Notes on Shadowing a Hospitalist

Highly recommend reading Atul Gawande's "Checklist Manifesto" [0] if you are interested in the operational results of adding something like checklists to medical care.

Case in point: requiring everyone in the operating room to say their name, specialty and reason for the operation (and their part in it).

You might ask why the above is necessary?

Well:

- everyone is wearing a mask, cap and possibly glasses which makes them hard to recognize

- the patient is often draped in such a way that you can't tell who they are

- many Operating Rooms(ORs) look the same

- there are apparently COUNTLESS stories of medical personnel going into the wrong OR and not realizing until the surgery has started

Another fascinating point about checklists since the OP article mentions doctors vs nurses: checklists give nurses the power to challenge doctors. e.g. "Dr, I believe the next step on the checklist we agreed on is to do X".

If you have no checklist, the Dr can just say "No, we don't need that, I know what I'm doing. Shut up, Nurse!" (this is a real example from the book btw).

He also has an article comparing the Cheesecake Factory to health care that I also highly recommend [1]

0 - https://amzn.to/3KyLK1x

1 - https://www.newyorker.com/magazine/2012/08/13/big-med

As I'm in my 60s, I have elderly friends and relatives who have spent time in hospitals and rehab facilities. The patient needs to have an advocate who is informed of their situation and is present when the doctor makes their brief daily or weekly visit. I've seen decisions made, that contradicted the information in their "chart" such as exercise sessions for a person with a documented broken spine, treated as inviolable by the nurses and other clinical staff. Only the doctor can change the facts of the case.

What I suggest is that if you have a friend or relative visiting you, they should bring a "flip chart" -- the old fashioned 2 x 3 foot pad of paper -- and write down in huge letters the most important details of the case. Ask the doctor to help you fill it in.

> 1. Everyone jokes about death

I spent most of my life perceiving comedy to be one of the less serious art forms. “You can make a beloved film but won’t win a Best Picture award” kind of less serious.

But I read sections like this one, and I experience the use of comedy for community-building and healing and discussing politics safely. And I’m growing a belief that it’s the highest, purest, most honest form of communication we have as a species.

We want to make death less taboo, but what we really need is to make joking about death less taboo.

Wow. Fascinating article. I am an engineer in a family that is otherwise purely medical (mom nurse, dad pediatrician, sister veterinarian).

Over the years I hear a lot of their pain points, and EMR's are consistently very painful for my boomer parents who are not tech savvy (my understanding is that it's not an age thing, though).

I have personal experience with pt. 8: Doctors know who's good, they just won't tell you. When I had a meniscectomy with poor results, none of the orthopedists I visited after the surgery would comment even lightly on the appropriateness of that procedure given my symptoms and MRI. This isn't different to other professions, where you generally have nothing to gain from badmouthing colleagues, but its incredibly painful that thousands of people are prevented from good care because of this meritocratic breakdown.

As a totally separate point-- this format of shadowing notes in incredibly compelling! I've been shadowing chemistry and biology wet-labs lately, and I wonder if making similar writeups would be interesting to others?

I've often thought there should generally be more work-shadowing. Not just from young people looking for a first job, but from all sorts of cross-professional and seniority groups. I think there would be a lot of benefit from seeing how some random other person does his job.

Another aspect is automation development. Particularly for people who are supposed to be writing tools for another profession, it's worthwhile spending time getting some notes like thing.

hospitalist here - I think “everyone hates epic” is a major over-generalization. If you have worked with one implementation of Epic, you have worked with one implementation of Epic. It probably does not meet the standards of popular modern software, but it is complicated. If it is implemented as a replacement for paper charts, it can be terrible. If it is thoughtfully customized to support common and important workflows and support high quality care, it can be a life and efficiency saver.

Is 'Hospitalist' an American thing? I'm afraid the word grates on my European ears.

Reading this, it's not surprising why alternative medicine remains popular. Generally, the practitioner both acts like a human and treats their patient like a human. That doesn't appear to be the case in a conventional hospital.

I find these to be astute and fascinating observations. Thanks for the read!

> Doctor competence is highly variable, as there are few incentives for improvement.

> But all hospitalists are paid under the same schedule (based on years of experience), meaning that the high-agency hospitalist is getting paid the same as their counterparts. Greater intrinsic motivation and competence are not explicitly rewarded.

I find it very hard to believe that it’s possible to measure “greater intrinsic motivation and competence” objectively here (and for GPs as well, basically any profession with high variety in the Stafford Beer sense), so explicitly rewarding that seems fraught with Goodhart-style problems.