A Long, Interrupted Day


click above to watch the video
click above to watch the video

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.


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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.

Video and photos by Manuel Noguera -


"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."

click above to watch the video

In a rare moment of comedic relief, Dr. Bitetto (top) shares a laugh with colleagues during an end-of-day staff meeting. Dr. Bitetto fields the first of dozens of phone calls during the 7 a.m. meeting (middle), at which the HM group divvied up 82 patients. At bottom, Dr. Bitetto checks the breathing of patient Richard Ambrose, who was admitted with a recurrent back and spine infection.


Later, a patient complains of pain and the team is divided in its course of action. Dr. Bitetto takes the lead: "Nobody ever died of pain."

His colleagues refer to him as a "workhorse" and "accomplished" teacher. The nurses praise Dr. Bitetto and the other hospitalists, as it's "nice to have them in the hospital, and not on-call."

He didn't eat breakfast (or lunch), instead opting for a few Hershey's Kisses before meeting his girlfriend for dinner at 6:30 p.m. Twelve hours, 16 patients, and dozens of problems solved.

It's par for the course, Dr. Bitetto says—a typical day in the life of a hospitalist.

By The Numbers

3 - Times Dr. Bitetto and his team arrived at a patient's room to find no patient in the room

3 - Number of HM groups serving Lehigh Valley Health Network (LVHN)

4 - FTE non-physician providers (NPPs) in Dr. Bitetto's hospitalist group

4x4 - Euphemism for "four systems, four things," a billing and coding teaching moment between Dr. Bitetto and his overnight residents

7 - Times Dr. Bitetto and his team passed the Starbucks kiosk in the hospital lobby

8 - Number of times the "Rock-a-Bye Baby" jingle was played on the public address system, indicating a new delivery

11 - Number of phone calls that interrupted "sit-down" rounds

16 - Dr. Bitetto's patient census

16 - FTE hospitalists in Dr. Bitetto's group

19 - Students in LVHN's first class of medical students, in partnership with the University of South Florida in Tampa

48 - Resident slots at LVHN

82 - Number of patients divvied up between Dr. Bitetto and four colleagues; the group also employs a "triage" hospitalist for day shift

182 - Days Dr. Bitetto worked in 2011

500 - Hospital-employed physicians at LVHN Cedar Crest

709 - Beds at LVHN Cedar Crest

1,500 - Dr. Bitetto's total patient encounters in 2011

1973 - Year LVHN's Cedar Crest facility opened

2004 - Year Dr. Bitetto's HM group started at LVHN

3,200 - Dr. Bitetto's work RVU total in 2011

10,500 - LVHN employees

Jason Carris is editor of The Hospitalist.

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