthquake here in San Francisco can tell you exactly where they were and what they were doing at the time.

Final Thoughts

In the wake of Hurricane Katrina my wife and I have been talking a lot about earthquakes and how to ensure that we are prepared—if such a thing is even possible. The news reports tell us to have 72 hours’ worth of food and water, a battery operated radio, gas in the car, flashlights, and other necessities. We promise ourselves to get all the supplies we need and believe we will do so. But I also realize that denial is part of life and that in living near an earthquake fault denial might be necessary; just as living on the Gulf Coast may require a certain denial about the destructive power of hurricanes. But as one e-mail correspondent from New Orleans wrote, “Despite it all, this is a soul-edifying experience.”

Perhaps the tragedy that hit the Gulf Coast will help each of us edify our souls through less drastic measures and remind us that any day can be our last. This knowledge is a gift to help us spend our time in the best way possible. Those who are helping the people whose lives were ravaged by Hurricane Katrina remind us of the good that we can do in the world. As hospitalists we get to experience this good every day at the bedside through the privilege of patient care. May we cherish this opportunity and fulfill it with dignity and pride. To all those involved in hurricane relief efforts, thank you, and to all those whose lives were ravaged by the hurricane I wish you strength and recovery. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

M­y mind has been very much on New Orleans and the Gulf Coast the past couple of weeks. The utter devastation wrought by Hurricane Katrina, and the horrific images of stranded people clinging to rooftops, are shocking. Sitting in San Francisco it was hard to imagine just how terrifying and chaotic it could be.

What a different image than the one I had during my first visit to New Orleans in 1999 for the 2nd Annual Meeting of the National Association of Inpatient Physicians. I remember being enchanted by New Orleans and thinking how it seemed more European than American and the most foreign of any American city I had visited.

I brought my family to the meeting, and we had a wonderful visit. We stayed near the convention center and enjoyed strolling the streets of the French Quarter, eating beignets, and riding the streetcar. I had an unforgettable dinner at Emeril’s that still ranks among the finest I’ve ever had. These memories are completely at odds with the images in the newspaper and on television. Some of the most vivid stories I read of Hurricane Katrina were e-mails from hospitalists on the ground in New Orleans and from others helping to care for sick patients evacuated from hospitals in Louisiana.

The first-hand accounts from hospitalists in New Orleans were gripping. I read the now-familiar stories of trying to live in a city with no electricity, no safe drinking water, no sewer system, and no government. I read of one physician entering a darkened pharmacy under police escort so that he could gather life-saving medicines for people whose prescriptions were destroyed along with their homes. Steve Deitzelsweig, MD, FACP, a hospitalist at Ochsner Clinic in New Orleans described the fear of epidemics in the Wall Street Journal, as well as in The Hospitalist (see October, p. 1). The possibility of a typhoid outbreak in 21st century America seemed more like a plot from a bad movie than a headline in a major newspaper. Even hospitalists far from New Orleans enlisted in aiding evacuees.

E-mail dispatches from Pat Cawley, MD, in South Carolina and others described hospitalists helping care for the sick airlifted from Louisiana, Mississippi, and Alabama. Jeanne Huddleston, MD, SHM’s immediate past president, described her role leading a team of doctors from Mayo Clinic who went to Louisiana to care for the sick and injured.

Perhaps the most frightening images were of doctors and nurses caring for critically ill patients without the help of monitors, ventilators, or other equipment when the emergency power went out. The images of patients waiting for helicopters to airlift them to safety were harrowing. Also striking were reports from hospitalists whose families had been evacuated, their homes destroyed—and they were at the hospital caring for those who were sick prior to and because of the hurricane.

My gratitude and admiration go out to all of the doctors, nurses, respiratory therapists, pharmacists, social workers, chaplains, and others in the hurricane-devastated regions and elsewhere who worked so valiantly to help patients in the face of chaos. As president of SHM I am proud of the efforts of our members and of all hospitalists who continue to assist in the face of this tragedy.

The medical crisis caused by Hurricane Katrina is perhaps most noteworthy because it happened in America. Of course, physicians and nurses struggle to help their patients under similar or worse conditions every day across the world without the ability to airlift their patients anywhere. Nonetheless, to watch this happen in New Orleans was shocking and offered insights into what it must be like in war zones and the developing world.

In addition, this was the fist time I recall hospitalists playing a prominent role in the medical response (see “Tours of Duty,” p. 1 and “The Red Badge of Katrina,” p. 13). To be sure, hospitals and healthcare personnel responded actively to tragedies like this one before hospitalists. But to the many advantages we bring as hospitalists, we can now add being in place—in the hospital—when disaster strikes. I do not pretend that this reason will convince many hospitals to start hospitalist programs—there are better and more pressing reasons to do so. But the ability to respond to disaster is clearly a benefit of a hospitalist program.

Included among the many e-mails circulating on the SHM listserv and among hospitalists was the question of whether hospitalists were included in official disaster response plans including those by FEMA and other agencies. After Hurricane Katrina, we will be.

Dire Inequities

Among the many tragedies revealed by Hurricane Katrina perhaps none was so striking as the inequities in our society. Even if we are willing to accept that in a free-market society some have more than others, the desperate situation faced by so many in New Orleans who were left behind is an indictment of a system that pays too little attention to those who have no resources.

We are aware of inequities in healthcare evidenced in part by the fact that millions of Americans have no health insurance. This tragedy showed that, in addition to not having health insurance, being poor exposes you to the brunt of a natural disaster that those with money can escape. The buses that arrived days after Hurricane Katrina to take people to Houston and elsewhere should have been there days before the hurricane.

What role do we play in changing this system? I can’t say that I have easy answers. Many of us contributed our skills after the tragedy to help those in need. Some of us farther away contributed money or goods to assist those affected by the hurricane. Some of us will begin or continue to advocate for a more just system.

While some of these issues are beyond the scope of SHM, during our planned legislative day preceding the 2006 Annual Meeting in Washington, D.C., we will have the opportunity to meet with our elected representatives to tell them about hospitalists and hospital medicine. We should share with them our experience from the frontline of American healthcare: Every day we care for many people who present to the hospital with illnesses that could have been prevented or significantly ameliorated by earlier intervention if they had only had access to healthcare. We are direct witnesses to what befalls those who lack health insurance and have poor access to healthcare. I hope that one of the messages we bring to Congress is that all Americans should have access to healthcare with health insurance.

The scenes of the hurricane-ravaged Gulf Coast also led me to reflect on the fragility of life and its precarious balance. Here in San Francisco we are safe from hurricanes, but at the mercy of earthquakes. It is still true that anyone who experienced the 1989 earthquake here in San Francisco can tell you exactly where they were and what they were doing at the time.

Final Thoughts

In the wake of Hurricane Katrina my wife and I have been talking a lot about earthquakes and how to ensure that we are prepared—if such a thing is even possible. The news reports tell us to have 72 hours’ worth of food and water, a battery operated radio, gas in the car, flashlights, and other necessities. We promise ourselves to get all the supplies we need and believe we will do so. But I also realize that denial is part of life and that in living near an earthquake fault denial might be necessary; just as living on the Gulf Coast may require a certain denial about the destructive power of hurricanes. But as one e-mail correspondent from New Orleans wrote, “Despite it all, this is a soul-edifying experience.”

Perhaps the tragedy that hit the Gulf Coast will help each of us edify our souls through less drastic measures and remind us that any day can be our last. This knowledge is a gift to help us spend our time in the best way possible. Those who are helping the people whose lives were ravaged by Hurricane Katrina remind us of the good that we can do in the world. As hospitalists we get to experience this good every day at the bedside through the privilege of patient care. May we cherish this opportunity and fulfill it with dignity and pride. To all those involved in hurricane relief efforts, thank you, and to all those whose lives were ravaged by the hurricane I wish you strength and recovery. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

M­y mind has been very much on New Orleans and the Gulf Coast the past couple of weeks. The utter devastation wrought by Hurricane Katrina, and the horrific images of stranded people clinging to rooftops, are shocking. Sitting in San Francisco it was hard to imagine just how terrifying and chaotic it could be.

What a different image than the one I had during my first visit to New Orleans in 1999 for the 2nd Annual Meeting of the National Association of Inpatient Physicians. I remember being enchanted by New Orleans and thinking how it seemed more European than American and the most foreign of any American city I had visited.

I brought my family to the meeting, and we had a wonderful visit. We stayed near the convention center and enjoyed strolling the streets of the French Quarter, eating beignets, and riding the streetcar. I had an unforgettable dinner at Emeril’s that still ranks among the finest I’ve ever had. These memories are completely at odds with the images in the newspaper and on television. Some of the most vivid stories I read of Hurricane Katrina were e-mails from hospitalists on the ground in New Orleans and from others helping to care for sick patients evacuated from hospitals in Louisiana.

The first-hand accounts from hospitalists in New Orleans were gripping. I read the now-familiar stories of trying to live in a city with no electricity, no safe drinking water, no sewer system, and no government. I read of one physician entering a darkened pharmacy under police escort so that he could gather life-saving medicines for people whose prescriptions were destroyed along with their homes. Steve Deitzelsweig, MD, FACP, a hospitalist at Ochsner Clinic in New Orleans described the fear of epidemics in the Wall Street Journal, as well as in The Hospitalist (see October, p. 1). The possibility of a typhoid outbreak in 21st century America seemed more like a plot from a bad movie than a headline in a major newspaper. Even hospitalists far from New Orleans enlisted in aiding evacuees.

E-mail dispatches from Pat Cawley, MD, in South Carolina and others described hospitalists helping care for the sick airlifted from Louisiana, Mississippi, and Alabama. Jeanne Huddleston, MD, SHM’s immediate past president, described her role leading a team of doctors from Mayo Clinic who went to Louisiana to care for the sick and injured.

Perhaps the most frightening images were of doctors and nurses caring for critically ill patients without the help of monitors, ventilators, or other equipment when the emergency power went out. The images of patients waiting for helicopters to airlift them to safety were harrowing. Also striking were reports from hospitalists whose families had been evacuated, their homes destroyed—and they were at the hospital caring for those who were sick prior to and because of the hurricane.

My gratitude and admiration go out to all of the doctors, nurses, respiratory therapists, pharmacists, social workers, chaplains, and others in the hurricane-devastated regions and elsewhere who worked so valiantly to help patients in the face of chaos. As president of SHM I am proud of the efforts of our members and of all hospitalists who continue to assist in the face of this tragedy.

The medical crisis caused by Hurricane Katrina is perhaps most noteworthy because it happened in America. Of course, physicians and nurses struggle to help their patients under similar or worse conditions every day across the world without the ability to airlift their patients anywhere. Nonetheless, to watch this happen in New Orleans was shocking and offered insights into what it must be like in war zones and the developing world.

In addition, this was the fist time I recall hospitalists playing a prominent role in the medical response (see “Tours of Duty,” p. 1 and “The Red Badge of Katrina,” p. 13). To be sure, hospitals and healthcare personnel responded actively to tragedies like this one before hospitalists. But to the many advantages we bring as hospitalists, we can now add being in place—in the hospital—when disaster strikes. I do not pretend that this reason will convince many hospitals to start hospitalist programs—there are better and more pressing reasons to do so. But the ability to respond to disaster is clearly a benefit of a hospitalist program.

Included among the many e-mails circulating on the SHM listserv and among hospitalists was the question of whether hospitalists were included in official disaster response plans including those by FEMA and other agencies. After Hurricane Katrina, we will be.

Dire Inequities

Among the many tragedies revealed by Hurricane Katrina perhaps none was so striking as the inequities in our society. Even if we are willing to accept that in a free-market society some have more than others, the desperate situation faced by so many in New Orleans who were left behind is an indictment of a system that pays too little attention to those who have no resources.

We are aware of inequities in healthcare evidenced in part by the fact that millions of Americans have no health insurance. This tragedy showed that, in addition to not having health insurance, being poor exposes you to the brunt of a natural disaster that those with money can escape. The buses that arrived days after Hurricane Katrina to take people to Houston and elsewhere should have been there days before the hurricane.

What role do we play in changing this system? I can’t say that I have easy answers. Many of us contributed our skills after the tragedy to help those in need. Some of us farther away contributed money or goods to assist those affected by the hurricane. Some of us will begin or continue to advocate for a more just system.

While some of these issues are beyond the scope of SHM, during our planned legislative day preceding the 2006 Annual Meeting in Washington, D.C., we will have the opportunity to meet with our elected representatives to tell them about hospitalists and hospital medicine. We should share with them our experience from the frontline of American healthcare: Every day we care for many people who present to the hospital with illnesses that could have been prevented or significantly ameliorated by earlier intervention if they had only had access to healthcare. We are direct witnesses to what befalls those who lack health insurance and have poor access to healthcare. I hope that one of the messages we bring to Congress is that all Americans should have access to healthcare with health insurance.

The scenes of the hurricane-ravaged Gulf Coast also led me to reflect on the fragility of life and its precarious balance. Here in San Francisco we are safe from hurricanes, but at the mercy of earthquakes. It is still true that anyone who experienced the 1989 earthquake here in San Francisco can tell you exactly where they were and what they were doing at the time.

Final Thoughts

In the wake of Hurricane Katrina my wife and I have been talking a lot about earthquakes and how to ensure that we are prepared—if such a thing is even possible. The news reports tell us to have 72 hours’ worth of food and water, a battery operated radio, gas in the car, flashlights, and other necessities. We promise ourselves to get all the supplies we need and believe we will do so. But I also realize that denial is part of life and that in living near an earthquake fault denial might be necessary; just as living on the Gulf Coast may require a certain denial about the destructive power of hurricanes. But as one e-mail correspondent from New Orleans wrote, “Despite it all, this is a soul-edifying experience.”

Perhaps the tragedy that hit the Gulf Coast will help each of us edify our souls through less drastic measures and remind us that any day can be our last. This knowledge is a gift to help us spend our time in the best way possible. Those who are helping the people whose lives were ravaged by Hurricane Katrina remind us of the good that we can do in the world. As hospitalists we get to experience this good every day at the bedside through the privilege of patient care. May we cherish this opportunity and fulfill it with dignity and pride. To all those involved in hurricane relief efforts, thank you, and to all those whose lives were ravaged by the hurricane I wish you strength and recovery. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

A good friend once said of parenthood, “The nights are long and the years are short.” That has certainly been my experience as a parent, and as I get older, the years seem to get even shorter. As president of SHM, this past year has seemed especially short and time has flown by. It has been a year of fun, excitement, and pride as I have had the privilege of leading our growing organization and having a front-row seat to all that is happening at SHM.

As I write this column—my last as president—I am flying back from a meeting of our board of directors. We spent two days discussing the business and future of SHM. Reflecting on all that we considered, I am again amazed at what our young organization and field have accomplished, what we’ve done in the past year, and where we are going. I want to share with you some of the highlights and close with some thoughts about our work.

Education

The most important advance in education this year has been the publication of the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine (JHM). The core competencies delineate the clinical conditions, procedures, and systems issues that form the basis of hospital medicine and define what a hospitalist needs to know and what our field is about.

I am particularly proud that our core competencies include a section on systems issues. Reflecting the central role of hospitalists in improving the systems of care in addition to focusing on the single patient, the systems section has the most chapters in the core competencies. Topics such as quality improvement, information management, patient handoff, patient safety, palliative care, communication, care of the elderly patient, and professionalism and medical ethics demonstrate that we understand that to really improve the care of patients you need to see the big picture of how care is delivered and to understand how to make the system work better.

If you haven’t yet done so, I encourage you to peruse the core competencies to see what you know and what you want to learn. You will see us use the core competencies in The Hospitalist, JHM, the SHM web site, and our educational programs at the annual meeting and elsewhere.

I want to thank Alpesh Amin, MD, Daniel Dressler, MD, Sylvia McKean, MD, Michael Pistoria, MD, and Tina Budnitz, MPH, who spent countless hours on this project and the many other hospitalists and others who contributed time and expertise to producing such an important document for our field.

Quality

SHM continues to take a lead in improving patient safety and quality of care, reflecting our belief that hospitalists play a key role in these important areas. I invite you to visit the SHM Web site page titled “Quality and Safety” to see the impressive resource rooms that have been developed. Covering topics from antimicrobial resistance to stroke to venous thromboembolism to heart failure, these resource rooms provide all the elements you need to implement a quality improvement project at your hospital.

