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JEFF GLASHEEN: What's Been, What's Next, and a Hogan Update


 

By now you are no doubt aware that the world will soon end. And by soon, I don’t mean Dec. 21, 2012, as predicted by the Mayans—rather, July 21, the date the Weekly World News recently reported that the Earth will hurdle into the planet Nibiru, no doubt inconveniencing my son’s tee-ball game and upending my father’s 72nd annual failed attempt at pulling off the white T, black socks, and sandals look at the beach.

The tabloid also reports that Elvis was spotted pilfering a Vegas buffet (photos of inexplicably barren shrimp cocktail containers support their case), a manigator is loose in Alabama (heads up if you’re reading this in Mobile!), and that duck hunters mistakenly shot an angel (bad move angering the angels right before Doomsday).

OK, maybe you don’t believe that the world will end in 2012. But one thing that will end is my tenure as physician editor of The Hospitalist. The date: March 31, 2012. Yes, after nearly five years, I’m passing the baton and moving on before my editing career takes on an overweight, beefy side-burned, flowing-jumpsuit-in-Vegas course of its own.

And after editing and writing columns for 55 issues of the definitive publication in hospital medicine, what question do I get the most?

How’s Hogan?

History Through Headlines

Looking back at my columns, I now see that some themes developed. I touched on disease states (Spanish Flu Redux?), obesity (Fight the Losing Battle), electronic health records (Only Fools Rush In), patient satisfaction (Doctor Remodel), physician burnout (Left Turns), and healthcare reform (Get Well Now). I wrote about the births of my children, Greyson (Lesson of the Titanic) and Kaiya (Undercover, MD), Grey’s trip to the ED (Mind Games & Silence), and the myriad ways my father can irritate from the backseat of a car (Minivan, Major Lesson).

But over the years, I also increasingly wrote about patient safety (Bueller … Bueller?; Handless Employees; Designed to Harm; A Run For Safety), quality improvement (Something Interesting Happened; Quality Defined) and the need for hospitalists to lead these imperatives (Exceed Acceptable; Promise or Insanity?; Subsidy or Payment?; Fiddling As HM Burns).

And along the way, my monologue turned into a dialogue. I remember the first email that proved someone other than my coerced wife read my column. Then again, I shouldn’t have been surprised that my dad emailed to tell me to stop writing about him.

But then it happened again. And again. And again.

I was surprised to hear from so many readers. People wrote that they, too, had embarrassingly misdiagnosed their child’s croup as a life-threatening disorder, were struggling with burnout and balance, didn’t like the new ABIM recognition of focused practice in hospital medicine (Urban Legends; Certified Special), and, in the case of my chair of medicine, that they could not achieve my challenge (Transitions Telethon) to call every PCP on discharge for one week.

Readers wrote that I made them laugh, that a story touched them, or that they were angry. One was upset that I called childbirth a “miracle,” another that I was too forgiving about the new duty hours (Rise of the Napturnist), and my father that I still hadn’t stopped writing about him.

But none of this generated the interest that Hogan did.

What Would Hogan Want?

In August 2009, I wrote The Anvil of Indecision column about my dog, Hogan, and our experience with his incidentally discovered 5-cm lung mass. It was my first personal foray into end-of-life decision-making, and it came in the form of a 10-year-old Weimaraner. Hogan was present for many of the most important strata of my life—his rings counting my single-guy resident days, early hospitalist career, marriage, a few relocations, and the births of my kids. And along the way, he was the one constant, the glue that kept my life together.

Best friends are like that.

As I noted in that column, my wife and I struggled with “how much physical distress, how much intervention we afford to an older, sleep-most-of-the-day arthritic dog.” Not knowing if the mass was benign or malignant, should we work it up or just let nature sort it out? If we treated, should we diagnose and stage the tumor, blindly surgically remove it, or just give palliative chemotherapy? What if it was isolated and surgery would be curative? What if it was metastatic and surgery just added morbidity? What if this was benign and Hogan died in the operating room? What would Hogan want? Hogan trusted me to make the right decision.

Best friends are like that.

I’d likely write about bundled payments and ACOs. I believe these are potential game-changers in much the same way the prospective payment system was in the 1980s. The latter laid the groundwork for hospitalists. Will new payment models prove a boon or a death knell?

This was the easiest column I’d ever typed but the hardest I’d ever written. I wrote it in about an hour and then cried about it for two days. I was distraught, miserable, and unmoored in the way that only pet-lovers who have faced the demise of a loved one can understand.

I was truly confounded, and the act of writing was cathartic. It was my first venture beyond standard professional content. I spent two weeks deciding if I could really publish it. It was difficult, I found, to expose myself—to be vulnerable in this manner.

No one can beat you up for saying we should care about patient safety and improve quality. Dedicating an entire column to a dog? What if my peers, the society, my bosses found it immature or self-pitying? What if they didn’t get it?

Within days of publishing the column about Hogan, I’d received hundreds of comments from readers, most relating their similar experiences, all expressing support—by far more interest than I got about anything else I’d written.

Turns out, you got it.

What’s Next?

I wonder what my next 55 columns would have looked like. I surely would continue to discuss HM’s struggles to operationalize the quality and safety promise we hold. This should continue to be our singular goal.

I’d likely write about bundled payments and ACOs. I believe these are potential game-changers in much the same way the prospective payment system was in the 1980s. The latter laid the groundwork for hospitalists. Will new payment models prove a boon or a death knell?

I’d spill ink, no doubt, about the financing of HM groups. As hospital reimbursement fades, can hospitalist salaries be far behind? Will this push us toward more encounters and more shifts, leaving less time for meaningful process improvement work, less time for personal and professional balance, less satisfaction in our careers?

I would wrestle with how we can attract the best and brightest to our field. Who will fill the next 20,000 hospitalist positions?

I would, no doubt, chronicle the tribulations of my kids (a record to be leveraged when I look to move in with them in 2040), send a few more barbs my father’s way (payback for the 1980s, Dad!), and deprecate a few of my future dimwitted moves.

And I might even devote a few more inches of column to Hogan.

Because, you see, Hogan is doing well. He’s cancer-free nearly three years after surgery and chemotherapy for metastatic pulmonary adenocarcinoma. I’ll skip the details and just say “thanks.”

Thanks for asking. Thanks for reading.

Dr. Glasheen is physician editor of The Hospitalist.

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