The Hospitalist Blog

It may be an exaggeration to call IPC’s 3-day hospitalist training course a boot camp. But the phrase does capture some of the flavor of what we strive to achieve in the IPC Hospitalist Leadership Program. Twice yearly we gather our new hires along with some of our most experienced practice group leaders and managers. Together we create an intensive learning environment with the objective of developing the hospitalists’ abilities in leadership, management and communications. Now in its tenth year of operation, we believe is without peer or parallel in hospital medicine.   

You have to see it to appreciate the tremendous synergistic effect of bringing 80 hospitalists together; most of them only recently out of residency or with a few years of experience. For example, the program features real-life “Lessons From The Field” delivered from their more senior mentors as well as each other, as the training group listens and learns with the enthusiasm of providers who really want to be true hospitalists and not just internists practicing medicine in a hospital.  

Today there are well over 1000 practicing hospitalists that have been through our Leadership Program, some of them now working for other practice groups. I am confident they are better hospitalists for it, and that each of them can reflect back proudly to their IPC Leadership Program experience.

 

We all know the feeling. We want to express our thanks to someone for their help or a job well done, but for some reason or other we just don’t have the opportunity to do it. That happens with patients, too, who want to say thanks to their hospitalist. Well, maybe the patient just plum forgot to say something when the doctor came by for his last visit to say goodbye. Or the patient was just not feeling up to it at the time. Or for some reason the patient was just a little too shy – that happens too.  

But the patient may say something to the nurse afterward, maybe even after discharge, about how great their hospitalist’s care has been. Here’s an example of a letter to IPC’s Dr. Hanafi from a Nurse Manager at DePaul Medical Center in St. Louis:

Dr. Hanafi, 

I spoke with a patient of yours by phone today, [name withheld]. She said she had an amazing stay at DePaul because she had such a great doctor. She wanted me to be sure and tell you. She was discharged 3/23 and was here for headaches. Thank you Dr. Hanafi for the concern you show to our patients and the time you spend with them. You make a difference.  

Mary
5 South Nurse Manager

For many of us, delivering a compliment to a third person is sometimes more comfortable. But it can also be viewed as even more valuable by the person on the receiving end, because now Dr. Hanafi knows that Mary knows just how that patient felt about him. Although in this case and Mary says as much, the patient’s compliment comes as no big surprise. She knows a caring doctor like Dr. Hanafi when she sees one.

 

In the letter below, Dr. Whitely of Houston TX describes with great insight how hospitalists such as IPC’s Dr. Lucas and Dr. Harrell in Houston TX can provide true value to the practice of a primary care physician. I am including the letter in its entirety, and then my blog continues:

With all the success of hospital medicine we must not allow ourselves to become jaded, lest we forget what a positive impact hospitalists have on primary care physicians we work with in such close partnership. And that impact is fresh and new and important each and every time it happens. This letter is an aptly phrased description of the hospitalist-PCP relationship that speaks for tens of thousands of PCPs who recognize and appreciate that partnership every day.

 

The patients at Baylor All Saints Medical Center in Ft. Worth TX are lucky to have a CEO in Steve Newton who not only visits his patients but also leaves enough of an impression on their families to prompt a letter of thanks. That sort of leadership clearly creates a culture of caring and respect with everyone he touches, and I am so glad to see IPC’s physicians all caught up in it. A patient’s daughter writes:  

Dear Steve:   Please accept and pass on my family’s thanks for the care received by my father during his hospitalization. My dad’s needs were met in a timely and caring fashion each day and night. Dr. Lewis provided thorough management of my dad’s illness; it was a pleasure to hear so many members of the nursing staff comment on how much they enjoy working with him… Just the simple fact that staff members addressed my dad as Dr. ________ (patient name withheld) validated his self-worth and enhanced his confidence during his hospitalization.  

This very astute family member felt the respect accorded to her father by Dr. Lewis and the entire Baylor All Saints staff. Even more interesting, she had the insight to notice not just the excellent treatment her dad received but the “thorough management” of his care. For an IPC hospitalist, that is showing respect of the highest order.