Each resource room was developed with a project team of experts in the area. The team collected all the best evidence, outlined arguments for why to act, provided tools that can be adapted or used as is, and offered an opportunity to ask questions of the experts. A geriatrics resource room is coming soon. If you are asked to implement a quality improvement or patient safety project, take advantage of this outstanding resource.

Journal of Hospital Medicine

By now all SHM members should have received the first issue of the JHM. Another project that was years in the making, the journal represents one more important step forward in the growth and maturation of our field. I remember the first discussions at a board meeting several years ago when we decided to develop a journal. We worried whether the field was ready and whether there would be enough content of sufficient quality to support a journal.

One look at JHM and you can see that any worries were unfounded. The quality of the journal and of the content is outstanding. Kudos go to Mark Williams, MD, the editor of JHM, his coeditors, and the many staff at SHM and our publisher, John Wiley & Sons, who brought this to fruition.

As we move ahead with other important initiatives such as certification, the presence of a high quality journal for our field only strengthens our position. Please submit your papers to JHM. Share your work with your colleagues. Contribute to the success of this important publication.

Recognition for Hospitalists

In another sign of the growth of our field, we have been pursuing recognition of expertise in hospital medicine. Unlike the core competencies, resource rooms, and journal that have already come to pass, formal recognition is still a ways off. And while the final outcome is far from certain, the signs all point toward a separate recognition for hospitalists.

There are many details to be worked out. I wish I had more details to share with you, but I can tell you that we are committed to a formal recognition that will have meaning to hospitalists, our employers, our patients, and to a process that is not burdensome. Also, recognition will not involve another test, but will occur during the maintenance of certification process that is currently in place for all physicians certified by the American Board of Internal Medicine (ABIM). Our initial efforts are with the ABIM because the majority of hospitalists are internists and because the ABIM has been very interested in working with us. I can promise you that once we figure out a process in internal medicine we will use our knowledge to pursue similar certification in pediatrics and family practice.

Public Policy and Advocacy

This year, SHM has taken a big step forward in public policy and advocacy to address the key policy issues affecting hospital medicine. We have a very active public policy committee chaired by Eric Siegal, MD, and a new senior advisor for policy, Laura Allendorf, who have been leading our efforts in this area.

Two key issues being discussed are pay for performance and incentive alignment. Look to The Hospitalist for future articles on these important topics. We also commissioned a white paper on policy issues in hospital medicine that will teach readers about our field and outline our top legislative priorities. This white paper and the recommendations it contains will form the foundation of our first Legislative Day on May 3, 2006 (the precourse day for the annual meeting). Any SHM member who signs up in advance can participate in Legislative Day and have a chance to meet with their elected members of Congress or their staff to educate them about hospitalists and the issues that are important to the field of hospital medicine. Increasingly we see that our new field is raising issues that need to be addressed on the national level. The work of the public policy committee will give a clear voice to SHM in this arena.

Research

At last year’s annual meeting I shared with you my vision for research in hospital medicine and the role of SHM in research. Last month I further outlined my ideas. With a new journal and the largest number of submissions to our research, innovations and vignettes competition ever, we are well on our way to taking a leading role in research in hospital medicine.

Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a toolkit to support discharge planning for elders. Stay tuned for more projects in this area and please apply when we send out a call for applications.

Palliative Care

As you probably know by now, palliative care is near and dear to my heart. Hospital medicine can fulfill the promise of compassionate care for people with serious and life-threatening illness and ensure that all patients have access to high quality palliative care. The palliative care task force that I appointed under the leadership of Chad Whelan, MD, has shown enormous energy and enthusiasm. The task force is planning a resource room and a series of articles about palliative care for JHM.

In addition, the task force is sponsoring two sessions at this year’s annual meeting: Pain Management (Thurs., May 4 from 1:20-2:35 p.m.) and The Basic “Why” and “How” to Develop a Hospital-Based Palliative Care Program (Fri., May 5 from 1:35 to 3:05 p.m.). I encourage you to attend one or both. From the flurry of activity already generated by the palliative care task force, I know that we will see much more relating to palliative care. As a core competency for hospital medicine, palliative care is central to our work. As a compassionate response to the suffering of our patients, it is one of the most rewarding parts of practicing medicine.

All in Service of Caring for the Patient

With all the exciting initiatives happening at SHM, we must never lose sight of why all this activity is important. Ultimately all of this work comes down to caring for our patients. At our core, hospitalists and hospital medicine are about providing the highest quality care to hospitalized patients. Our educational programs, journal, quality projects, policy initiatives, research, and palliative care task force as well as the many other important programs at SHM are all in service of caring for the patient. All that we do to improve the care of patients improves us, our field, and our society.

In the end, as a field, as an organization, and as individual hospitalists, we will be judged by whether our work improved the care of our patients. From my front row seat, I am confident that we will be judged a success because I see firsthand all of the great work being done around the country and within SHM to advance this goal.

It has been a supreme privilege to serve as president of this outstanding organization and to get to know so many of you who make it what it is. I offer my deep gratitude to everyone who has made this past year so great. With all that we have accomplished, there is still much more to do. If you are not yet a member of SHM, join. If you are a member of SHM, get involved. Help shape our growing field. Help make care better, safer, and more compassionate for our patients. This rocket is still gaining speed—join the ride. TH

Dr. Pantilat is the outgoing president of SHM.

A good friend once said of parenthood, “The nights are long and the years are short.” That has certainly been my experience as a parent, and as I get older, the years seem to get even shorter. As president of SHM, this past year has seemed especially short and time has flown by. It has been a year of fun, excitement, and pride as I have had the privilege of leading our growing organization and having a front-row seat to all that is happening at SHM.

As I write this column—my last as president—I am flying back from a meeting of our board of directors. We spent two days discussing the business and future of SHM. Reflecting on all that we considered, I am again amazed at what our young organization and field have accomplished, what we’ve done in the past year, and where we are going. I want to share with you some of the highlights and close with some thoughts about our work.

Education

The most important advance in education this year has been the publication of the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine (JHM). The core competencies delineate the clinical conditions, procedures, and systems issues that form the basis of hospital medicine and define what a hospitalist needs to know and what our field is about.

I am particularly proud that our core competencies include a section on systems issues. Reflecting the central role of hospitalists in improving the systems of care in addition to focusing on the single patient, the systems section has the most chapters in the core competencies. Topics such as quality improvement, information management, patient handoff, patient safety, palliative care, communication, care of the elderly patient, and professionalism and medical ethics demonstrate that we understand that to really improve the care of patients you need to see the big picture of how care is delivered and to understand how to make the system work better.

If you haven’t yet done so, I encourage you to peruse the core competencies to see what you know and what you want to learn. You will see us use the core competencies in The Hospitalist, JHM, the SHM web site, and our educational programs at the annual meeting and elsewhere.

I want to thank Alpesh Amin, MD, Daniel Dressler, MD, Sylvia McKean, MD, Michael Pistoria, MD, and Tina Budnitz, MPH, who spent countless hours on this project and the many other hospitalists and others who contributed time and expertise to producing such an important document for our field.

Quality

SHM continues to take a lead in improving patient safety and quality of care, reflecting our belief that hospitalists play a key role in these important areas. I invite you to visit the SHM Web site page titled “Quality and Safety” to see the impressive resource rooms that have been developed. Covering topics from antimicrobial resistance to stroke to venous thromboembolism to heart failure, these resource rooms provide all the elements you need to implement a quality improvement project at your hospital.

Each resource room was developed with a project team of experts in the area. The team collected all the best evidence, outlined arguments for why to act, provided tools that can be adapted or used as is, and offered an opportunity to ask questions of the experts. A geriatrics resource room is coming soon. If you are asked to implement a quality improvement or patient safety project, take advantage of this outstanding resource.

Journal of Hospital Medicine

By now all SHM members should have received the first issue of the JHM. Another project that was years in the making, the journal represents one more important step forward in the growth and maturation of our field. I remember the first discussions at a board meeting several years ago when we decided to develop a journal. We worried whether the field was ready and whether there would be enough content of sufficient quality to support a journal.

One look at JHM and you can see that any worries were unfounded. The quality of the journal and of the content is outstanding. Kudos go to Mark Williams, MD, the editor of JHM, his coeditors, and the many staff at SHM and our publisher, John Wiley & Sons, who brought this to fruition.

As we move ahead with other important initiatives such as certification, the presence of a high quality journal for our field only strengthens our position. Please submit your papers to JHM. Share your work with your colleagues. Contribute to the success of this important publication.

Recognition for Hospitalists

In another sign of the growth of our field, we have been pursuing recognition of expertise in hospital medicine. Unlike the core competencies, resource rooms, and journal that have already come to pass, formal recognition is still a ways off. And while the final outcome is far from certain, the signs all point toward a separate recognition for hospitalists.

There are many details to be worked out. I wish I had more details to share with you, but I can tell you that we are committed to a formal recognition that will have meaning to hospitalists, our employers, our patients, and to a process that is not burdensome. Also, recognition will not involve another test, but will occur during the maintenance of certification process that is currently in place for all physicians certified by the American Board of Internal Medicine (ABIM). Our initial efforts are with the ABIM because the majority of hospitalists are internists and because the ABIM has been very interested in working with us. I can promise you that once we figure out a process in internal medicine we will use our knowledge to pursue similar certification in pediatrics and family practice.

Public Policy and Advocacy

This year, SHM has taken a big step forward in public policy and advocacy to address the key policy issues affecting hospital medicine. We have a very active public policy committee chaired by Eric Siegal, MD, and a new senior advisor for policy, Laura Allendorf, who have been leading our efforts in this area.

Two key issues being discussed are pay for performance and incentive alignment. Look to The Hospitalist for future articles on these important topics. We also commissioned a white paper on policy issues in hospital medicine that will teach readers about our field and outline our top legislative priorities. This white paper and the recommendations it contains will form the foundation of our first Legislative Day on May 3, 2006 (the precourse day for the annual meeting). Any SHM member who signs up in advance can participate in Legislative Day and have a chance to meet with their elected members of Congress or their staff to educate them about hospitalists and the issues that are important to the field of hospital medicine. Increasingly we see that our new field is raising issues that need to be addressed on the national level. The work of the public policy committee will give a clear voice to SHM in this arena.

Research

At last year’s annual meeting I shared with you my vision for research in hospital medicine and the role of SHM in research. Last month I further outlined my ideas. With a new journal and the largest number of submissions to our research, innovations and vignettes competition ever, we are well on our way to taking a leading role in research in hospital medicine.

Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a toolkit to support discharge planning for elders. Stay tuned for more projects in this area and please apply when we send out a call for applications.

Palliative Care

As you probably know by now, palliative care is near and dear to my heart. Hospital medicine can fulfill the promise of compassionate care for people with serious and life-threatening illness and ensure that all patients have access to high quality palliative care. The palliative care task force that I appointed under the leadership of Chad Whelan, MD, has shown enormous energy and enthusiasm. The task force is planning a resource room and a series of articles about palliative care for JHM.

In addition, the task force is sponsoring two sessions at this year’s annual meeting: Pain Management (Thurs., May 4 from 1:20-2:35 p.m.) and The Basic “Why” and “How” to Develop a Hospital-Based Palliative Care Program (Fri., May 5 from 1:35 to 3:05 p.m.). I encourage you to attend one or both. From the flurry of activity already generated by the palliative care task force, I know that we will see much more relating to palliative care. As a core competency for hospital medicine, palliative care is central to our work. As a compassionate response to the suffering of our patients, it is one of the most rewarding parts of practicing medicine.

All in Service of Caring for the Patient

With all the exciting initiatives happening at SHM, we must never lose sight of why all this activity is important. Ultimately all of this work comes down to caring for our patients. At our core, hospitalists and hospital medicine are about providing the highest quality care to hospitalized patients. Our educational programs, journal, quality projects, policy initiatives, research, and palliative care task force as well as the many other important programs at SHM are all in service of caring for the patient. All that we do to improve the care of patients improves us, our field, and our society.

In the end, as a field, as an organization, and as individual hospitalists, we will be judged by whether our work improved the care of our patients. From my front row seat, I am confident that we will be judged a success because I see firsthand all of the great work being done around the country and within SHM to advance this goal.

It has been a supreme privilege to serve as president of this outstanding organization and to get to know so many of you who make it what it is. I offer my deep gratitude to everyone who has made this past year so great. With all that we have accomplished, there is still much more to do. If you are not yet a member of SHM, join. If you are a member of SHM, get involved. Help shape our growing field. Help make care better, safer, and more compassionate for our patients. This rocket is still gaining speed—join the ride. TH

Dr. Pantilat is the outgoing president of SHM.

A good friend once said of parenthood, “The nights are long and the years are short.” That has certainly been my experience as a parent, and as I get older, the years seem to get even shorter. As president of SHM, this past year has seemed especially short and time has flown by. It has been a year of fun, excitement, and pride as I have had the privilege of leading our growing organization and having a front-row seat to all that is happening at SHM.

As I write this column—my last as president—I am flying back from a meeting of our board of directors. We spent two days discussing the business and future of SHM. Reflecting on all that we considered, I am again amazed at what our young organization and field have accomplished, what we’ve done in the past year, and where we are going. I want to share with you some of the highlights and close with some thoughts about our work.

Education

The most important advance in education this year has been the publication of the Core Competencies in Hospital Medicine as a supplement to the first issue of the Journal of Hospital Medicine (JHM). The core competencies delineate the clinical conditions, procedures, and systems issues that form the basis of hospital medicine and define what a hospitalist needs to know and what our field is about.

I am particularly proud that our core competencies include a section on systems issues. Reflecting the central role of hospitalists in improving the systems of care in addition to focusing on the single patient, the systems section has the most chapters in the core competencies. Topics such as quality improvement, information management, patient handoff, patient safety, palliative care, communication, care of the elderly patient, and professionalism and medical ethics demonstrate that we understand that to really improve the care of patients you need to see the big picture of how care is delivered and to understand how to make the system work better.

If you haven’t yet done so, I encourage you to peruse the core competencies to see what you know and what you want to learn. You will see us use the core competencies in The Hospitalist, JHM, the SHM web site, and our educational programs at the annual meeting and elsewhere.

I want to thank Alpesh Amin, MD, Daniel Dressler, MD, Sylvia McKean, MD, Michael Pistoria, MD, and Tina Budnitz, MPH, who spent countless hours on this project and the many other hospitalists and others who contributed time and expertise to producing such an important document for our field.

Quality

SHM continues to take a lead in improving patient safety and quality of care, reflecting our belief that hospitalists play a key role in these important areas. I invite you to visit the SHM Web site page titled “Quality and Safety” to see the impressive resource rooms that have been developed. Covering topics from antimicrobial resistance to stroke to venous thromboembolism to heart failure, these resource rooms provide all the elements you need to implement a quality improvement project at your hospital.

Each resource room was developed with a project team of experts in the area. The team collected all the best evidence, outlined arguments for why to act, provided tools that can be adapted or used as is, and offered an opportunity to ask questions of the experts. A geriatrics resource room is coming soon. If you are asked to implement a quality improvement or patient safety project, take advantage of this outstanding resource.

Journal of Hospital Medicine

By now all SHM members should have received the first issue of the JHM. Another project that was years in the making, the journal represents one more important step forward in the growth and maturation of our field. I remember the first discussions at a board meeting several years ago when we decided to develop a journal. We worried whether the field was ready and whether there would be enough content of sufficient quality to support a journal.

One look at JHM and you can see that any worries were unfounded. The quality of the journal and of the content is outstanding. Kudos go to Mark Williams, MD, the editor of JHM, his coeditors, and the many staff at SHM and our publisher, John Wiley & Sons, who brought this to fruition.

As we move ahead with other important initiatives such as certification, the presence of a high quality journal for our field only strengthens our position. Please submit your papers to JHM. Share your work with your colleagues. Contribute to the success of this important publication.

Recognition for Hospitalists

In another sign of the growth of our field, we have been pursuing recognition of expertise in hospital medicine. Unlike the core competencies, resource rooms, and journal that have already come to pass, formal recognition is still a ways off. And while the final outcome is far from certain, the signs all point toward a separate recognition for hospitalists.

