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.
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.
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.
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.
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.