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All Atwitter at HM09


The world is atwitter over Twitter—the social networking utility that allows users to send immediate, 140-character text messages known as “tweets.” From then-presidential-nominee Barack Obama updating the masses on his campaign travels to actor Ashton Kutcher challenging the entire CNN news organization to a Twitter challenge (the former beat the latter by achieving 1 million Twitter followers first) to Britney Spears micro-blogging updates from her ever-so-fascinating life, Twitter is all the rage. The site describes its mission as allowing friends and family to stay connected through quick, frequent text answers to one question: “What are you doing?”

Not one to be left out, I thought I’d give it a shot. However, my tweeting ability is hamstrung by two serious insufficiencies: First, I’m a technology buffoon. Second, there’s no way I can keep my glorious insights to 140 characters.

So, with respect to the folks at Twitter, here’s a not-so-real-time chronicle of how I spent my time at HM09 in Chicago.

In the current healthcare environment, there are more than enough questions to launch all of our academic careers.

Us vs. Them?

The main session opened with a panel discussion about the future role of hospitalist leaders. The most poignant moment came when the panel of chief medical officers was asked how they viewed hospitalists. One recognized the tremendous potential hospitalists offer as the go-to resource for tackling important quality, efficiency, and process issues. This was countered by another participant warning that this potential can go untapped when HM group leaders function as “union stewards,” protecting hospitalists’ interests without a thought to the greater needs of the hospital. While recognizing advocacy as an important part of a group leader’s job, the message was clear: Too much advocacy can create an adversarial relationship that undermines our great potential. (That’s 769 characters.)

Laws Are Like Sausages: It’s Best Not to Watch Them Being Made

Mark Chassin, MD, MPP, MPH, president of The Joint Commission, discussed the quality revolution. He outlined the growing need and role of hospitalists in crossing the hospital quality chasm. He fired a cautionary shot across our bow by noting the increasing shortcomings of the public-private enterprise in improving healthcare quality. His clear concern is that if we don’t improve quality drastically, the government will step in and pass legislation—something that would most likely impact hospitals and hospitalists negatively. (532)


A highly informative physician roundtable tackled value-based purchasing. The Reporting Hospital Quality Data for Annual Payment Update, or RHQDAPU—pronounced “rack-da-poo”—is a voluntary (insofar as hospitals who don’t comply lose 2% of Medicare reimbursement) hospital reporting system for adherence to core measures. This program, widely viewed as the foundation for future hospital pay for performance, will be a budget-neutral process such that some hospitals will win while an equal number will lose. Up to 5% of hospital reimbursement could be at risk. Data is available at Check out your hospital; your patients already are. (659)

The Eagle Has Landed

At the end of the first day I co-chaired the Academic/Research special-interest forum with David Meltzer, MD, PhD, of the University of Chicago. The group grappled with a number of questions, from struggles with QI work to finding ways to support research to the development of young academicians. One comment, from Kim Eagle, MD, a world-renowned cardiologist at the University of Michigan and SHM’s visiting professor, resonated with the group. Dr. Eagle sagely responded to a young physician having difficulty developing a research interest by stating research is not about research but about answering questions. In the current healthcare environment, there are more than enough questions to launch all of our academic careers. (734)

Is HM Intensive Enough?

The second day got off to a roaring start with the best of the Research, Innovations and Clinical Vignettes (RIV). The most hotly anticipated research was from Emory University, where Kristin Wise, MD, and her colleagues evaluated an intensivist vs. hospitalist model for ICU staffing and found that after correction for baseline differences in acute illnesses, overall there were no differences in mortality between the two groups. Despite being constrained by methodological differences between the comparator groups and a lack of randomization, the data represents an important first step in addressing the huge shortfall of intensivist providers. (650)

Why My Wife Never Listens

Vinny Arora, MD, MA, of the University of Chicago and Erin R. Stucky, MD, of Rady Children’s Hospital in San Diego addressed the tremendously important topic of improving in-hospital handoffs. Part of the problem, they noted, is the egocentric heuristic. This cognitive shortcoming results in the sender believing that they are clearly expressing themselves because the message is apparent to them. Research shows that 40% of the time, the piece of information deemed most important by the sender is not identified as such by the recipient. Disconnect increases the better the sender knows the recipient, which explains much of our difficulty communicating in the hospital and domestically. Overcoming this requires vigilance on the sender’s part to be sure the message is accurately conveyed. (793)

Could We Go Bankrupt?

We all have too many patients and not enough providers. Thus, I was shocked when Scott F. Enderby, MD, of East Bay Physicians Medical Group in San Francisco spoke of a hospitalist group that went from profitability to bankruptcy in one year after adding four new employees. In his Finance 101 session, we learned how it happened despite an expected increase in clinical revenue: The group was constrained by a lack of liquidity that was retrospectively obvious from their balance sheet and operations and cash flow statements. Considering that more than a third of hospitalist directors do not know their group’s most basic financial metrics, this was a reminder that many more of us may be at risk in this increasingly unforgiving economy. (741)

Wachter’s World

As has become an annual meeting tradition, HM pioneer Robert Wachter, MD, FHM, professor and associate chairman of the department of medicine at the University of California at San Francisco, closed the meeting with his uniquely insightful comments on the state of healthcare. In using a case of mistaken identity he adeptly illustrated many of the key safety problems we face in healthcare. Further, he called for a transition away from a “no blame” medical culture to one of accountability. Once again, Dr. Wachter proved that despite going last, he continues to be out in front. (582)

A Child’s Calming Touch

This was my seventh consecutive annual meeting, and like the six before, it has exceeded my every expectation. From knowledge gained to the chance to speak and share my research to the opportunity to network and catch up with friends, the meeting was filled with lasting memories. Still, at times my hectic schedule bordered on chaos. It was during those times that I turned to a short, 23-second voicemail my wife sent the first day. On it my son, almost 2 years old, is belly-laughing as only a child can—pure, unbridled, carefree.

For me, it acted as a mariner, calming me at the end of a busy day, serving as a reminder of the important things in life, guiding me home. (674)

Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of hospital medicine and the hospitalist training program, and as associate program director of the Internal Medicine Residency Program.

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