There are many details to be worked out. I wish I had more details to share with you, but I can tell you that we are committed to a formal recognition that will have meaning to hospitalists, our employers, our patients, and to a process that is not burdensome. Also, recognition will not involve another test, but will occur during the maintenance of certification process that is currently in place for all physicians certified by the American Board of Internal Medicine (ABIM). Our initial efforts are with the ABIM because the majority of hospitalists are internists and because the ABIM has been very interested in working with us. I can promise you that once we figure out a process in internal medicine we will use our knowledge to pursue similar certification in pediatrics and family practice.

Public Policy and Advocacy

This year, SHM has taken a big step forward in public policy and advocacy to address the key policy issues affecting hospital medicine. We have a very active public policy committee chaired by Eric Siegal, MD, and a new senior advisor for policy, Laura Allendorf, who have been leading our efforts in this area.

Two key issues being discussed are pay for performance and incentive alignment. Look to The Hospitalist for future articles on these important topics. We also commissioned a white paper on policy issues in hospital medicine that will teach readers about our field and outline our top legislative priorities. This white paper and the recommendations it contains will form the foundation of our first Legislative Day on May 3, 2006 (the precourse day for the annual meeting). Any SHM member who signs up in advance can participate in Legislative Day and have a chance to meet with their elected members of Congress or their staff to educate them about hospitalists and the issues that are important to the field of hospital medicine. Increasingly we see that our new field is raising issues that need to be addressed on the national level. The work of the public policy committee will give a clear voice to SHM in this arena.

Research

At last year’s annual meeting I shared with you my vision for research in hospital medicine and the role of SHM in research. Last month I further outlined my ideas. With a new journal and the largest number of submissions to our research, innovations and vignettes competition ever, we are well on our way to taking a leading role in research in hospital medicine.

Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a toolkit to support discharge planning for elders. Stay tuned for more projects in this area and please apply when we send out a call for applications.

Palliative Care

As you probably know by now, palliative care is near and dear to my heart. Hospital medicine can fulfill the promise of compassionate care for people with serious and life-threatening illness and ensure that all patients have access to high quality palliative care. The palliative care task force that I appointed under the leadership of Chad Whelan, MD, has shown enormous energy and enthusiasm. The task force is planning a resource room and a series of articles about palliative care for JHM.

In addition, the task force is sponsoring two sessions at this year’s annual meeting: Pain Management (Thurs., May 4 from 1:20-2:35 p.m.) and The Basic “Why” and “How” to Develop a Hospital-Based Palliative Care Program (Fri., May 5 from 1:35 to 3:05 p.m.). I encourage you to attend one or both. From the flurry of activity already generated by the palliative care task force, I know that we will see much more relating to palliative care. As a core competency for hospital medicine, palliative care is central to our work. As a compassionate response to the suffering of our patients, it is one of the most rewarding parts of practicing medicine.

All in Service of Caring for the Patient

With all the exciting initiatives happening at SHM, we must never lose sight of why all this activity is important. Ultimately all of this work comes down to caring for our patients. At our core, hospitalists and hospital medicine are about providing the highest quality care to hospitalized patients. Our educational programs, journal, quality projects, policy initiatives, research, and palliative care task force as well as the many other important programs at SHM are all in service of caring for the patient. All that we do to improve the care of patients improves us, our field, and our society.

In the end, as a field, as an organization, and as individual hospitalists, we will be judged by whether our work improved the care of our patients. From my front row seat, I am confident that we will be judged a success because I see firsthand all of the great work being done around the country and within SHM to advance this goal.

It has been a supreme privilege to serve as president of this outstanding organization and to get to know so many of you who make it what it is. I offer my deep gratitude to everyone who has made this past year so great. With all that we have accomplished, there is still much more to do. If you are not yet a member of SHM, join. If you are a member of SHM, get involved. Help shape our growing field. Help make care better, safer, and more compassionate for our patients. This rocket is still gaining speed—join the ride. TH

Dr. Pantilat is the outgoing president of SHM.

In February we experienced a landmark in the development of the field of hospital medicine with the publication of the premiere issue of the Journal of Hospital Medicine (JHM). The debut of JHM demonstrates that hospital medicine is maturing as a field and—even more importantly—that it is developing as a new field with specific issues relevant to its practice.

It is difficult to overestimate the critical role that our journal will play in the growth of our field. The content for the inaugural issue of JHM reflects the depth and breadth of hospital medicine—community acquired pneumonia, palliative care, gastrointestinal bleeding, geriatrics, and a patient’s perspective on hospital care. The many authors who submitted their manuscripts took a leap of faith that our journal would be a respected and widely read vehicle for disseminating their hard work. This leap is even greater given that JHM is not yet listed in PubMed. Nonetheless these authors believe that JHM will thrive, be well read, and influence practice and patient care.

I agree because I know the talent of hospitalists and the potential of our field. The first issue of JHM also included a supplement devoted to the core competencies in hospital medicine. These core competencies represent another milestone in the growth of our field. With the core competencies we have outlined the specific knowledge, skills, and attitudes that define who we are and what we do.

Bringing a journal from concept to reality takes a Herculean effort by many people. I especially want to thank Mark Williams, MD, editor of JHM, for his leadership and grand vision for JHM that reflects our society and field so well. I also want to thank the associate editors and editorial board for giving their time, energy, and expertise to our journal.

I want to share my gratitude and appreciation for Larry Wellikson, MD, the CEO of SHM, who took an idea and mandate presented by the SHM Board of Directors and “operationalized” it in the most effective way. Finally, I want to thank Vickie Thaw, associate publisher at John Wiley & Sons, and her publishing team who have been such great partners in this endeavor.

Growth in Research at the SHM

Papers published in JHM represent only the tip of the iceberg of research in hospital medicine. This year we had 176 abstracts submitted for presentation at our annual meeting in May. These abstracts in research, innovations, and vignettes reflect the enthusiasm, interest, and dedication of many hospitalists. I am always impressed as I read the abstracts and wander through the poster session at the amount of work and creativity represented.

What is even more impressive about these abstracts is that they reflect the breadth of hospital medicine—adult medicine and pediatrics; academic and community hospitals; clinical work and administration; internal medicine, family practice, and pediatrics; disease-specific treatments; and system approaches to care. This year for the first time we will publish the abstracts in a supplement to both The Hospitalist and JHM. All hospitalists who have an abstract accepted for the meeting will be able to cite their work. The supplement marks another advance for our society and field.

I hope that many of you who have submitted abstracts will consider turning them into manuscripts and submitting to JHM. Abstracts whet the appetite to know more, and papers provide the details to improve care.

The Importance of Pursuing Research at SHM

These efforts are critical to our field and represent one visible way that SHM pursues research. SHM must pursue research because it helps define our field. We must ensure that the questions asked are relevant to hospital medicine and that the interventions tested and solutions advocated reflect the real world.

While we welcome anyone to pursue research in hospital medicine and how to improve the care of hospitalized patients, we must ensure that hospitalists play a key role in conducting this research. Research conducted by non-hospitalists may advocate for unrealistic interventions or result in research that is not representative of our field. As the organization that represents hospitalists, SHM can also ensure that research asks the right questions and finds practical solutions with real-world applicability.

For example, SHM should promote:

• Research about best practices, innovations in care delivery, and implementation of known beneficial treatments;
• New approaches to system issues, including error reduction, inpatient-outpatient communication, information systems and transitions; and
• Clinical trials of common inpatient conditions, such as pneumonia and acute decompensated heart failure.

By playing a central role in research, SHM can also advocate for community-based initiatives that ensure research occurs where the majority of patients are cared for.

If we fail to lead in research someone else will, and others will be able to define best practices in hospital medicine. We should not let others define hospital medicine. We took a critical step in defining our field by developing and publishing the core competencies in hospital medicine. Research will be another important way for us to delineate our field. Finally, if SHM does not pursue research we risk losing our academic credentials as a society and a field. Ultimately it will be difficult to succeed as a field and specialty if we do not succeed in academic centers because that is where students and residents—the hospitalists of tomorrow—choose their careers. Hospitalists are great teachers and role models for students and residents. However, in order to ensure that the role models and teachers flourish, we need to pursue research so hospital medicine remains a legitimate part of the academic mission.

SHM Research Initiatives

Although JHM may be the most visible sign of research at SHM, it is not the only one. Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a tool kit to support discharge planning for elders.

I am especially proud that each of these projects involves community and academic hospitalist programs. The SHM Research Committee, chaired by Andy Auerbach, MD, has played a key role in defining a vision for research at the SHM, and I thank Dr. Auerbach and the committee for their efforts and guidance. I am also delighted that SHM recently hired Kathleen Kerr as a senior advisor for research. Kerr’s extensive experience with hospitalists, quality improvement, and research at the University of California, San Francisco, makes her the ideal person to help spearhead this important initiative at SHM. Taken together we have a strong foundation for our research initiative and ensuring that SHM plays a key role in helping to define and shepherd research in hospital medicine.

The Future of Research at SHM

As difficult as it is to publish the first issue of a new journal, the real challenge will be to publish the second issue and beyond. Sustaining the quality and breadth reflected in the first issue will take the combined efforts of the entire editorial staff at JHM, all hospitalists, and all others interested in improving the care of hospitalized patients.

The good news is that, as reflected in our abstract submissions, there is a deep pool of good work in hospital medicine to write about and publish. The other good news is that our field is one in which many of the best innovations and much of the important research comes from community settings and not just academic centers. In fact our strength in research comes from the fact that we can draw from both academic and community programs to create new, “generalizable” knowledge. An even greater strength is when these programs collaborate to take advantage of the best that each has to offer to research.

I encourage each of us to think about the work we are doing and to think about what innovative, creative, or successful program should be shared and implore each of us to submit our work to JHM. Help make JHM the best source for innovation and best practices in hospital medicine. Help shape JHM into the best possible journal it can be—the one you open right away and read through because it is so relevant to your practice.

As our field grows we will look back on this moment as a critical landmark in the development of our field. Hold on to your first issue: It may be a valuable collector’s item when volume 50 is being published and JHM is one of the world’s leading journals. What practices will we look back on and laugh at? What practices will have survived years of scrutiny? What will our field look like? Only time will tell. Read JHM to find out. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

In February we experienced a landmark in the development of the field of hospital medicine with the publication of the premiere issue of the Journal of Hospital Medicine (JHM). The debut of JHM demonstrates that hospital medicine is maturing as a field and—even more importantly—that it is developing as a new field with specific issues relevant to its practice.

It is difficult to overestimate the critical role that our journal will play in the growth of our field. The content for the inaugural issue of JHM reflects the depth and breadth of hospital medicine—community acquired pneumonia, palliative care, gastrointestinal bleeding, geriatrics, and a patient’s perspective on hospital care. The many authors who submitted their manuscripts took a leap of faith that our journal would be a respected and widely read vehicle for disseminating their hard work. This leap is even greater given that JHM is not yet listed in PubMed. Nonetheless these authors believe that JHM will thrive, be well read, and influence practice and patient care.

I agree because I know the talent of hospitalists and the potential of our field. The first issue of JHM also included a supplement devoted to the core competencies in hospital medicine. These core competencies represent another milestone in the growth of our field. With the core competencies we have outlined the specific knowledge, skills, and attitudes that define who we are and what we do.

Bringing a journal from concept to reality takes a Herculean effort by many people. I especially want to thank Mark Williams, MD, editor of JHM, for his leadership and grand vision for JHM that reflects our society and field so well. I also want to thank the associate editors and editorial board for giving their time, energy, and expertise to our journal.

I want to share my gratitude and appreciation for Larry Wellikson, MD, the CEO of SHM, who took an idea and mandate presented by the SHM Board of Directors and “operationalized” it in the most effective way. Finally, I want to thank Vickie Thaw, associate publisher at John Wiley & Sons, and her publishing team who have been such great partners in this endeavor.

Growth in Research at the SHM

Papers published in JHM represent only the tip of the iceberg of research in hospital medicine. This year we had 176 abstracts submitted for presentation at our annual meeting in May. These abstracts in research, innovations, and vignettes reflect the enthusiasm, interest, and dedication of many hospitalists. I am always impressed as I read the abstracts and wander through the poster session at the amount of work and creativity represented.

What is even more impressive about these abstracts is that they reflect the breadth of hospital medicine—adult medicine and pediatrics; academic and community hospitals; clinical work and administration; internal medicine, family practice, and pediatrics; disease-specific treatments; and system approaches to care. This year for the first time we will publish the abstracts in a supplement to both The Hospitalist and JHM. All hospitalists who have an abstract accepted for the meeting will be able to cite their work. The supplement marks another advance for our society and field.

I hope that many of you who have submitted abstracts will consider turning them into manuscripts and submitting to JHM. Abstracts whet the appetite to know more, and papers provide the details to improve care.

The Importance of Pursuing Research at SHM

These efforts are critical to our field and represent one visible way that SHM pursues research. SHM must pursue research because it helps define our field. We must ensure that the questions asked are relevant to hospital medicine and that the interventions tested and solutions advocated reflect the real world.

While we welcome anyone to pursue research in hospital medicine and how to improve the care of hospitalized patients, we must ensure that hospitalists play a key role in conducting this research. Research conducted by non-hospitalists may advocate for unrealistic interventions or result in research that is not representative of our field. As the organization that represents hospitalists, SHM can also ensure that research asks the right questions and finds practical solutions with real-world applicability.

For example, SHM should promote:

• Research about best practices, innovations in care delivery, and implementation of known beneficial treatments;
• New approaches to system issues, including error reduction, inpatient-outpatient communication, information systems and transitions; and
• Clinical trials of common inpatient conditions, such as pneumonia and acute decompensated heart failure.

By playing a central role in research, SHM can also advocate for community-based initiatives that ensure research occurs where the majority of patients are cared for.

If we fail to lead in research someone else will, and others will be able to define best practices in hospital medicine. We should not let others define hospital medicine. We took a critical step in defining our field by developing and publishing the core competencies in hospital medicine. Research will be another important way for us to delineate our field. Finally, if SHM does not pursue research we risk losing our academic credentials as a society and a field. Ultimately it will be difficult to succeed as a field and specialty if we do not succeed in academic centers because that is where students and residents—the hospitalists of tomorrow—choose their careers. Hospitalists are great teachers and role models for students and residents. However, in order to ensure that the role models and teachers flourish, we need to pursue research so hospital medicine remains a legitimate part of the academic mission.

SHM Research Initiatives

Although JHM may be the most visible sign of research at SHM, it is not the only one. Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a tool kit to support discharge planning for elders.

I am especially proud that each of these projects involves community and academic hospitalist programs. The SHM Research Committee, chaired by Andy Auerbach, MD, has played a key role in defining a vision for research at the SHM, and I thank Dr. Auerbach and the committee for their efforts and guidance. I am also delighted that SHM recently hired Kathleen Kerr as a senior advisor for research. Kerr’s extensive experience with hospitalists, quality improvement, and research at the University of California, San Francisco, makes her the ideal person to help spearhead this important initiative at SHM. Taken together we have a strong foundation for our research initiative and ensuring that SHM plays a key role in helping to define and shepherd research in hospital medicine.

The Future of Research at SHM

As difficult as it is to publish the first issue of a new journal, the real challenge will be to publish the second issue and beyond. Sustaining the quality and breadth reflected in the first issue will take the combined efforts of the entire editorial staff at JHM, all hospitalists, and all others interested in improving the care of hospitalized patients.

The good news is that, as reflected in our abstract submissions, there is a deep pool of good work in hospital medicine to write about and publish. The other good news is that our field is one in which many of the best innovations and much of the important research comes from community settings and not just academic centers. In fact our strength in research comes from the fact that we can draw from both academic and community programs to create new, “generalizable” knowledge. An even greater strength is when these programs collaborate to take advantage of the best that each has to offer to research.

I encourage each of us to think about the work we are doing and to think about what innovative, creative, or successful program should be shared and implore each of us to submit our work to JHM. Help make JHM the best source for innovation and best practices in hospital medicine. Help shape JHM into the best possible journal it can be—the one you open right away and read through because it is so relevant to your practice.

