A Long, Interrupted Day

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Hospitalist Daniel Bitetto, MD (left), runs morning rounds with intern Ranjit Nair (middle) and chief resident Erica Peart, DO.

It was 11:04 a.m., he’d been at the hospital for more than four hours, had been teased by colleagues for his lack of a Spanish accent, had evolved from 24-ounce cups of coffee to highly caffeinated energy drinks, and still had yet to see his first patient.

And once Daniel Bitetto, MD, climbed stairs, then wandered through an adult unit and a pediatric unit, he reached the doorway of the first name on his 16-patient panel on a cool, rainy Thursday at Lehigh Valley Health Network in Allentown, Pa. Not three seconds later, however, Dr. Bitetto exited the room and craned his neck searching for a nurse.

Dr. Bitetto discusses a patient with a nurse; checks on patient lab results; greets patient Robert Snyder; and reviews a patient’s record with resident Ayaz Sahlbzada, MD, during “sit-down” rounds in the cafeteria.

“Where is…?” he started to ask, looking through the charts and realizing his first patient likely was in dialysis. It wouldn’t be the last time he arrived at a room only to find his patient missing.

Meetings, phone calls, and stairwells comprised much of Dr. Bitetto’s 12-hour shift. In between, he quizzed and instructed his residents and students, wrote a handful of orders and scripts, and met with hospital administration for nearly an hour.

At 9:15 a.m., Dr. Bitetto met with his team—a third-year resident, intern, medical student, and physician assistant student—for what he called “sit-down rounds” in the back of hospital cafeteria. Seeking out teaching moments at every turn, his style can best be described as half inquisitor, half answerer.

“Is anyone sick or dying?” was Dr. Bitetto’s first question.

The answer: a collective “no.”

“There is a blip,” said intern Stuart Hartman, DO, after listening to a patient’s heartbeat.

Normally, i don’t say this, but your aggressive, brow-beating style works well with these kinds of patients

“Could you try to be a little more scientific?” Dr. Bitetto queries.

Another patient offers the team resistance to the care plan, which resident Ayaz Sahlbzada, MD, handles in his own way.

“Normally, I don’t say this,” Dr. Bitetto says, “but your aggressive, brow-beating style works well with these kinds of patients.”

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