 

What many of us love the most about being a hospitalist is the intensity and intimacy we develop with our patients in a very compressed period of time. A natural, spontaneous bond can build between hospitalist and patient inside of a week. For an outpatient physician it might take years to reach that same emotional pitch. That’s the nature of the business. As professional hospitalists we then disengage emotionally from the patient at the end of the patient’s stay, as we must. That’s a skill in itself, and we build that skill through experience and the good mentoring of our more senior practice group partners.  

From the patient’s point of view, however, this sometimes isn’t so easy. Over the course of his stay the patient may look at that hospitalist and ask himself if the care he is receiving could be any better than it is right now. Here’s but one example from a Patient in Tucson, AZ, writing our Regional Executive Director Dr. Bowman about Jeffrey Mack MD:  

Dear Dr.  Bowman: 

I just wanted to take a minute of your time to tell you what a great physician Dr. Jeffrey Mack, MD is. I recently had a stroke and after my hospital stay I was sent to the Health South rehabilitation center near Northwest Hospital as an inpatient. I found him to be extremely caring… I saw him frequently over the six days I was there… He has a great sense of humor and always had an uplifting word for me. I am almost sorry that you have him because I would use him as my personal physician in a heartbeat…

Parting is such sweet sorrow, especially if you’re a patient with a hospitalist like Dr. Mack. And no doubt it can be a little painful for Dr. Mack too. Until his next intensely rewarding patient encounter.

 

IPC employs doctors who come from over 50 countries around the world. That makes for a lot of names that are difficult for unworldly Americans such as me to pronounce. But it’s my job to learn them. Not so for patients, who sometimes make the extra effort and sometimes don’t.  

Here’s is a letter from the daughter of one of Dr. Chike Onyejekwe’s [pronounced oh-NAJ-e-QUA] patients in Parkview Medical Center in Pueblo CO, who thought enough of him both to learn his name and to thank him for his special efforts:

“Dr. Oneyjekwe I will never forget my mother’s joking in her hospital bed. You had been in to see her; I didn’t get your name, so I asked you to repeat it later. I left the room and when I got back my mom, always the “jokester,” said your doctor boyfriend came in and told me to give you this (your business card). She got such a kick out of teasing me. I just shook my head and laughed with her. Then she moved to Denver. She tells me two things when I get into her room after the flight of her life:

1) the helicopter ride was better than she could have imagined.
2) you went into her room before she was transferred, kissed her and told her good bye.

Thank you, thank you, thank you. You brought more than healing and comfort to her in her last days. You brought love.” 

It matters little how difficult it might be to properly pronounce Dr. Onyejekwe’s name. What does matter is that he is a doctor that’s so very easy to appreciate.

 

Houssein Ajrouche MD, an IPC hospitalist, is a member of the Pre-Surgical Screening (PSS) Department at Providence Hospital in Southfield MI. PSS is an excellent use of a hospitalist’s special skill set, especially for Dr. Ajrouche. This letter from the hospital’s the PSS Program Group Leader, clearly shows why. 

“On Tuesday October 30, 2007 a patient presented to the Joint Clinic with shortness of breath and wheezing. Her BP was 200/70, P-44 R-30. Dr Ajrouche assessed the patient and told us she needed to be admitted to the hospital. He discovered that this patient had not been compliant with medications. We transported the patient to the ED by shuttle because we know we could get her there much quicker. Dr. Ajrouche accompanied us to the ED and waited until she was taken back to be seen. He checked on the patient the next day and told us that she had been in CHF and had an MI. His assessment of the patient and dedication to her was awesome!!!!  I also would like to take the time to say that we are very grateful for the presence of all of you in the PSS department. We are very lucky to have you. If there is anything we can do to make things better for you, please don’t hesitate to ask.”

Lucky to have you indeed. That’s what I say about Drs. Ajrouche and Demrick as true IPC leaders in pre-surgical screening.