As our field grows we will look back on this moment as a critical landmark in the development of our field. Hold on to your first issue: It may be a valuable collector’s item when volume 50 is being published and JHM is one of the world’s leading journals. What practices will we look back on and laugh at? What practices will have survived years of scrutiny? What will our field look like? Only time will tell. Read JHM to find out. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

In February we experienced a landmark in the development of the field of hospital medicine with the publication of the premiere issue of the Journal of Hospital Medicine (JHM). The debut of JHM demonstrates that hospital medicine is maturing as a field and—even more importantly—that it is developing as a new field with specific issues relevant to its practice.

It is difficult to overestimate the critical role that our journal will play in the growth of our field. The content for the inaugural issue of JHM reflects the depth and breadth of hospital medicine—community acquired pneumonia, palliative care, gastrointestinal bleeding, geriatrics, and a patient’s perspective on hospital care. The many authors who submitted their manuscripts took a leap of faith that our journal would be a respected and widely read vehicle for disseminating their hard work. This leap is even greater given that JHM is not yet listed in PubMed. Nonetheless these authors believe that JHM will thrive, be well read, and influence practice and patient care.

I agree because I know the talent of hospitalists and the potential of our field. The first issue of JHM also included a supplement devoted to the core competencies in hospital medicine. These core competencies represent another milestone in the growth of our field. With the core competencies we have outlined the specific knowledge, skills, and attitudes that define who we are and what we do.

Bringing a journal from concept to reality takes a Herculean effort by many people. I especially want to thank Mark Williams, MD, editor of JHM, for his leadership and grand vision for JHM that reflects our society and field so well. I also want to thank the associate editors and editorial board for giving their time, energy, and expertise to our journal.

I want to share my gratitude and appreciation for Larry Wellikson, MD, the CEO of SHM, who took an idea and mandate presented by the SHM Board of Directors and “operationalized” it in the most effective way. Finally, I want to thank Vickie Thaw, associate publisher at John Wiley & Sons, and her publishing team who have been such great partners in this endeavor.

Growth in Research at the SHM

Papers published in JHM represent only the tip of the iceberg of research in hospital medicine. This year we had 176 abstracts submitted for presentation at our annual meeting in May. These abstracts in research, innovations, and vignettes reflect the enthusiasm, interest, and dedication of many hospitalists. I am always impressed as I read the abstracts and wander through the poster session at the amount of work and creativity represented.

What is even more impressive about these abstracts is that they reflect the breadth of hospital medicine—adult medicine and pediatrics; academic and community hospitals; clinical work and administration; internal medicine, family practice, and pediatrics; disease-specific treatments; and system approaches to care. This year for the first time we will publish the abstracts in a supplement to both The Hospitalist and JHM. All hospitalists who have an abstract accepted for the meeting will be able to cite their work. The supplement marks another advance for our society and field.

I hope that many of you who have submitted abstracts will consider turning them into manuscripts and submitting to JHM. Abstracts whet the appetite to know more, and papers provide the details to improve care.

The Importance of Pursuing Research at SHM

These efforts are critical to our field and represent one visible way that SHM pursues research. SHM must pursue research because it helps define our field. We must ensure that the questions asked are relevant to hospital medicine and that the interventions tested and solutions advocated reflect the real world.

While we welcome anyone to pursue research in hospital medicine and how to improve the care of hospitalized patients, we must ensure that hospitalists play a key role in conducting this research. Research conducted by non-hospitalists may advocate for unrealistic interventions or result in research that is not representative of our field. As the organization that represents hospitalists, SHM can also ensure that research asks the right questions and finds practical solutions with real-world applicability.

For example, SHM should promote:

• Research about best practices, innovations in care delivery, and implementation of known beneficial treatments;
• New approaches to system issues, including error reduction, inpatient-outpatient communication, information systems and transitions; and
• Clinical trials of common inpatient conditions, such as pneumonia and acute decompensated heart failure.

By playing a central role in research, SHM can also advocate for community-based initiatives that ensure research occurs where the majority of patients are cared for.

If we fail to lead in research someone else will, and others will be able to define best practices in hospital medicine. We should not let others define hospital medicine. We took a critical step in defining our field by developing and publishing the core competencies in hospital medicine. Research will be another important way for us to delineate our field. Finally, if SHM does not pursue research we risk losing our academic credentials as a society and a field. Ultimately it will be difficult to succeed as a field and specialty if we do not succeed in academic centers because that is where students and residents—the hospitalists of tomorrow—choose their careers. Hospitalists are great teachers and role models for students and residents. However, in order to ensure that the role models and teachers flourish, we need to pursue research so hospital medicine remains a legitimate part of the academic mission.

SHM Research Initiatives

Although JHM may be the most visible sign of research at SHM, it is not the only one. Research projects directly sponsored by SHM include a demonstration project evaluating interventions to improve care of patients with heart failure, a planned survey of hospitalist involvement in managing heart failure in the emergency department and observation units, and a project to develop and evaluate a tool kit to support discharge planning for elders.

I am especially proud that each of these projects involves community and academic hospitalist programs. The SHM Research Committee, chaired by Andy Auerbach, MD, has played a key role in defining a vision for research at the SHM, and I thank Dr. Auerbach and the committee for their efforts and guidance. I am also delighted that SHM recently hired Kathleen Kerr as a senior advisor for research. Kerr’s extensive experience with hospitalists, quality improvement, and research at the University of California, San Francisco, makes her the ideal person to help spearhead this important initiative at SHM. Taken together we have a strong foundation for our research initiative and ensuring that SHM plays a key role in helping to define and shepherd research in hospital medicine.

The Future of Research at SHM

As difficult as it is to publish the first issue of a new journal, the real challenge will be to publish the second issue and beyond. Sustaining the quality and breadth reflected in the first issue will take the combined efforts of the entire editorial staff at JHM, all hospitalists, and all others interested in improving the care of hospitalized patients.

The good news is that, as reflected in our abstract submissions, there is a deep pool of good work in hospital medicine to write about and publish. The other good news is that our field is one in which many of the best innovations and much of the important research comes from community settings and not just academic centers. In fact our strength in research comes from the fact that we can draw from both academic and community programs to create new, “generalizable” knowledge. An even greater strength is when these programs collaborate to take advantage of the best that each has to offer to research.

I encourage each of us to think about the work we are doing and to think about what innovative, creative, or successful program should be shared and implore each of us to submit our work to JHM. Help make JHM the best source for innovation and best practices in hospital medicine. Help shape JHM into the best possible journal it can be—the one you open right away and read through because it is so relevant to your practice.

As our field grows we will look back on this moment as a critical landmark in the development of our field. Hold on to your first issue: It may be a valuable collector’s item when volume 50 is being published and JHM is one of the world’s leading journals. What practices will we look back on and laugh at? What practices will have survived years of scrutiny? What will our field look like? Only time will tell. Read JHM to find out. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

When I meet new people, I’m commonly asked, “So what do you do?” The first answer is easy: “I’m a doctor.” It’s the follow-up question that’s tricky: “What kind of doctor?”

“I’m a hospitalist,” I say.

“What’s that?”

I imagine that each of us faces similar questions almost daily from friends, family, patients, or strangers we meet. This tells me people are still learning who we are and what we are. I also imagine each of us has developed a standard way of answering that second question.

I like to say that a hospitalist is “a doctor who is an expert in taking care of people in the hospital.” Though not necessarily comprehensive, my definition usually does the job in casual conversation. In many ways I find this explanation easier than when I tried to describe myself as an “internist,” for which I never developed an easy definition. My favorite one-liner for internist was “pediatrician for adults,” but even that prompted blank stares or polite nods.

Early Definitions of Hospitalists

My definition certainly works in casual conversation. But the question gets to the heart of who we are, what we do, and what our field is about. Our ability to define these issues is critical to clarifying what hospitalists and hospital medicine are about.

It is interesting to look at early definitions of hospitalists. The first time the word hospitalist was published in 1996, hospitalists were defined as “specialists in inpatient medicine ... who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are responsible for managing the care of outpatients.”1

At the beginning there was a need to compare what hospitalists do, or will do, to something that was already known. The concept was so new that it needed an analogy to be explained. Even in 1999, a paper published in Annals of Internal Medicine defined hospitalists as “physicians who assume the care of hospitalized patients in place of the patients’ primary care provider.”2

Three years after the term was first coined, hospitalists were still being defined in relationship to other physicians. Another paper in Annals of Internal Medicine in 1999 defined a hospitalist as “a physician who spends at least 25% of his or her time serving as the physician-of-record for inpatients, during which time he or she accepts ‘hand-offs’ of hospitalized patients from primary care providers, returning patients to their primary care providers at the time of hospital discharge.”3 Of course that definition was quite a mouthful when explaining what you do to, say, your mother. But there were two important issues wrapped up in that definition.

The first was recognizing that some hospitalists were primarily engaged in research or leadership positions and did not provide a great deal of direct patient care, yet clearly defined themselves as hospitalists. The second was that we were still defined by our relationship to the primary care physician role. Our field was too new to be defined on its own and had to be explained in terms of the existing paradigm.

What became clear was that hospitalists should not be defined by the amount of inpatient care we provided but by our professional focus. For many hospitalists, the thought of caring for hospitalized patients only 25% of the time seemed ridiculous. To others involved in leadership or research who focused exclusively on hospital medicine yet did little patient care the definition seemed too restrictive.

In the end, any definition of hospitalists that depended on time could not encompass the wide range of roles and responsibilities that hospitalists held. Finally, a few months ago, hospitalist was included in the dictionary for the first time. The 2005 update of the Eleventh edition of Merriam-Webster’s Collegiate Dictionary defines a hospitalist as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.” Although I am delighted to see hospitalist in the dictionary, this definition is too limited to be useful or accurate. It is certainly true that the presence of hospitalists means other physicians can come to the hospital less, but that is far from what hospitalists or hospital medicine are about.

SHM Definition of Hospitalists

Our society has an official definition of hospitalists: “Physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.”

I wish the dictionary had used this definition because it gets to the heart of what hospitalists are and defines us in a positive way, on our own terms, and not in relation to other physicians. This definition embraces the broad range of professional activities that hospitalists perform. Our definition even allows for hospitalists to engage in nonhospital-based activities such as outpatient care. The key to this definition is the emphasis of our professional focus being the care of hospitalized patients.

The Big Tent

What the SHM definition of hospitalists recognizes is the great diversity of physicians who serve as hospitalists and the wide variety of roles we all play in the service of caring for hospitalized patients. Both MDs and DOs serve as hospitalists, and they do so as internists, family physicians, and pediatricians. That all these physicians can come together in the same professional organization speaks to the importance of the unifying goal of caring for hospitalized patients that defines what each of us does.

Further, hospitalists can be involved exclusively in patient care, research, teaching, or leadership or in a combination of these roles. Once again the common principle is the focus on the care of hospitalized patients. In fact our society and field are better, more robust, more innovative, and more responsive to the needs of patients because we represent such a broad range of physicians in so many roles.

Our coming together in one organization creates a “big tent” for hospital medicine and allows for cross-fertilization of ideas. However, like any big tent, the strength of our diversity also creates challenges. For example, from an educational standpoint, we need to design programs and materials that meet the needs of all hospitalists. We have found that we share much, regardless of the setting in which we practice, the age of our patients, or the type of work we do. Patient safety, leadership, palliative care, and quality improvement are just a sample of the issues that pertain to all hospitalists.

Additionally, understanding these issues and addressing them takes people who are experts in patient care, teaching, research, and leadership—precisely the job descriptions found within the SHM. I am proud that SHM is one of the only professional societies to include internists, family physicians, and pediatricians from community practice, academia, and industry. Our big tent even extends beyond physicians to include nurse practitioners, physician assistants, pharmacists, nurses, and others who enrich our society and strengthen our field. In fact, our name—the Society of Hospital Medicine—was deliberately chosen to reflect the big tent. We specifically rejected a name that focused on the word hospitalist—not because we are not proud of it, but because we wanted all of those who work to improve the care of hospitalized patients to feel welcome in our society and to join in our mission.

Hospitalist Takes Hold

The phenomenon we now see is the emergence of “surgical” and “OB” hospitalists who care for hospitalized patients who otherwise do not have access to such physicians. Whether these physicians will assume the role of improving the system to provide better care to all inpatients or serve solely as technicians who work a shift and go home remains to be seen.

What is clear, however, is that in just 10 short years we have moved from having hospitalists defined in relationship to other physicians to having other physicians defined in relationship to hospitalists. This evolution is good for our field as we emerge from being the new kids on the block to being part of the existing paradigm.

Hope for the Future

The evolved definition of hospitalist reflects the maturing of our field and leaves me optimistic and hopeful for the future of hospitalists and hospital medicine. I hope that the dictionary will adopt our definition of hospitalist. I hope that one day hospitalist will be as well-known a word as pediatrician. I hope that as our field matures we never lose our enthusiasm and energy. And finally, I hope that our field stays unified and that the SHM continues to represent the broad range of physicians who work as hospitalists. Our field will be stronger and our achievements greater when we stand together, recognizing all that we share in common as hospitalists and respectful of the diversity that adds richness to our field. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514-517.
2. Lindenauer PK, Pantilat SZ, Katz PP, et al. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130(4Pt2):343-349.
3. Wachter RM. An introduction to the hospitalist model. Ann Intern Med. 1999;130(4Pt2):338-342.

When I meet new people, I’m commonly asked, “So what do you do?” The first answer is easy: “I’m a doctor.” It’s the follow-up question that’s tricky: “What kind of doctor?”

“I’m a hospitalist,” I say.

“What’s that?”

I imagine that each of us faces similar questions almost daily from friends, family, patients, or strangers we meet. This tells me people are still learning who we are and what we are. I also imagine each of us has developed a standard way of answering that second question.

I like to say that a hospitalist is “a doctor who is an expert in taking care of people in the hospital.” Though not necessarily comprehensive, my definition usually does the job in casual conversation. In many ways I find this explanation easier than when I tried to describe myself as an “internist,” for which I never developed an easy definition. My favorite one-liner for internist was “pediatrician for adults,” but even that prompted blank stares or polite nods.

Early Definitions of Hospitalists

My definition certainly works in casual conversation. But the question gets to the heart of who we are, what we do, and what our field is about. Our ability to define these issues is critical to clarifying what hospitalists and hospital medicine are about.

It is interesting to look at early definitions of hospitalists. The first time the word hospitalist was published in 1996, hospitalists were defined as “specialists in inpatient medicine ... who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are responsible for managing the care of outpatients.”1

At the beginning there was a need to compare what hospitalists do, or will do, to something that was already known. The concept was so new that it needed an analogy to be explained. Even in 1999, a paper published in Annals of Internal Medicine defined hospitalists as “physicians who assume the care of hospitalized patients in place of the patients’ primary care provider.”2

Three years after the term was first coined, hospitalists were still being defined in relationship to other physicians. Another paper in Annals of Internal Medicine in 1999 defined a hospitalist as “a physician who spends at least 25% of his or her time serving as the physician-of-record for inpatients, during which time he or she accepts ‘hand-offs’ of hospitalized patients from primary care providers, returning patients to their primary care providers at the time of hospital discharge.”3 Of course that definition was quite a mouthful when explaining what you do to, say, your mother. But there were two important issues wrapped up in that definition.

The first was recognizing that some hospitalists were primarily engaged in research or leadership positions and did not provide a great deal of direct patient care, yet clearly defined themselves as hospitalists. The second was that we were still defined by our relationship to the primary care physician role. Our field was too new to be defined on its own and had to be explained in terms of the existing paradigm.

What became clear was that hospitalists should not be defined by the amount of inpatient care we provided but by our professional focus. For many hospitalists, the thought of caring for hospitalized patients only 25% of the time seemed ridiculous. To others involved in leadership or research who focused exclusively on hospital medicine yet did little patient care the definition seemed too restrictive.

In the end, any definition of hospitalists that depended on time could not encompass the wide range of roles and responsibilities that hospitalists held. Finally, a few months ago, hospitalist was included in the dictionary for the first time. The 2005 update of the Eleventh edition of Merriam-Webster’s Collegiate Dictionary defines a hospitalist as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.” Although I am delighted to see hospitalist in the dictionary, this definition is too limited to be useful or accurate. It is certainly true that the presence of hospitalists means other physicians can come to the hospital less, but that is far from what hospitalists or hospital medicine are about.

SHM Definition of Hospitalists

Our society has an official definition of hospitalists: “Physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.”

