When clinical guidelines aren't followed, it's tempting to think physicians either don't know them, or lack easy protocols to observe them. In the case of health care-associated pneumonia (HCAP), however, there may be more to the story. While guidelines call for an initial regimen of broad-spectrum antibiotics for all patients with HCAP, some experts say they shouldn't be given to relatively healthy patients, as doing so contributes to the problems of drug resistance and high health costs. Guidelines supporters note, however, that not giving these antibiotics when patients may need them results in a higher risk of death—a gamble they say isn't worth taking. For an in-depth look at how physicians and hospitals handle HCAP, turn to our cover feature.
Physicians aren't the only ones who bend the rules when it comes to treatment. The percentage of patients who left the hospital against medical advice (AMA) increased significantly between 1997 and 2007, leaving hospitalists to wonder how they can persuade patients to stay. Writer Beth Thomas Hertz talks about the kinds of patients that are most likely to leave AMA, and useful strategies for convincing them to remain in the hospital.
On a lighter note, medical student Brian Pavic muses about the brave new world of personal genetic tests, wondering if they might someday be used to cure children of paste-eating tendencies, or reform his own mother of a passion for wrought-iron furniture. And ACP Member Lisa Sanders dishes on what it's like to be a technical advisor for one of the most popular medical dramas on television, “House, M.D.”
Also, we offer a sneak peek into new offerings for hospitalists at ACP's upcoming annual conference, Internal Medicine 2010, this April in Toronto. Courses in transfusion medicine and teaching in the hospital have been added to the scientific program, while two new hands-on precourses cover basic and advanced mechanical ventilation. The Herbert S. Waxman Clinical Skills Center will give hospitalists a chance to practice inpatient procedures on simulators, including lumbar puncture and peripherally inserted central catheter placement. Don't forget to swing by ACP Hospitalist's booth in the Exhibit Hall to say hello, as well.
How does your hospital handle HCAP guidelines, or deal with patients who defy medical advice? Share your experience by email.
Editor, ACP Hospitalist