 

Dr. Obinna Egbo at St. Joseph’s Hospital in Phoenix is one busy doctor. Yet the hospital staff that works with Dr. Egbo sees him as completely patient-focused, so “there” for each and every patient, as if time management was simply not much of a challenge for him.

Here’s an excerpt of an internal memo from a nurse at St. Josephs that was forwarded to me:

“Dr. Egbo is always pleasant to work with. I was very impressed recently with his bedside manner that I observed. He is always willing to spend as much time with a patient that they and their family desire. He listens to their concerns carefully and truly cares about each patient under his care. I enjoy taking care of his patients because he always asks if there is anything he can do for us (nurses). His patients receive better care because of his great communication with all staff.” 

Dr. Egbo is highly productive, yet he somehow manages to keep the stresses and pressures of the job out of the eye of patients and staff. He knows that it is the quality of his encounters with patients that really matters, not just the number of minutes. That’s what I call doing a great job and making it look easy. And Dr. Egbo is what I call a valuable asset for IPC.

 

Hospitalists tend to “travel light” as they make the rounds through their facility. Stethoscope over their shoulder, a notepad and script pad in their pockets, perhaps a cell phone and pager, usually not much more than that.  

But Dr. Nana Britwum, a hospitalist at St. Alexius outside of Chicago, carries something extra. He carries special thoughts of appreciation of a daughter of one of his former patients. Some excerpts from the letter he received follow below.  

Dear Dr. Britwum,  

I’m sure you found out on Monday that my dad passed away Saturday evening.  After you saw him Friday afternoon, he never really came back to being alert or aware all day Saturday. He had one episode in the afternoon (about 4 p.m.) where his respirations slowed to 12, bp down to 70/40 and oxygen level about 30, but he just naturally came back up again. By 8 p.m. his respirations were about 6 and at 8:18 p.m. he took his last breath as I was holding his hand and talking to him about what a great dad and grandpa he was.  I’m so glad I was able to be with him. He was peaceful and his breathing was not as labored as before.  He got his wish not to go on hospice (I’m glad I was able to uphold that for him) and went out “fighting” (important to him) but not struggling.  He had had a couple doses of morphine Fri. overnight, but it was held in the morning so Dr. C could see him to evaluate him.  Then he had 1 mg. at 1:30 and 1 mg. at 3:30 p.m. (no more after that since his respirations were so low).  I believe it was your opinion that such a low dose would just ease his hard work with the breathing. 

I just wanted to thank you so much for your kindness with my dad and to me.  I know you did all you could and I sincerely appreciated your advice and the fact that you took time to call me several times and talk things over. That meant a lot at this difficult time.  St. Alexius and all the patients you treat are very lucky to have you…  Thank you again so much for everything. 

(name withheld) 

Dr. Britwum says that he refers back to this letter “from time to time for inspiration”. How fortunate he is to carry such a gift of gratitude from a former patient’s family. How fortunate IPC is for having Dr. Britwum to provide inspiration to us all.

 

Hospitals face the challenge every day and every night of maintaining the trust, the confidence and the satisfaction of its patients. At
Littleton Adventist Hospital in Colorado the Director of Quality Management knows that Fred Wolf MD, the hospitalist team’s practice group leader, delivers the level of patient satisfaction the hospital is looking for.  

The Quality Director writes, “I just wanted to let you know that I heard some compliments about you. [name withheld] said you were very responsive and that you were very concerned about wanting to maintain a good rapport with the patient. The other compliment came from [name withheld] in the lab. She told me about how you always take the time to review medications with patients when they are confused, even missing lunch to do this… I also want to thank you for the time you spend at Medicare peer review, ICU Committee and Clinical Effectiveness Committee… Thank you for being so committed to making Littleton Hospital a better place for our patients.”  

Savvy hospital executives understand that no one in the hospital is in a better position than the hospitalist to drive patient satisfaction. Fortunately for Littleton Adventist they have such a driver in Dr. Wolf.  

Drivers wanted.