I wish the dictionary had used this definition because it gets to the heart of what hospitalists are and defines us in a positive way, on our own terms, and not in relation to other physicians. This definition embraces the broad range of professional activities that hospitalists perform. Our definition even allows for hospitalists to engage in nonhospital-based activities such as outpatient care. The key to this definition is the emphasis of our professional focus being the care of hospitalized patients.

The Big Tent

What the SHM definition of hospitalists recognizes is the great diversity of physicians who serve as hospitalists and the wide variety of roles we all play in the service of caring for hospitalized patients. Both MDs and DOs serve as hospitalists, and they do so as internists, family physicians, and pediatricians. That all these physicians can come together in the same professional organization speaks to the importance of the unifying goal of caring for hospitalized patients that defines what each of us does.

Further, hospitalists can be involved exclusively in patient care, research, teaching, or leadership or in a combination of these roles. Once again the common principle is the focus on the care of hospitalized patients. In fact our society and field are better, more robust, more innovative, and more responsive to the needs of patients because we represent such a broad range of physicians in so many roles.

Our coming together in one organization creates a “big tent” for hospital medicine and allows for cross-fertilization of ideas. However, like any big tent, the strength of our diversity also creates challenges. For example, from an educational standpoint, we need to design programs and materials that meet the needs of all hospitalists. We have found that we share much, regardless of the setting in which we practice, the age of our patients, or the type of work we do. Patient safety, leadership, palliative care, and quality improvement are just a sample of the issues that pertain to all hospitalists.

Additionally, understanding these issues and addressing them takes people who are experts in patient care, teaching, research, and leadership—precisely the job descriptions found within the SHM. I am proud that SHM is one of the only professional societies to include internists, family physicians, and pediatricians from community practice, academia, and industry. Our big tent even extends beyond physicians to include nurse practitioners, physician assistants, pharmacists, nurses, and others who enrich our society and strengthen our field. In fact, our name—the Society of Hospital Medicine—was deliberately chosen to reflect the big tent. We specifically rejected a name that focused on the word hospitalist—not because we are not proud of it, but because we wanted all of those who work to improve the care of hospitalized patients to feel welcome in our society and to join in our mission.

Hospitalist Takes Hold

The phenomenon we now see is the emergence of “surgical” and “OB” hospitalists who care for hospitalized patients who otherwise do not have access to such physicians. Whether these physicians will assume the role of improving the system to provide better care to all inpatients or serve solely as technicians who work a shift and go home remains to be seen.

What is clear, however, is that in just 10 short years we have moved from having hospitalists defined in relationship to other physicians to having other physicians defined in relationship to hospitalists. This evolution is good for our field as we emerge from being the new kids on the block to being part of the existing paradigm.

Hope for the Future

The evolved definition of hospitalist reflects the maturing of our field and leaves me optimistic and hopeful for the future of hospitalists and hospital medicine. I hope that the dictionary will adopt our definition of hospitalist. I hope that one day hospitalist will be as well-known a word as pediatrician. I hope that as our field matures we never lose our enthusiasm and energy. And finally, I hope that our field stays unified and that the SHM continues to represent the broad range of physicians who work as hospitalists. Our field will be stronger and our achievements greater when we stand together, recognizing all that we share in common as hospitalists and respectful of the diversity that adds richness to our field. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514-517.
2. Lindenauer PK, Pantilat SZ, Katz PP, et al. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130(4Pt2):343-349.
3. Wachter RM. An introduction to the hospitalist model. Ann Intern Med. 1999;130(4Pt2):338-342.

When I meet new people, I’m commonly asked, “So what do you do?” The first answer is easy: “I’m a doctor.” It’s the follow-up question that’s tricky: “What kind of doctor?”

“I’m a hospitalist,” I say.

“What’s that?”

I imagine that each of us faces similar questions almost daily from friends, family, patients, or strangers we meet. This tells me people are still learning who we are and what we are. I also imagine each of us has developed a standard way of answering that second question.

I like to say that a hospitalist is “a doctor who is an expert in taking care of people in the hospital.” Though not necessarily comprehensive, my definition usually does the job in casual conversation. In many ways I find this explanation easier than when I tried to describe myself as an “internist,” for which I never developed an easy definition. My favorite one-liner for internist was “pediatrician for adults,” but even that prompted blank stares or polite nods.

Early Definitions of Hospitalists

My definition certainly works in casual conversation. But the question gets to the heart of who we are, what we do, and what our field is about. Our ability to define these issues is critical to clarifying what hospitalists and hospital medicine are about.

It is interesting to look at early definitions of hospitalists. The first time the word hospitalist was published in 1996, hospitalists were defined as “specialists in inpatient medicine ... who will be responsible for managing the care of hospitalized patients in the same way that primary care physicians are responsible for managing the care of outpatients.”1

At the beginning there was a need to compare what hospitalists do, or will do, to something that was already known. The concept was so new that it needed an analogy to be explained. Even in 1999, a paper published in Annals of Internal Medicine defined hospitalists as “physicians who assume the care of hospitalized patients in place of the patients’ primary care provider.”2

Three years after the term was first coined, hospitalists were still being defined in relationship to other physicians. Another paper in Annals of Internal Medicine in 1999 defined a hospitalist as “a physician who spends at least 25% of his or her time serving as the physician-of-record for inpatients, during which time he or she accepts ‘hand-offs’ of hospitalized patients from primary care providers, returning patients to their primary care providers at the time of hospital discharge.”3 Of course that definition was quite a mouthful when explaining what you do to, say, your mother. But there were two important issues wrapped up in that definition.

The first was recognizing that some hospitalists were primarily engaged in research or leadership positions and did not provide a great deal of direct patient care, yet clearly defined themselves as hospitalists. The second was that we were still defined by our relationship to the primary care physician role. Our field was too new to be defined on its own and had to be explained in terms of the existing paradigm.

What became clear was that hospitalists should not be defined by the amount of inpatient care we provided but by our professional focus. For many hospitalists, the thought of caring for hospitalized patients only 25% of the time seemed ridiculous. To others involved in leadership or research who focused exclusively on hospital medicine yet did little patient care the definition seemed too restrictive.

In the end, any definition of hospitalists that depended on time could not encompass the wide range of roles and responsibilities that hospitalists held. Finally, a few months ago, hospitalist was included in the dictionary for the first time. The 2005 update of the Eleventh edition of Merriam-Webster’s Collegiate Dictionary defines a hospitalist as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.” Although I am delighted to see hospitalist in the dictionary, this definition is too limited to be useful or accurate. It is certainly true that the presence of hospitalists means other physicians can come to the hospital less, but that is far from what hospitalists or hospital medicine are about.

SHM Definition of Hospitalists

Our society has an official definition of hospitalists: “Physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.”

I wish the dictionary had used this definition because it gets to the heart of what hospitalists are and defines us in a positive way, on our own terms, and not in relation to other physicians. This definition embraces the broad range of professional activities that hospitalists perform. Our definition even allows for hospitalists to engage in nonhospital-based activities such as outpatient care. The key to this definition is the emphasis of our professional focus being the care of hospitalized patients.

The Big Tent

What the SHM definition of hospitalists recognizes is the great diversity of physicians who serve as hospitalists and the wide variety of roles we all play in the service of caring for hospitalized patients. Both MDs and DOs serve as hospitalists, and they do so as internists, family physicians, and pediatricians. That all these physicians can come together in the same professional organization speaks to the importance of the unifying goal of caring for hospitalized patients that defines what each of us does.

Further, hospitalists can be involved exclusively in patient care, research, teaching, or leadership or in a combination of these roles. Once again the common principle is the focus on the care of hospitalized patients. In fact our society and field are better, more robust, more innovative, and more responsive to the needs of patients because we represent such a broad range of physicians in so many roles.

Our coming together in one organization creates a “big tent” for hospital medicine and allows for cross-fertilization of ideas. However, like any big tent, the strength of our diversity also creates challenges. For example, from an educational standpoint, we need to design programs and materials that meet the needs of all hospitalists. We have found that we share much, regardless of the setting in which we practice, the age of our patients, or the type of work we do. Patient safety, leadership, palliative care, and quality improvement are just a sample of the issues that pertain to all hospitalists.

Additionally, understanding these issues and addressing them takes people who are experts in patient care, teaching, research, and leadership—precisely the job descriptions found within the SHM. I am proud that SHM is one of the only professional societies to include internists, family physicians, and pediatricians from community practice, academia, and industry. Our big tent even extends beyond physicians to include nurse practitioners, physician assistants, pharmacists, nurses, and others who enrich our society and strengthen our field. In fact, our name—the Society of Hospital Medicine—was deliberately chosen to reflect the big tent. We specifically rejected a name that focused on the word hospitalist—not because we are not proud of it, but because we wanted all of those who work to improve the care of hospitalized patients to feel welcome in our society and to join in our mission.

Hospitalist Takes Hold

The phenomenon we now see is the emergence of “surgical” and “OB” hospitalists who care for hospitalized patients who otherwise do not have access to such physicians. Whether these physicians will assume the role of improving the system to provide better care to all inpatients or serve solely as technicians who work a shift and go home remains to be seen.

What is clear, however, is that in just 10 short years we have moved from having hospitalists defined in relationship to other physicians to having other physicians defined in relationship to hospitalists. This evolution is good for our field as we emerge from being the new kids on the block to being part of the existing paradigm.

Hope for the Future

The evolved definition of hospitalist reflects the maturing of our field and leaves me optimistic and hopeful for the future of hospitalists and hospital medicine. I hope that the dictionary will adopt our definition of hospitalist. I hope that one day hospitalist will be as well-known a word as pediatrician. I hope that as our field matures we never lose our enthusiasm and energy. And finally, I hope that our field stays unified and that the SHM continues to represent the broad range of physicians who work as hospitalists. Our field will be stronger and our achievements greater when we stand together, recognizing all that we share in common as hospitalists and respectful of the diversity that adds richness to our field. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514-517.
2. Lindenauer PK, Pantilat SZ, Katz PP, et al. Hospitalists and the practice of inpatient medicine: results of a survey of the National Association of Inpatient Physicians. Ann Intern Med. 1999;130(4Pt2):343-349.
3. Wachter RM. An introduction to the hospitalist model. Ann Intern Med. 1999;130(4Pt2):338-342.

W­hen I was a kid I remember saying that “ain’t ain’t a word because ain’t ain’t in the dictionary.” I just found “ain’t” in my online dictionary, which warned against using “ain’t” because it “does not form a part of standard English and should not be used in formal contexts.”

If the dictionary is the final arbiter of what is and is not a word, then finally “hospitalist” is a word (as we reported last month, see Nov. The Hospitalist, p. 17). Of course we have been using the word since Bob Wachter and Lee Goldman first coined it in their paper in the New England Journal of Medicine in 1996.1 But the 2005 update of the Eleventh Edition of Merriam-Webster’s Collegiate Dictionary defines a “hospitalist” as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.”

While I am delighted that our specialty is in the dictionary, I would argue that the role of a hospitalist is about more than saving other physicians’ commute time. In fact SHM published an entire supplement that catalogued the many roles of hospitalists and how we add value.2 But even if the dictionary didn’t get the definition quite right, the presence of the word hospitalist is yet more evidence of the increasing importance and growth of our field. I want to share with you some of the exciting projects that the SHM is working on to further define our field.

Board Certification

We have been in discussion with the American Board of Internal Medicine and other societies that represent important interests in internal medicine regarding board certification for hospitalists. At this point I cannot tell you what certification will look like, how it will be conferred, or when it will come about; however, SHM is committed to developing a process that recognizes the expertise and experience of hospitalists and supports high quality care for patients. As you might imagine, any process of certification for hospitalists has huge implications for all physicians who practice internal medicine, and we are working to consider these issues carefully as we move ahead. Board certification, and the process of making it come about, marks another step along the path in the maturing of our field.

Journal of Hospital Medicine and Research

More evidence of our growth as a field is the coming publication of the Journal of Hospital Medicine. Under the editorship of Mark Williams, MD, the journal will be the first dedicated to hospital medicine and the care of hospitalized patients. I still remember the early discussions at the SHM Board of Directors meetings where we first discussed having a journal. At the time there were only three or four hospitalist researchers and our major concern was whether there would be sufficient content to fill a journal once let alone six or more times a year; however, at the time we also saw where our field was headed. We knew that in order to continue to define the field of hospital medicine a journal was key.

Perhaps our decision several years ago was hubris, perhaps it was blind optimism, but I like to think it was faith in our members and our society and a belief that hospital medicine was here to stay and would only get bigger. Next month SHM will proudly publish the first volume of the Journal of Hospital Medicine. I am happy to report that we have plenty of high quality content to fill the journal. Our field has continued to expand and with it more and more researchers are focusing on hospital medicine. One walk around the poster session at our annual meeting is enough to demonstrate all of the outstanding academic work that hospitalists at academic centers and community hospitals are doing.

Hand in hand with the publication of our journal has been our research initiative. I firmly believe that in order for SHM to lead hospital medicine, we must also lead in the area of research. In order to coordinate and expand our efforts in research, we recently brought Kathleen Kerr on board at SHM as a senior advisor to lead our research initiative. Kathleen brings a new level of rigor and enthusiasm to our research initiative and helps support the outstanding work of our research committee led by Andy Auerbach, MD. At SHM research reflects our members and includes hospitalists from all settings. I invite you to present your work at our annual meeting (we are currently accepting submissions through Jan. 6, 2006, for the Research, Innovations and Clinical Vignettes competition for the 2006 annual meeting) so we can all benefit and learn from the work we are doing. I also invite you to submit your work for publication in the Journal of Hospital Medicine.

Core Competency

Yet another sign of our maturing as a field will be the publication of the Core Competencies in Hospital Medicine as a supplement to the first volume of the Journal of Hospital Medicine. The core competencies reflect hundreds of hours of work by a dedicated group of hospitalists and SHM staff led by Tina Budnitz MPH, to define the core of what hospitalists need to know. Yes, hospitalists are more than just timesavers for other physicians. The core competencies in hospital medicine will outline what hospital medicine is about and serve as the foundation for educational programs, curricula, and initiatives in hospital medicine. The core competencies will also form the basis for certification of hospitalists by defining the key attitudes and skills needed to be a hospitalist. Look for the core competencies in early 2006 along with your first volume of the journal.

Evolution of Other “Ists”

If imitation is the finest form of flattery, then hospitalists should be very flattered by the proliferation of other “-ists.” Within our own field we find “nocurnists,” hospitalists who care for patients in the hospital overnight. Although it is not clear whether being a nocturnist is a permanent state in which you work only nights or a title that you hold temporarily, it is clear that “hospitalist” is leading to a wide use of the “-ist” suffix to describe the practice of physicians.

Even more interesting is the emergence of hospitalists in other fields such as surgery and obstetrics (see our related coverage in The Hospitalist—“What Is a Laborist,” Oct. 2005, p. 6; “Trendwatch: The specialization of hospital medicine,” Oct. 2005, p. 27; and “The Doctor Is In: The role of psychiatric hospitalists,” Oct. 2005, p. 30). Because the “ist” doesn’t work well universally (neither “surgicalist” nor “obstetricist” sounds right and neither does “deliverist”) the terms being used are “surgical hospitalist” or “OB hospitalist.” In either case the idea is that there is a physician, surgeon, or an obstetrician who sees patients in the hospital instead of the patients’ primary physician. Typically these physicians are employed by the hospital to care for unassigned patients admitted through the emergency department. The adoption of “hospitalist” by other fields in medicine to describe clinicians whose professional identity revolves around the hospital is a testament to the acceptance—and even normalization—of hospitalists and to the profound change in the way we care for hospitalized patients brought about by our field.

We certainly have come a long way from the days when our newly formed society decided not to use the word hospitalist or hospital or anything like it in our name for fear of inciting animosity. In just a few short years we find a world where hospitalist is in the dictionary and other physicians begin to use the term to describe themselves. Reflecting this maturing of our field, SHM is involved in several initiatives including certification, research, a journal, and core competencies to further define hospital medicine.

If you have been thinking about getting more involved in the SHM, do so now. Become an active member; volunteer for committees. Help shape our field and the world of hospital medicine in the future. This ride certainly ain’t over. In fact, it’s just beginning. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.
2. Pile J. How hospitalists add value. The Hospitalist. 2005;9:Supplement 1.

