Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 7
Mar -
The focus of 9 inpatients
29 Jun2009
I made rounds today on 9 patients. I would categorize the issues:
- Stabilize acid-base status
- End-of-life discussion
- Nuclear medicine stress test in woman with recent NSTEMI
- Cellulitis which followed a traumatic amputation
- Hyponatremia secondary to psychogenic polydipsia and (perhaps) thiazides, presented as altered mental status
- Achalasia – needs myotomy
- Lung cancer with bony metatases – needs biopsy documentation
- Patient s/p below knee amputation for gangrene – awaiting rehab placement
- Severe tonsillitis – probably bacteremic – responding to clindamycin
Did I do a good job? Would any of the current performance measures apply?
I can provide a similar list almost every day I make rounds. What is the point of performance measures if they do not relate to the main issues that I see on daily rounds? How would you judge my quality?
Related posts:
- Deconstructing quality – the nine patients
- Comparative effectiveness research – more thoughts
- What is quality – a reader asks
- Another performance measure challenged – BP goal
- My position on performance measures
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- In: Medical Rants
1 Response to The focus of 9 inpatients
Jim Long MD
June 29th, 2009 at 10:27 pm
Ok, but what I really want to know is: Did you code these encounters as 1, 2 or 3s and if so are you SURE you got the right number of ROS catagories in your hospital note. Oh , and exactly how long did the end of life discussion last? Did you document that? And about that ALOS problem – why is the NSTEMI patient still in the hospital ? That stress test is an outpatient procedure!
I bet each of your patients got excellent care with careful judgement on your part just like the vast majority of us deliver daily. Too bad you will probably get “RAC-ed” this year and have to pay most of it back.
Isn’t it interesting that in the health care debate that the internists (the few left anyway) and FPs are left out of the equation? THE big secret is that we COULD cut costs and improve care – there is documentation of that . Wonder why nobody asks us what is needed? Wait! I know! Performance Measures are the answer!