Alex Coolidge at The Cincinnati Enquirer turned a terrific holiday travel story I haven't seen before. He looked at how travel restrictions make life especially tough for musicians who don't have enough room in the small overhead bins on regional jets for instruments bigger than a mandolin.
The musicians have few options. Some buy a seat for their instrument. Others resign themselves to driving.
Text Messaging Hot on New Year's Eve
The Canadian Broadcasting Corp. says
New Year's Eve is THE text messaging peak of the year. People send more text messages just before a new year than at any other time, according to Virgin Mobile Canada.
The story says one in four people surveyed believe they will get lucky through a naughty text message tonight.
The CBC story also says:
- Canadians will send on average two text messages each on New Year's Eve, double the size of last year's forecast.
- Textaholics aged 18-30 will be the biggest texters on the 31st, sending an average of four text messages each.
Need some help writing or reading text message shorthand?
Try NetLingo. Caution: Some of the phrases are off-color.
The Rise of the "Hospitalist"A
physician friend of mine was explaining to me last month how he was
about to close his ob-gyn practice and become a "hospitalist." It was
a new phrase to me, but
The New England Journal of Medicine says the rise of hospitalists is a big trend. And it just may be happening near you.
The NEJM article opened with this line:
The hospitalist model is rapidly altering the landscape for inpatient care in the United States.
A hospitalist is a physician who only works in a hospital. It is a break from the notion that your physician -- the one you see in his or her office -- also cares for you in the hospital. The hospitalist takes over your case when you come to the hospital.
The study in the NEJM says when patients are cared for by hospitalists, they tend to have slightly shorter hospital stays. Hospitalists allow office-based doctors to see and concentrate on more patients. But patients may not be comfortable with a doctor in the hospital who has never seen them before, and hospitalists may order unneeded tests for patients they have just met.
According to the article, hospitalists are way more common that you might think:
Since they were first described little more than a decade ago, hospitalists have emerged as one of the fastest growing physician groups in the United States. Recent data suggest that 29 percent of hospitals, including 55 percent of hospitals with 200 or more beds, have hospitalists on their medical staffs, and more than 12,000 hospitalists practice in the United States. If the hospitalist model of inpatient care becomes predominant, it has been estimated that hospitalists will eventually number as many as 30,000 -- approximately the same as the number of cardiologists in the United States.
The article goes on to describe the pros and cons of the new system of care:
As compared with traditional inpatient care, the hospitalist model offers many potential advantages. First, their availability all day (and sometimes around the clock) allows hospitalists to respond quickly to acute symptoms or new test results, reducing delays and potentially improving outcomes. Second, physicians who are based within a hospital may learn to navigate its complex environment more efficiently. Third, hospitalists may develop greater clinical expertise as a result of added experience. Fourth, the financial support provided by many hospitals to meet the operating expenses of hospitalist programs is often associated with explicit or implicit incentives to reduce the length of hospital stay and costs. Finally, the presence of hospitalists allows primary care physicians to increase their availability and productivity in the office setting because they no longer need to travel to the hospital to see one or two patients. Being allowed to focus on one clinical setting may also improve the quality of work life for physicians who refer patients to hospitalists.
At the same time, the hospitalist model introduces handoffs at the time of admission and at discharge, transitions during which the risk of errors and adverse events is high. These discontinuities, coupled with a lack of previous knowledge of a patient's care, may lead hospitalists to order excessive diagnostic tests, resulting in higher costs with no benefit to hospitalized patients. Concerns regarding the potentially negative effect of hospitalist programs on the satisfaction of primary care physicians and patients have not been borne out.
ERs Need Specialists
The above story is especially noteworthy when you read this piece from
The Washington Post
about how ERs have a heck of a time finding specialists such as
neurologists or cardiologists who are willing to be on call 24 hours a day:
Hospital emergency departments across the
United States, already struggling with overcrowding and growing patient
loads, are increasingly unable to find specialists to help treat
seriously injured and ill patients, according to medical experts.
Crucial
minutes, hours and even days can go by as patients suffering from
trauma, strokes, broken bones and other maladies await evaluations by
neurologists, orthopedic surgeons and other specialists because
hospitals are having difficulty getting them to serve 24-hour emergency
"on-call" shifts.
"It
can mean death," said Linda Lawrence, president of the American College
of Emergency Physicians and a practicing emergency department doctor in
California. "Patients have died in transport, or waiting to find a
neurosurgeon, or getting to a heart center for a cardiologist."
We are always looking for your great ideas. Send Al a few sentences and links.
Editor's
Note: Al's Morning Meeting is a compendium of ideas, edited story
excerpts and other materials from a variety of Web sites, as well as
original concepts and analysis. When the information comes directly
from another source, it will be attributed and a link will be provided
whenever possible. The column is fact-checked, but depends on the
accuracy and integrity of the original sources cited. Errors and
inaccuracies found will be corrected.
If this is a trend, besides affecting hospital experiences, it...