W­hen I was a kid I remember saying that “ain’t ain’t a word because ain’t ain’t in the dictionary.” I just found “ain’t” in my online dictionary, which warned against using “ain’t” because it “does not form a part of standard English and should not be used in formal contexts.”

If the dictionary is the final arbiter of what is and is not a word, then finally “hospitalist” is a word (as we reported last month, see Nov. The Hospitalist, p. 17). Of course we have been using the word since Bob Wachter and Lee Goldman first coined it in their paper in the New England Journal of Medicine in 1996.1 But the 2005 update of the Eleventh Edition of Merriam-Webster’s Collegiate Dictionary defines a “hospitalist” as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.”

While I am delighted that our specialty is in the dictionary, I would argue that the role of a hospitalist is about more than saving other physicians’ commute time. In fact SHM published an entire supplement that catalogued the many roles of hospitalists and how we add value.2 But even if the dictionary didn’t get the definition quite right, the presence of the word hospitalist is yet more evidence of the increasing importance and growth of our field. I want to share with you some of the exciting projects that the SHM is working on to further define our field.

Board Certification

We have been in discussion with the American Board of Internal Medicine and other societies that represent important interests in internal medicine regarding board certification for hospitalists. At this point I cannot tell you what certification will look like, how it will be conferred, or when it will come about; however, SHM is committed to developing a process that recognizes the expertise and experience of hospitalists and supports high quality care for patients. As you might imagine, any process of certification for hospitalists has huge implications for all physicians who practice internal medicine, and we are working to consider these issues carefully as we move ahead. Board certification, and the process of making it come about, marks another step along the path in the maturing of our field.

Journal of Hospital Medicine and Research

More evidence of our growth as a field is the coming publication of the Journal of Hospital Medicine. Under the editorship of Mark Williams, MD, the journal will be the first dedicated to hospital medicine and the care of hospitalized patients. I still remember the early discussions at the SHM Board of Directors meetings where we first discussed having a journal. At the time there were only three or four hospitalist researchers and our major concern was whether there would be sufficient content to fill a journal once let alone six or more times a year; however, at the time we also saw where our field was headed. We knew that in order to continue to define the field of hospital medicine a journal was key.

Perhaps our decision several years ago was hubris, perhaps it was blind optimism, but I like to think it was faith in our members and our society and a belief that hospital medicine was here to stay and would only get bigger. Next month SHM will proudly publish the first volume of the Journal of Hospital Medicine. I am happy to report that we have plenty of high quality content to fill the journal. Our field has continued to expand and with it more and more researchers are focusing on hospital medicine. One walk around the poster session at our annual meeting is enough to demonstrate all of the outstanding academic work that hospitalists at academic centers and community hospitals are doing.

Hand in hand with the publication of our journal has been our research initiative. I firmly believe that in order for SHM to lead hospital medicine, we must also lead in the area of research. In order to coordinate and expand our efforts in research, we recently brought Kathleen Kerr on board at SHM as a senior advisor to lead our research initiative. Kathleen brings a new level of rigor and enthusiasm to our research initiative and helps support the outstanding work of our research committee led by Andy Auerbach, MD. At SHM research reflects our members and includes hospitalists from all settings. I invite you to present your work at our annual meeting (we are currently accepting submissions through Jan. 6, 2006, for the Research, Innovations and Clinical Vignettes competition for the 2006 annual meeting) so we can all benefit and learn from the work we are doing. I also invite you to submit your work for publication in the Journal of Hospital Medicine.

Core Competency

Yet another sign of our maturing as a field will be the publication of the Core Competencies in Hospital Medicine as a supplement to the first volume of the Journal of Hospital Medicine. The core competencies reflect hundreds of hours of work by a dedicated group of hospitalists and SHM staff led by Tina Budnitz MPH, to define the core of what hospitalists need to know. Yes, hospitalists are more than just timesavers for other physicians. The core competencies in hospital medicine will outline what hospital medicine is about and serve as the foundation for educational programs, curricula, and initiatives in hospital medicine. The core competencies will also form the basis for certification of hospitalists by defining the key attitudes and skills needed to be a hospitalist. Look for the core competencies in early 2006 along with your first volume of the journal.

Evolution of Other “Ists”

If imitation is the finest form of flattery, then hospitalists should be very flattered by the proliferation of other “-ists.” Within our own field we find “nocurnists,” hospitalists who care for patients in the hospital overnight. Although it is not clear whether being a nocturnist is a permanent state in which you work only nights or a title that you hold temporarily, it is clear that “hospitalist” is leading to a wide use of the “-ist” suffix to describe the practice of physicians.

Even more interesting is the emergence of hospitalists in other fields such as surgery and obstetrics (see our related coverage in The Hospitalist—“What Is a Laborist,” Oct. 2005, p. 6; “Trendwatch: The specialization of hospital medicine,” Oct. 2005, p. 27; and “The Doctor Is In: The role of psychiatric hospitalists,” Oct. 2005, p. 30). Because the “ist” doesn’t work well universally (neither “surgicalist” nor “obstetricist” sounds right and neither does “deliverist”) the terms being used are “surgical hospitalist” or “OB hospitalist.” In either case the idea is that there is a physician, surgeon, or an obstetrician who sees patients in the hospital instead of the patients’ primary physician. Typically these physicians are employed by the hospital to care for unassigned patients admitted through the emergency department. The adoption of “hospitalist” by other fields in medicine to describe clinicians whose professional identity revolves around the hospital is a testament to the acceptance—and even normalization—of hospitalists and to the profound change in the way we care for hospitalized patients brought about by our field.

We certainly have come a long way from the days when our newly formed society decided not to use the word hospitalist or hospital or anything like it in our name for fear of inciting animosity. In just a few short years we find a world where hospitalist is in the dictionary and other physicians begin to use the term to describe themselves. Reflecting this maturing of our field, SHM is involved in several initiatives including certification, research, a journal, and core competencies to further define hospital medicine.

If you have been thinking about getting more involved in the SHM, do so now. Become an active member; volunteer for committees. Help shape our field and the world of hospital medicine in the future. This ride certainly ain’t over. In fact, it’s just beginning. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.
2. Pile J. How hospitalists add value. The Hospitalist. 2005;9:Supplement 1.

W­hen I was a kid I remember saying that “ain’t ain’t a word because ain’t ain’t in the dictionary.” I just found “ain’t” in my online dictionary, which warned against using “ain’t” because it “does not form a part of standard English and should not be used in formal contexts.”

If the dictionary is the final arbiter of what is and is not a word, then finally “hospitalist” is a word (as we reported last month, see Nov. The Hospitalist, p. 17). Of course we have been using the word since Bob Wachter and Lee Goldman first coined it in their paper in the New England Journal of Medicine in 1996.1 But the 2005 update of the Eleventh Edition of Merriam-Webster’s Collegiate Dictionary defines a “hospitalist” as “a physician who specializes in treating hospitalized patients of other physicians in order to minimize the number of hospital visits by other physicians.”

While I am delighted that our specialty is in the dictionary, I would argue that the role of a hospitalist is about more than saving other physicians’ commute time. In fact SHM published an entire supplement that catalogued the many roles of hospitalists and how we add value.2 But even if the dictionary didn’t get the definition quite right, the presence of the word hospitalist is yet more evidence of the increasing importance and growth of our field. I want to share with you some of the exciting projects that the SHM is working on to further define our field.

Board Certification

We have been in discussion with the American Board of Internal Medicine and other societies that represent important interests in internal medicine regarding board certification for hospitalists. At this point I cannot tell you what certification will look like, how it will be conferred, or when it will come about; however, SHM is committed to developing a process that recognizes the expertise and experience of hospitalists and supports high quality care for patients. As you might imagine, any process of certification for hospitalists has huge implications for all physicians who practice internal medicine, and we are working to consider these issues carefully as we move ahead. Board certification, and the process of making it come about, marks another step along the path in the maturing of our field.

Journal of Hospital Medicine and Research

More evidence of our growth as a field is the coming publication of the Journal of Hospital Medicine. Under the editorship of Mark Williams, MD, the journal will be the first dedicated to hospital medicine and the care of hospitalized patients. I still remember the early discussions at the SHM Board of Directors meetings where we first discussed having a journal. At the time there were only three or four hospitalist researchers and our major concern was whether there would be sufficient content to fill a journal once let alone six or more times a year; however, at the time we also saw where our field was headed. We knew that in order to continue to define the field of hospital medicine a journal was key.

Perhaps our decision several years ago was hubris, perhaps it was blind optimism, but I like to think it was faith in our members and our society and a belief that hospital medicine was here to stay and would only get bigger. Next month SHM will proudly publish the first volume of the Journal of Hospital Medicine. I am happy to report that we have plenty of high quality content to fill the journal. Our field has continued to expand and with it more and more researchers are focusing on hospital medicine. One walk around the poster session at our annual meeting is enough to demonstrate all of the outstanding academic work that hospitalists at academic centers and community hospitals are doing.

Hand in hand with the publication of our journal has been our research initiative. I firmly believe that in order for SHM to lead hospital medicine, we must also lead in the area of research. In order to coordinate and expand our efforts in research, we recently brought Kathleen Kerr on board at SHM as a senior advisor to lead our research initiative. Kathleen brings a new level of rigor and enthusiasm to our research initiative and helps support the outstanding work of our research committee led by Andy Auerbach, MD. At SHM research reflects our members and includes hospitalists from all settings. I invite you to present your work at our annual meeting (we are currently accepting submissions through Jan. 6, 2006, for the Research, Innovations and Clinical Vignettes competition for the 2006 annual meeting) so we can all benefit and learn from the work we are doing. I also invite you to submit your work for publication in the Journal of Hospital Medicine.

Core Competency

Yet another sign of our maturing as a field will be the publication of the Core Competencies in Hospital Medicine as a supplement to the first volume of the Journal of Hospital Medicine. The core competencies reflect hundreds of hours of work by a dedicated group of hospitalists and SHM staff led by Tina Budnitz MPH, to define the core of what hospitalists need to know. Yes, hospitalists are more than just timesavers for other physicians. The core competencies in hospital medicine will outline what hospital medicine is about and serve as the foundation for educational programs, curricula, and initiatives in hospital medicine. The core competencies will also form the basis for certification of hospitalists by defining the key attitudes and skills needed to be a hospitalist. Look for the core competencies in early 2006 along with your first volume of the journal.

Evolution of Other “Ists”

If imitation is the finest form of flattery, then hospitalists should be very flattered by the proliferation of other “-ists.” Within our own field we find “nocurnists,” hospitalists who care for patients in the hospital overnight. Although it is not clear whether being a nocturnist is a permanent state in which you work only nights or a title that you hold temporarily, it is clear that “hospitalist” is leading to a wide use of the “-ist” suffix to describe the practice of physicians.

Even more interesting is the emergence of hospitalists in other fields such as surgery and obstetrics (see our related coverage in The Hospitalist—“What Is a Laborist,” Oct. 2005, p. 6; “Trendwatch: The specialization of hospital medicine,” Oct. 2005, p. 27; and “The Doctor Is In: The role of psychiatric hospitalists,” Oct. 2005, p. 30). Because the “ist” doesn’t work well universally (neither “surgicalist” nor “obstetricist” sounds right and neither does “deliverist”) the terms being used are “surgical hospitalist” or “OB hospitalist.” In either case the idea is that there is a physician, surgeon, or an obstetrician who sees patients in the hospital instead of the patients’ primary physician. Typically these physicians are employed by the hospital to care for unassigned patients admitted through the emergency department. The adoption of “hospitalist” by other fields in medicine to describe clinicians whose professional identity revolves around the hospital is a testament to the acceptance—and even normalization—of hospitalists and to the profound change in the way we care for hospitalized patients brought about by our field.

We certainly have come a long way from the days when our newly formed society decided not to use the word hospitalist or hospital or anything like it in our name for fear of inciting animosity. In just a few short years we find a world where hospitalist is in the dictionary and other physicians begin to use the term to describe themselves. Reflecting this maturing of our field, SHM is involved in several initiatives including certification, research, a journal, and core competencies to further define hospital medicine.

If you have been thinking about getting more involved in the SHM, do so now. Become an active member; volunteer for committees. Help shape our field and the world of hospital medicine in the future. This ride certainly ain’t over. In fact, it’s just beginning. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

References

1. Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335(7):514-517.
2. Pile J. How hospitalists add value. The Hospitalist. 2005;9:Supplement 1.

At times it seems as though the solution to every problem in the medical center is for the hospitalists to do it. At the University of California at San Francisco, my hospitalist colleagues lead efforts in information technology, quality improvement, perioperative care, transfers of patients to the medical center, and chair countless medical staff committees.

SHM published a supplement (2005; vol. 9, supp. 1) to The Hospitalist detailing the ways hospitalists add value. The supplement contained articles about treating unassigned patients, leading medical staffs, providing extraordinary availability, improving resource utilization, maximizing throughput and improving patient flow, educating staff and colleagues, and improving patient safety and quality of care.

Given all these activities, it’s no wonder life as a hospitalist is busy. But these activities also add a richness and variety to work and place us at the center of the life of the hospital. As our field continues to grow, our responsibilities will continue to grow. In the years ahead, one challenge for our field will be to know when to say “no.”

At an increasing number of hospitals across the country hospitalists add value in another important way by becoming involved with starting, staffing, and using palliative care services. Hospitalists already play a central role in caring for patients with life-threatening illness by providing expert symptom management and talking with them and their families frankly and compassionately about their illness, prognosis, and preferences for care. While this opportunity to affect the care of individual patients and their families is critical, we can better improve the care of these patients by participating in and leading efforts to establish palliative care services within our institutions.

For hospitalists, the arguments that support starting a palliative care service will be familiar because they involve many of the same issues as when starting a hospitalist program. It is helpful to consider why a hospitalist would want to undertake such an endeavor and why a hospital would support it. Here are the key issues:

1) Need: Many hospitalist programs are started to care for patients for whom there was not a doctor available. While inpatients who need palliative care may already have a doctor, the same argument about need applies. Simply put, the hospital is where half of Americans die and where others with serious, chronic, and life-threatening illness spend time. If for no other reason, palliative care services, like hospitalist programs, are necessary because so many patients need this care.

2) Quality: One of the most important drivers of hospitalist programs is quality. Because hospitalists focus on the care of hospitalized patients they can develop expertise and deliver higher quality. The same holds for palliative care. Studies demonstrate widespread shortfalls in

the quality of care that seriously ill and dying patients receive.1 In addition to doing a poor job managing pain, we typically fail to elicit and respect patient preferences. Just as a hospitalist program provides clinicians focused on the care of inpatients, a palliative care team consisting of physicians, nurses, a social worker, pharmacist, and chaplain provides expertise to address the broad range of issues that arise for patients and their families in a comprehensive and high-quality way.

3) Economics: Studies show that hospitalist programs can reduce length of stay and costs at similar quality.2 While cost-cutting is never the sole reason and often not the most important reason for starting a hospitalist program, the fact that these programs can reduce costs makes them financially attractive to hospitals. Palliative care programs provide the same financial advantages, usually with improved quality.

When given a choice, patients faced with a terminal illness will often choose care focused on symptom management and quality of life rather than longevity. Most often this care requires administering simple medications such as opioids, avoiding invasive procedures, and dedicating clinicians’ time to ensure that symptoms are well-managed, and the broad range of concerns are addressed. At UCSF and elsewhere palliative care programs consistently demonstrate cost savings.3 As our chief operating officer says, “We support palliative care because it’s the right thing to do. It helps that it reduces costs, but that’s not why we do it.”

4) Mission alignment: Hospitalist programs align beautifully with the mission of hospitals to provide high-quality, safe patient care at lower cost and with higher satisfaction. Many hospitals have other concerns that hospitalists help with, such as increasing throughput, managing unassigned patients, and improving care processes. Similarly palliative care programs improve the quality of care for patients with life-threatening illness, reduce costs, and increase patient and family satisfaction. Palliative care services also help with throughput by helping to transition patients to less intensive levels of care consistent with their preferences and expediting discharge to home and hospice.

5) Interdisciplinary skills: No hospitalist is an island. The effective hospitalist understands the benefits and necessity of working closely with colleagues from other disciplines to provide high-quality care. In the same way it requires an interdisciplinary palliative care team to address the range of issues facing patients from pain and symptom management to depression and anxiety to spiritual concerns to practical questions about how to get help at home and who will pay for it. The skills that hospitalists develop working with colleagues in the hospital are identical to those needed to provide palliative care.

WHY HOSPITALISTS MUST GET INVOLVED

The parallels between hospitalist programs and palliative care programs support the role of hospitalists in providing palliative care. But there are other important reasons for hospitalists to become involved with palliative care teams.

First, palliative care adds variety to work. Although it may seem that any given day already has too much variety, focusing on palliative care issues, and visiting with patients about their hopes and fears can be a welcome change from general hospitalist work. Second, palliative care can provide incredible personal rewards. Third, palliative care can add diversification to a hospitalist’s income stream through professional fees and hospital support directed at palliative care. Fourth, for the vast majority of us hospitalists who are generalists, palliative care offers the opportunity to develop special expertise and even board certification. Finally, a palliative care service in the hospital can increase the status of the institution, improving family satisfaction, addressing many JCAHO requirements, and supporting the bottom line.

As hospitalists we have many ways to get involved with a palliative care service. Those who are really motivated can lead the implementation of a palliative care service. Because only a minority of hospitals have palliative care programs, this opportunity will be available at many institutions.4,5 But even if you don’t want to lead the effort, you can still play a key role by joining an existing palliative care team or joining a team that is planning to start a program.

Palliative care programs can improve the care of seriously ill and dying patients. They address an important and unmet patient care need and mesh well with the mission and goals of nearly all hospitals. Hospitalists are perfectly positioned to participate in, lead, and use palliative care services. Such work not only helps our patients but benefits us as well by providing the rewards of helping patients and families in need. In the end, we gain not only from easing the suffering of our fellow human beings but from remembering how precious life is, how limited our time is, and how important our choices are about how we spend our time. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at UCSF.

REFERENCES

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591-1598.
2. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287(4):487-494.
3. Smith TJ, Coyne PJ, Cassel B, et al. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med. 2003;6(5):699-705.
4. Pan CX, Morrison RS, Meier DE, et al. How prevalent are hospital-based palliative care programs? Status report and future directions. J Palliat Med. 2001;4(3):315-324.
5. Pantilat SZ, Billings JA. Prevalence and structure of palliative care services in California hospitals. Arch Intern Med. May 12 2003;163(9):1084-1088.

At times it seems as though the solution to every problem in the medical center is for the hospitalists to do it. At the University of California at San Francisco, my hospitalist colleagues lead efforts in information technology, quality improvement, perioperative care, transfers of patients to the medical center, and chair countless medical staff committees.

SHM published a supplement (2005; vol. 9, supp. 1) to The Hospitalist detailing the ways hospitalists add value. The supplement contained articles about treating unassigned patients, leading medical staffs, providing extraordinary availability, improving resource utilization, maximizing throughput and improving patient flow, educating staff and colleagues, and improving patient safety and quality of care.

Given all these activities, it’s no wonder life as a hospitalist is busy. But these activities also add a richness and variety to work and place us at the center of the life of the hospital. As our field continues to grow, our responsibilities will continue to grow. In the years ahead, one challenge for our field will be to know when to say “no.”

At an increasing number of hospitals across the country hospitalists add value in another important way by becoming involved with starting, staffing, and using palliative care services. Hospitalists already play a central role in caring for patients with life-threatening illness by providing expert symptom management and talking with them and their families frankly and compassionately about their illness, prognosis, and preferences for care. While this opportunity to affect the care of individual patients and their families is critical, we can better improve the care of these patients by participating in and leading efforts to establish palliative care services within our institutions.

For hospitalists, the arguments that support starting a palliative care service will be familiar because they involve many of the same issues as when starting a hospitalist program. It is helpful to consider why a hospitalist would want to undertake such an endeavor and why a hospital would support it. Here are the key issues:

1) Need: Many hospitalist programs are started to care for patients for whom there was not a doctor available. While inpatients who need palliative care may already have a doctor, the same argument about need applies. Simply put, the hospital is where half of Americans die and where others with serious, chronic, and life-threatening illness spend time. If for no other reason, palliative care services, like hospitalist programs, are necessary because so many patients need this care.

2) Quality: One of the most important drivers of hospitalist programs is quality. Because hospitalists focus on the care of hospitalized patients they can develop expertise and deliver higher quality. The same holds for palliative care. Studies demonstrate widespread shortfalls in

the quality of care that seriously ill and dying patients receive.1 In addition to doing a poor job managing pain, we typically fail to elicit and respect patient preferences. Just as a hospitalist program provides clinicians focused on the care of inpatients, a palliative care team consisting of physicians, nurses, a social worker, pharmacist, and chaplain provides expertise to address the broad range of issues that arise for patients and their families in a comprehensive and high-quality way.

3) Economics: Studies show that hospitalist programs can reduce length of stay and costs at similar quality.2 While cost-cutting is never the sole reason and often not the most important reason for starting a hospitalist program, the fact that these programs can reduce costs makes them financially attractive to hospitals. Palliative care programs provide the same financial advantages, usually with improved quality.

When given a choice, patients faced with a terminal illness will often choose care focused on symptom management and quality of life rather than longevity. Most often this care requires administering simple medications such as opioids, avoiding invasive procedures, and dedicating clinicians’ time to ensure that symptoms are well-managed, and the broad range of concerns are addressed. At UCSF and elsewhere palliative care programs consistently demonstrate cost savings.3 As our chief operating officer says, “We support palliative care because it’s the right thing to do. It helps that it reduces costs, but that’s not why we do it.”

4) Mission alignment: Hospitalist programs align beautifully with the mission of hospitals to provide high-quality, safe patient care at lower cost and with higher satisfaction. Many hospitals have other concerns that hospitalists help with, such as increasing throughput, managing unassigned patients, and improving care processes. Similarly palliative care programs improve the quality of care for patients with life-threatening illness, reduce costs, and increase patient and family satisfaction. Palliative care services also help with throughput by helping to transition patients to less intensive levels of care consistent with their preferences and expediting discharge to home and hospice.

5) Interdisciplinary skills: No hospitalist is an island. The effective hospitalist understands the benefits and necessity of working closely with colleagues from other disciplines to provide high-quality care. In the same way it requires an interdisciplinary palliative care team to address the range of issues facing patients from pain and symptom management to depression and anxiety to spiritual concerns to practical questions about how to get help at home and who will pay for it. The skills that hospitalists develop working with colleagues in the hospital are identical to those needed to provide palliative care.

WHY HOSPITALISTS MUST GET INVOLVED

The parallels between hospitalist programs and palliative care programs support the role of hospitalists in providing palliative care. But there are other important reasons for hospitalists to become involved with palliative care teams.

First, palliative care adds variety to work. Although it may seem that any given day already has too much variety, focusing on palliative care issues, and visiting with patients about their hopes and fears can be a welcome change from general hospitalist work. Second, palliative care can provide incredible personal rewards. Third, palliative care can add diversification to a hospitalist’s income stream through professional fees and hospital support directed at palliative care. Fourth, for the vast majority of us hospitalists who are generalists, palliative care offers the opportunity to develop special expertise and even board certification. Finally, a palliative care service in the hospital can increase the status of the institution, improving family satisfaction, addressing many JCAHO requirements, and supporting the bottom line.

As hospitalists we have many ways to get involved with a palliative care service. Those who are really motivated can lead the implementation of a palliative care service. Because only a minority of hospitals have palliative care programs, this opportunity will be available at many institutions.4,5 But even if you don’t want to lead the effort, you can still play a key role by joining an existing palliative care team or joining a team that is planning to start a program.

Palliative care programs can improve the care of seriously ill and dying patients. They address an important and unmet patient care need and mesh well with the mission and goals of nearly all hospitals. Hospitalists are perfectly positioned to participate in, lead, and use palliative care services. Such work not only helps our patients but benefits us as well by providing the rewards of helping patients and families in need. In the end, we gain not only from easing the suffering of our fellow human beings but from remembering how precious life is, how limited our time is, and how important our choices are about how we spend our time. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at UCSF.

REFERENCES

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591-1598.
2. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287(4):487-494.
3. Smith TJ, Coyne PJ, Cassel B, et al. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med. 2003;6(5):699-705.
4. Pan CX, Morrison RS, Meier DE, et al. How prevalent are hospital-based palliative care programs? Status report and future directions. J Palliat Med. 2001;4(3):315-324.
5. Pantilat SZ, Billings JA. Prevalence and structure of palliative care services in California hospitals. Arch Intern Med. May 12 2003;163(9):1084-1088.

At times it seems as though the solution to every problem in the medical center is for the hospitalists to do it. At the University of California at San Francisco, my hospitalist colleagues lead efforts in information technology, quality improvement, perioperative care, transfers of patients to the medical center, and chair countless medical staff committees.

SHM published a supplement (2005; vol. 9, supp. 1) to The Hospitalist detailing the ways hospitalists add value. The supplement contained articles about treating unassigned patients, leading medical staffs, providing extraordinary availability, improving resource utilization, maximizing throughput and improving patient flow, educating staff and colleagues, and improving patient safety and quality of care.

Given all these activities, it’s no wonder life as a hospitalist is busy. But these activities also add a richness and variety to work and place us at the center of the life of the hospital. As our field continues to grow, our responsibilities will continue to grow. In the years ahead, one challenge for our field will be to know when to say “no.”

At an increasing number of hospitals across the country hospitalists add value in another important way by becoming involved with starting, staffing, and using palliative care services. Hospitalists already play a central role in caring for patients with life-threatening illness by providing expert symptom management and talking with them and their families frankly and compassionately about their illness, prognosis, and preferences for care. While this opportunity to affect the care of individual patients and their families is critical, we can better improve the care of these patients by participating in and leading efforts to establish palliative care services within our institutions.

For hospitalists, the arguments that support starting a palliative care service will be familiar because they involve many of the same issues as when starting a hospitalist program. It is helpful to consider why a hospitalist would want to undertake such an endeavor and why a hospital would support it. Here are the key issues:

1) Need: Many hospitalist programs are started to care for patients for whom there was not a doctor available. While inpatients who need palliative care may already have a doctor, the same argument about need applies. Simply put, the hospital is where half of Americans die and where others with serious, chronic, and life-threatening illness spend time. If for no other reason, palliative care services, like hospitalist programs, are necessary because so many patients need this care.

2) Quality: One of the most important drivers of hospitalist programs is quality. Because hospitalists focus on the care of hospitalized patients they can develop expertise and deliver higher quality. The same holds for palliative care. Studies demonstrate widespread shortfalls in

the quality of care that seriously ill and dying patients receive.1 In addition to doing a poor job managing pain, we typically fail to elicit and respect patient preferences. Just as a hospitalist program provides clinicians focused on the care of inpatients, a palliative care team consisting of physicians, nurses, a social worker, pharmacist, and chaplain provides expertise to address the broad range of issues that arise for patients and their families in a comprehensive and high-quality way.

3) Economics: Studies show that hospitalist programs can reduce length of stay and costs at similar quality.2 While cost-cutting is never the sole reason and often not the most important reason for starting a hospitalist program, the fact that these programs can reduce costs makes them financially attractive to hospitals. Palliative care programs provide the same financial advantages, usually with improved quality.

When given a choice, patients faced with a terminal illness will often choose care focused on symptom management and quality of life rather than longevity. Most often this care requires administering simple medications such as opioids, avoiding invasive procedures, and dedicating clinicians’ time to ensure that symptoms are well-managed, and the broad range of concerns are addressed. At UCSF and elsewhere palliative care programs consistently demonstrate cost savings.3 As our chief operating officer says, “We support palliative care because it’s the right thing to do. It helps that it reduces costs, but that’s not why we do it.”

4) Mission alignment: Hospitalist programs align beautifully with the mission of hospitals to provide high-quality, safe patient care at lower cost and with higher satisfaction. Many hospitals have other concerns that hospitalists help with, such as increasing throughput, managing unassigned patients, and improving care processes. Similarly palliative care programs improve the quality of care for patients with life-threatening illness, reduce costs, and increase patient and family satisfaction. Palliative care services also help with throughput by helping to transition patients to less intensive levels of care consistent with their preferences and expediting discharge to home and hospice.

5) Interdisciplinary skills: No hospitalist is an island. The effective hospitalist understands the benefits and necessity of working closely with colleagues from other disciplines to provide high-quality care. In the same way it requires an interdisciplinary palliative care team to address the range of issues facing patients from pain and symptom management to depression and anxiety to spiritual concerns to practical questions about how to get help at home and who will pay for it. The skills that hospitalists develop working with colleagues in the hospital are identical to those needed to provide palliative care.

WHY HOSPITALISTS MUST GET INVOLVED

The parallels between hospitalist programs and palliative care programs support the role of hospitalists in providing palliative care. But there are other important reasons for hospitalists to become involved with palliative care teams.

First, palliative care adds variety to work. Although it may seem that any given day already has too much variety, focusing on palliative care issues, and visiting with patients about their hopes and fears can be a welcome change from general hospitalist work. Second, palliative care can provide incredible personal rewards. Third, palliative care can add diversification to a hospitalist’s income stream through professional fees and hospital support directed at palliative care. Fourth, for the vast majority of us hospitalists who are generalists, palliative care offers the opportunity to develop special expertise and even board certification. Finally, a palliative care service in the hospital can increase the status of the institution, improving family satisfaction, addressing many JCAHO requirements, and supporting the bottom line.

As hospitalists we have many ways to get involved with a palliative care service. Those who are really motivated can lead the implementation of a palliative care service. Because only a minority of hospitals have palliative care programs, this opportunity will be available at many institutions.4,5 But even if you don’t want to lead the effort, you can still play a key role by joining an existing palliative care team or joining a team that is planning to start a program.

Palliative care programs can improve the care of seriously ill and dying patients. They address an important and unmet patient care need and mesh well with the mission and goals of nearly all hospitals. Hospitalists are perfectly positioned to participate in, lead, and use palliative care services. Such work not only helps our patients but benefits us as well by providing the rewards of helping patients and families in need. In the end, we gain not only from easing the suffering of our fellow human beings but from remembering how precious life is, how limited our time is, and how important our choices are about how we spend our time. TH

SHM President Dr. Pantilat is an associate professor of clinical medicine at UCSF.

REFERENCES

1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591-1598.
2. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287(4):487-494.
3. Smith TJ, Coyne PJ, Cassel B, et al. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med. 2003;6(5):699-705.
4. Pan CX, Morrison RS, Meier DE, et al. How prevalent are hospital-based palliative care programs? Status report and future directions. J Palliat Med. 2001;4(3):315-324.
5. Pantilat SZ, Billings JA. Prevalence and structure of palliative care services in California hospitals. Arch Intern Med. May 12 2003;163(9):1084-1088.

I recently picked up volume 1, number 1 of The Hospitalist, which was edited by John Nelson and Win Whitcomb and published in spring 1997. The Hospitalist was six pages long and had five articles and three job advertisements. The articles included one by Bob Wachter about how hospitalists represent “without a doubt … a bona fide new specialty in American medicine,” and one by Richard Slataper about how hospitalists improve quality of care.

As I compare volume 1, number 1 with the current volume, I marvel at how much things have changed—and how much they have stayed the same. The change is obvious just by looking at The Hospitalist. The similarities are evident by reading the content. We still talk about how hospital medicine is emerging as a new specialty and is taking important strides in that direction. Quality is still the key metric by which we measure our practice.

With this volume, we enter a new, exciting era for The Hospitalist with a new format, new editorial staff leadership, and a new publisher—but the same commitment to excellence and dedication to addressing key issues in the field of hospital medicine. I thank Jim Pile for his outstanding job as the previous editor of The Hospitalist. Jamie Newman assumes the role of physician editor with this issue, and I am excited to have his energy and creative ideas to lead the new phase of this important publication.

It has been said that half of what you learn in medical school is obsolete five years after you graduate. The trouble is you can’t know which half that will be until five years later. I remember being warned as an intern never to give a beta-blocker to a patient with heart failure. We now know that beta-blockers are lifesaving for people with heart failure. We are fortunate to practice in a world where scientific discoveries enhance our ability to help our patients and where the pace of discovery is growing by leaps and bounds. I wish I could list everything we do today that will be obsolete in five years, but my crystal ball is not that clear. Because I cannot predict what will change in medicine, I have instead thought about what does not change. As we celebrate the new with this volume of The Hospitalist I want to remember what is timeless in our profession.

Cornerstones of Diagnosis

With so much technology it is easy to believe that technology makes the diagnosis and heals the patient. But despite all of the new and amazing tests at our disposal, the patient history and physical examination remain the cornerstones of diagnosis.

It has been said that in more than 90% of cases the correct diagnosis appears on the differential after the history and physical. The tests merely help to confirm or rule out diagnoses. As technology races ahead the importance of sitting at the bedside, talking with the patient, and hearing her story stays constant.

One of my mentors says, “Don’t just do something, sit there.” When I’m confused about what is going on with a patient, my best aid in figuring things out is to pull up a chair and have the patient tell me his story from the beginning. What I like so much about being a hospitalist is that I have the ability to spend that kind of time when I need to. Unlike the outpatient setting where patients are scheduled every 15 minutes regardless of the reason for the visit, in the hospital I can be more flexible about how I allocate my time. I can spend time sitting and listening.

There is an apocryphal story I like that says that if you sit down in the patient’s room the patient will experience your visit as having lasted longer than if you stand for the same amount of time. I say apocryphal because I have searched for this study but have never found it; however, I believe it. Patients also like telling their story. There is healing in the telling and in knowing that you have been heard. As so much of medicine changes, sitting with the patient and hearing her story remains timeless.

Reach Out and Touch

Another part of medicine that has not changed over the millennia is the power of touch. During my second year of residency I realized that in many situations the physical examination just didn’t add much to my care of the patient. Perhaps this fact reflected my physical examination skills, but I believe it was more a function of realizing that in the absence of complaints in the chest I was unlikely to discover something on lung exam.

The great symbolism and importance of touching and examining the patient goes beyond discovering the unexpected finding. The laying on of hands creates a physical connection to the patient and can heal. I now make it a point to physically examine every patient every day. I examine patients not just to support billing and not just because there just may be a new finding, but because there is power and healing in touch. I want the patient to benefit from this power and I want to connect to it for myself. As a hospitalist I feel privileged to be able to be at the bedside with patients.

Identify with the Patient

Another timeless part of patient care is empathy. Many patients simply want someone to walk alongside them and understand their experience of illness. Empathy makes this possible.

As I talk with patients I use myself as a guide for understanding the patient’s emotional experience and try to reflect that back. More than simply taking the history or laying my hands on the patient, I try to understand what the patient is feeling and going through. The fear and loneliness of illness can be greatly relieved by knowing that another person understands your experience and is walking with you. Our patients’ need and desire for empathy has not changed despite all of our technological innovations.

As hospitalists we meet people at their sickest and most vulnerable. They enter the foreign world of the hospital where they are often alone and where they have little to no control over what happens to them. Patients typically can’t even dictate the basics of life in the hospital like when or what they can eat. Even if we imagine the ideal hospital of the future built around the patient and that affords maximum control to the patient, the hospital will still be foreign. The power of empathy and the human interaction it represents will remain as important in this ideal hospital as it is today and as it always has been.

Education Never Ends

The other certainty in medicine is that science and technology will advance, bringing new and better ways to diagnose and treat illness. Thus the final constant in medicine is the need to always be learning. As an attending I had to learn that beta-blockers were good for people with heart failure and saved lives. I have learned many more new things since residency and understand the need to continue to learn.

Another wonderful aspect of being a hospitalist is the continuous progress of medical care and the ability to apply it to help patients. Advances in diagnosis and treatment, changes to systems that ensure that all patients receive this care, and attention to patient safety, quality, and palliative care all help ensure that patients receive the best possible care. Hospitalists are at the forefront of all of these activities.

In Conclusion

I delight in the new and celebrate progress that this era for The Hospitalist represents. I’m proud of the The Hospitalist and look forward to it continuing the tradition of quality while it expands and grows in new ways. In the same way I’m excited about medical advances but try always to remember what is timeless. Sitting with patients, listening to them, touching them, and being empathic reap great rewards for patients and for us.

As hospitalists we care for people at their most vulnerable moments. At those times our humanity, our gentle, caring touch, and our empathy matter most. In addition to bringing to bear the best that modern medicine has to offer in medications, diagnostic tests, and interventions let us remember the power to heal that we bring to the bedside when we bring ourselves—open to being with the patient and not just doing something but sitting there. TH

Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

I recently picked up volume 1, number 1 of The Hospitalist, which was edited by John Nelson and Win Whitcomb and published in spring 1997. The Hospitalist was six pages long and had five articles and three job advertisements. The articles included one by Bob Wachter about how hospitalists represent “without a doubt … a bona fide new specialty in American medicine,” and one by Richard Slataper about how hospitalists improve quality of care.

As I compare volume 1, number 1 with the current volume, I marvel at how much things have changed—and how much they have stayed the same. The change is obvious just by looking at The Hospitalist. The similarities are evident by reading the content. We still talk about how hospital medicine is emerging as a new specialty and is taking important strides in that direction. Quality is still the key metric by which we measure our practice.

With this volume, we enter a new, exciting era for The Hospitalist with a new format, new editorial staff leadership, and a new publisher—but the same commitment to excellence and dedication to addressing key issues in the field of hospital medicine. I thank Jim Pile for his outstanding job as the previous editor of The Hospitalist. Jamie Newman assumes the role of physician editor with this issue, and I am excited to have his energy and creative ideas to lead the new phase of this important publication.

It has been said that half of what you learn in medical school is obsolete five years after you graduate. The trouble is you can’t know which half that will be until five years later. I remember being warned as an intern never to give a beta-blocker to a patient with heart failure. We now know that beta-blockers are lifesaving for people with heart failure. We are fortunate to practice in a world where scientific discoveries enhance our ability to help our patients and where the pace of discovery is growing by leaps and bounds. I wish I could list everything we do today that will be obsolete in five years, but my crystal ball is not that clear. Because I cannot predict what will change in medicine, I have instead thought about what does not change. As we celebrate the new with this volume of The Hospitalist I want to remember what is timeless in our profession.

Cornerstones of Diagnosis

With so much technology it is easy to believe that technology makes the diagnosis and heals the patient. But despite all of the new and amazing tests at our disposal, the patient history and physical examination remain the cornerstones of diagnosis.

It has been said that in more than 90% of cases the correct diagnosis appears on the differential after the history and physical. The tests merely help to confirm or rule out diagnoses. As technology races ahead the importance of sitting at the bedside, talking with the patient, and hearing her story stays constant.

One of my mentors says, “Don’t just do something, sit there.” When I’m confused about what is going on with a patient, my best aid in figuring things out is to pull up a chair and have the patient tell me his story from the beginning. What I like so much about being a hospitalist is that I have the ability to spend that kind of time when I need to. Unlike the outpatient setting where patients are scheduled every 15 minutes regardless of the reason for the visit, in the hospital I can be more flexible about how I allocate my time. I can spend time sitting and listening.

There is an apocryphal story I like that says that if you sit down in the patient’s room the patient will experience your visit as having lasted longer than if you stand for the same amount of time. I say apocryphal because I have searched for this study but have never found it; however, I believe it. Patients also like telling their story. There is healing in the telling and in knowing that you have been heard. As so much of medicine changes, sitting with the patient and hearing her story remains timeless.

Reach Out and Touch

Another part of medicine that has not changed over the millennia is the power of touch. During my second year of residency I realized that in many situations the physical examination just didn’t add much to my care of the patient. Perhaps this fact reflected my physical examination skills, but I believe it was more a function of realizing that in the absence of complaints in the chest I was unlikely to discover something on lung exam.

The great symbolism and importance of touching and examining the patient goes beyond discovering the unexpected finding. The laying on of hands creates a physical connection to the patient and can heal. I now make it a point to physically examine every patient every day. I examine patients not just to support billing and not just because there just may be a new finding, but because there is power and healing in touch. I want the patient to benefit from this power and I want to connect to it for myself. As a hospitalist I feel privileged to be able to be at the bedside with patients.

Identify with the Patient

Another timeless part of patient care is empathy. Many patients simply want someone to walk alongside them and understand their experience of illness. Empathy makes this possible.

As I talk with patients I use myself as a guide for understanding the patient’s emotional experience and try to reflect that back. More than simply taking the history or laying my hands on the patient, I try to understand what the patient is feeling and going through. The fear and loneliness of illness can be greatly relieved by knowing that another person understands your experience and is walking with you. Our patients’ need and desire for empathy has not changed despite all of our technological innovations.

As hospitalists we meet people at their sickest and most vulnerable. They enter the foreign world of the hospital where they are often alone and where they have little to no control over what happens to them. Patients typically can’t even dictate the basics of life in the hospital like when or what they can eat. Even if we imagine the ideal hospital of the future built around the patient and that affords maximum control to the patient, the hospital will still be foreign. The power of empathy and the human interaction it represents will remain as important in this ideal hospital as it is today and as it always has been.

Education Never Ends

The other certainty in medicine is that science and technology will advance, bringing new and better ways to diagnose and treat illness. Thus the final constant in medicine is the need to always be learning. As an attending I had to learn that beta-blockers were good for people with heart failure and saved lives. I have learned many more new things since residency and understand the need to continue to learn.

Another wonderful aspect of being a hospitalist is the continuous progress of medical care and the ability to apply it to help patients. Advances in diagnosis and treatment, changes to systems that ensure that all patients receive this care, and attention to patient safety, quality, and palliative care all help ensure that patients receive the best possible care. Hospitalists are at the forefront of all of these activities.

In Conclusion

I delight in the new and celebrate progress that this era for The Hospitalist represents. I’m proud of the The Hospitalist and look forward to it continuing the tradition of quality while it expands and grows in new ways. In the same way I’m excited about medical advances but try always to remember what is timeless. Sitting with patients, listening to them, touching them, and being empathic reap great rewards for patients and for us.

As hospitalists we care for people at their most vulnerable moments. At those times our humanity, our gentle, caring touch, and our empathy matter most. In addition to bringing to bear the best that modern medicine has to offer in medications, diagnostic tests, and interventions let us remember the power to heal that we bring to the bedside when we bring ourselves—open to being with the patient and not just doing something but sitting there. TH

Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.

I recently picked up volume 1, number 1 of The Hospitalist, which was edited by John Nelson and Win Whitcomb and published in spring 1997. The Hospitalist was six pages long and had five articles and three job advertisements. The articles included one by Bob Wachter about how hospitalists represent “without a doubt … a bona fide new specialty in American medicine,” and one by Richard Slataper about how hospitalists improve quality of care.

As I compare volume 1, number 1 with the current volume, I marvel at how much things have changed—and how much they have stayed the same. The change is obvious just by looking at The Hospitalist. The similarities are evident by reading the content. We still talk about how hospital medicine is emerging as a new specialty and is taking important strides in that direction. Quality is still the key metric by which we measure our practice.

With this volume, we enter a new, exciting era for The Hospitalist with a new format, new editorial staff leadership, and a new publisher—but the same commitment to excellence and dedication to addressing key issues in the field of hospital medicine. I thank Jim Pile for his outstanding job as the previous editor of The Hospitalist. Jamie Newman assumes the role of physician editor with this issue, and I am excited to have his energy and creative ideas to lead the new phase of this important publication.

It has been said that half of what you learn in medical school is obsolete five years after you graduate. The trouble is you can’t know which half that will be until five years later. I remember being warned as an intern never to give a beta-blocker to a patient with heart failure. We now know that beta-blockers are lifesaving for people with heart failure. We are fortunate to practice in a world where scientific discoveries enhance our ability to help our patients and where the pace of discovery is growing by leaps and bounds. I wish I could list everything we do today that will be obsolete in five years, but my crystal ball is not that clear. Because I cannot predict what will change in medicine, I have instead thought about what does not change. As we celebrate the new with this volume of The Hospitalist I want to remember what is timeless in our profession.

Cornerstones of Diagnosis

With so much technology it is easy to believe that technology makes the diagnosis and heals the patient. But despite all of the new and amazing tests at our disposal, the patient history and physical examination remain the cornerstones of diagnosis.

It has been said that in more than 90% of cases the correct diagnosis appears on the differential after the history and physical. The tests merely help to confirm or rule out diagnoses. As technology races ahead the importance of sitting at the bedside, talking with the patient, and hearing her story stays constant.

One of my mentors says, “Don’t just do something, sit there.” When I’m confused about what is going on with a patient, my best aid in figuring things out is to pull up a chair and have the patient tell me his story from the beginning. What I like so much about being a hospitalist is that I have the ability to spend that kind of time when I need to. Unlike the outpatient setting where patients are scheduled every 15 minutes regardless of the reason for the visit, in the hospital I can be more flexible about how I allocate my time. I can spend time sitting and listening.

There is an apocryphal story I like that says that if you sit down in the patient’s room the patient will experience your visit as having lasted longer than if you stand for the same amount of time. I say apocryphal because I have searched for this study but have never found it; however, I believe it. Patients also like telling their story. There is healing in the telling and in knowing that you have been heard. As so much of medicine changes, sitting with the patient and hearing her story remains timeless.

Reach Out and Touch

Another part of medicine that has not changed over the millennia is the power of touch. During my second year of residency I realized that in many situations the physical examination just didn’t add much to my care of the patient. Perhaps this fact reflected my physical examination skills, but I believe it was more a function of realizing that in the absence of complaints in the chest I was unlikely to discover something on lung exam.

The great symbolism and importance of touching and examining the patient goes beyond discovering the unexpected finding. The laying on of hands creates a physical connection to the patient and can heal. I now make it a point to physically examine every patient every day. I examine patients not just to support billing and not just because there just may be a new finding, but because there is power and healing in touch. I want the patient to benefit from this power and I want to connect to it for myself. As a hospitalist I feel privileged to be able to be at the bedside with patients.

Identify with the Patient

Another timeless part of patient care is empathy. Many patients simply want someone to walk alongside them and understand their experience of illness. Empathy makes this possible.

As I talk with patients I use myself as a guide for understanding the patient’s emotional experience and try to reflect that back. More than simply taking the history or laying my hands on the patient, I try to understand what the patient is feeling and going through. The fear and loneliness of illness can be greatly relieved by knowing that another person understands your experience and is walking with you. Our patients’ need and desire for empathy has not changed despite all of our technological innovations.

As hospitalists we meet people at their sickest and most vulnerable. They enter the foreign world of the hospital where they are often alone and where they have little to no control over what happens to them. Patients typically can’t even dictate the basics of life in the hospital like when or what they can eat. Even if we imagine the ideal hospital of the future built around the patient and that affords maximum control to the patient, the hospital will still be foreign. The power of empathy and the human interaction it represents will remain as important in this ideal hospital as it is today and as it always has been.

Education Never Ends

The other certainty in medicine is that science and technology will advance, bringing new and better ways to diagnose and treat illness. Thus the final constant in medicine is the need to always be learning. As an attending I had to learn that beta-blockers were good for people with heart failure and saved lives. I have learned many more new things since residency and understand the need to continue to learn.

Another wonderful aspect of being a hospitalist is the continuous progress of medical care and the ability to apply it to help patients. Advances in diagnosis and treatment, changes to systems that ensure that all patients receive this care, and attention to patient safety, quality, and palliative care all help ensure that patients receive the best possible care. Hospitalists are at the forefront of all of these activities.

In Conclusion

I delight in the new and celebrate progress that this era for The Hospitalist represents. I’m proud of the The Hospitalist and look forward to it continuing the tradition of quality while it expands and grows in new ways. In the same way I’m excited about medical advances but try always to remember what is timeless. Sitting with patients, listening to them, touching them, and being empathic reap great rewards for patients and for us.

As hospitalists we care for people at their most vulnerable moments. At those times our humanity, our gentle, caring touch, and our empathy matter most. In addition to bringing to bear the best that modern medicine has to offer in medications, diagnostic tests, and interventions let us remember the power to heal that we bring to the bedside when we bring ourselves—open to being with the patient and not just doing something but sitting there. TH

Dr. Pantilat is an associate professor of clinical medicine at the University of California at San Francisco.